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No need to repeat what Hospital already does

I

IanA123

Well-Known Member
Messages
67
Type of diabetes
Type 1
Treatment type
Insulin
Dear xxxx,

I am writing to formally request a change in how my diabetes care is recorded on my GP record.
I currently receive all my clinical management, including all blood tests (HbA1c, kidney function, etc.), via the xxxx Diabetes Clinic. My foot care is managed privately. My only requirement from the GP surgery is the processing of my repeat prescriptions for insulin as directed by the hospital specialists.
As I do not wish to attend the surgery for duplicate reviews, please ensure my record is updated with the following:
Shared Care/Specialist Led: Please ensure my record reflects that my diabetes is "Managed by Hospital Consultant" (SNOMED code: 407672007 or equivalent).
Personalised Care Adjustment (PCA): For QOF purposes, please record my status as "Informed Dissent" or "Care managed by specialist service" for all diabetes-related indicators. This should remove the need for your staff to contact me for annual reviews or "checks" that have already been completed elsewhere.
Data Entry: I am happy for you to continue coding the results from my hospital letters to maintain my record, but I do not require any further clinical intervention or phone calls from the GP practice regarding my diabetes management.
Please confirm in writing (or via the App) once my record has been updated to reflect that I am under specialist-led care only.

Yours sincerely,
xxxx

After many letters and calls from the GP practice, I have decided enough is enough. Have emailed this to the practice manager this morning . They are not part of my care team and are only there to sign off prescriptions for insulin in relation to my diabetic care. They have all the access they require from Hospital records and the data is shared with them online. So why should we repeat what has already been done?
 
I don’t go to my drs for any diabetic input, I go to the hospital clinic and see consultant’s that know what they are talking about. The gp does try to get me to go for blood tests etc but I refuse to go.
 
I completely understand that this may be frustrating and you absolutely have the option to tell the GP practice that you do not wish to have a diabetes review with them, but I just want to share some info as to why some GPs practices often still invite patients who are under the hospital in for a review with them.

Its in GP contracts as part of the quality outcomes frame work (QoF) that they ensure that Diabetics have certain checks done annually. Whilst if you are under diabetes care at a hospital, the hospital will do some of the required checks, they don't always cover everything required from the GP contract point of view.

Practices need to ensure that a certain percentage of patients have had all the checks required done in order to achieve QoF points. There is a minimum number of points they need to achieve in order to be paid for any of the work they ve done doing diabetic reviews.
If not all checks are completed for a patient and the patient hadnt clearly dissented and there are several patients like this, the practice may not be able to achieve the points required, despite them having carried this out for other patients - this may mean that they dont get paid for any of the reviews/checks they have done.

In addition, whilst your diabetes team at the hospital may have recommended what medication/ insulin you should be taking, it is actually the person writing/issuing the prescription that is responsible for prescribing that medication - so its the GP that is taking any liabilities and responsibilities for prescribing and therefore should be ensuring the appropriate checks are being carried out to ensure their prescribing is safe.

Hope that gives a bit of insight as to why some practices may still invite people in who are under hospital care.
 
The problem of course is that most GP's do not know a tenth of what an endocrinologist knows about T1, the many different modern insulins with their different action profiles, different pump and CGM systems. They prescribe what the endo tells them to.

I find the UK system baffling in this. In the Netherlands, any medical doctor can prescribe, so my endo prescribes my diabetes stuff, my GP prescribes whatever I need for whatever ails me outside diabetes.
 
To give a slightly different perspective, I Iive in New Zealand and while my diabetes care (pump etc) is done by the hospital, my GP does regular diabetic checks (hba1c, feet etc). I am lucky to get a hospital appointment every 2 years, so I do need the GP checks.... (Last hospital appointment was two years ago and realistically I doubt I'll get one this year, though I can email my DN. The hospital is completely snowed under with T1s starting pumps, which all New Zealand T1s are now entitled to, once they get the training to use them).

But if you are getting regular hospital appointments then I understand your frustration in doing the same tests twice.... I just wonder what will happen if your hospital clinic gets overloaded...

Good luck with the letter @IanA123 .
 
Where I live there is zero chance of any diabetes clinic. My GP has to handle everything.
 
GP does not decide which Insulin you take , hospital clinic monitors your usage with sensor data. So as long as the hospital clinic do not change it, it is of no concern to them. QOF i amnwell aware if and you donrealise if a GP practice repeats wjat a hospital clinic hasvalready completed, they are pulling down the same funding.Foot checks are paid for privately and more thorough than a gp practice can offer.
My interaction with GP practice is once a year for a medication review which they do not need to review which insulins I am on.
 
Hospital clinic i am at is one of the leading clinics in the UK, have patients flying in from Southampton. They are part of the university. Also being on a pump and cgm means that a GP surgery has none of the access or training for this. In fact a GP has little diabetes training
 
No they don’t have the training or the ability to keep you up to date with new technology or better insulins. However, the bottom line is they prescribe our medications and cover the cost. Therefore they are duty bound to see us once a year. I just jump through the hoop. It is my medication review at the same time. Medication that I’m very grateful to get in the way that we do so it seems a small price to pay. Plus the call up to a hospital appointment these days is erratic. Ironically more so if you are doing well and so you are not a high priority. The nurse usually asks if I have any problems but readily understands that my knowledge is better than hers. In and out in a short space of time. Another box ticked.
 
I live 6mths a year in Spain and up to 6 mths in UK. So I have two GPs. Self funded in Spain and NHS in UK. I also have access to specialists in both. Some prescriptions in Spain are cheaper than through NHS (going by amount paid to pharmacy). So I balance sources and availability- much quicker and available in Spain; I can see a specialist within a few days, my diabetes specialist within a few minutes (my GP).
So I do appreciate that my records are kept up to date by my U.K. GP.
So happy to allow them to tick theirs boxes with an occasional visit/telephone call to allow them whatever meagre funds from NHS.
It also allows me to help educate .. that is one of the prime advantages of UK practice contact. One we should all remember.
 
In my experience. My GP surgery covers the base level in fundamental checks.
The last few times seeing a specialist at the hospital I had nothing more than a nurse BP check then a 30 minute wait to be asked how I am by an endo. Whilst he looks at sensor daily patterns on my phone?
When I pushed for a pump. I was told, “we have the funding but not the people.”

To summarise; regardless of who I have an appointment with first. The GP surgery is the only one that does the blood draw & checks the feet for neuropathy. (Giving feedback on results.)
My specialist is basically a “tyre kicker?”
 
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