Patient-Centred Care Plan

[NewTD2]

How come the NHS, GPS or DNs does not provide any care plans for individual patients?

I actually ended up formulating my own care plan on a daily/weekly basis from doing my own research.

 

[NaijaChick]

All patients receiving treatment for LT condition s or needing specialists treatments must have a care plan. I did leave the NHS about 6 years ago but we always wrote care plans in my day.

 

[Bluetit1802]

How come the NHS, GPS or DNs does not provide any care plans for individual patients?

I actually ended up formulating my own care plan on a daily/weekly basis from doing my own research.

NICE has a recommended care plan for T2 diabetics. My nurse follows this to the letter. Of course it included dietary information, which I have ignored. I haven't missed out on anything. (face to face reviews and discussion, the correct blood tests at the correct times, annual foot checks, annual eye screening, invitation to a course (which I declined), blood pressure checks, urine tests, and so on.

 

[NewTD2]

I didn’t get one I’m afraid.

I had to literally chase up my DN and GP for everything!

 

[Bluetit1802]

I didn’t get one I’m afraid.

I had to literally chase up my DN and GP for everything!

Have you had your foot check and retinal eye screen yet .... or been referred and still waiting? Have you been referred to a course? How often do you see your nurse, and does she take your blood pressure etc. How often do you get blood tests and do you get the full lot (HbA1c, cholesterol, lipids, kidney/liver functions, eGFR and FBC)? These things are all in the NHS recommended care plan. What have you had to chase your nurse up for?

 

[NewTD2]

I haven’t had any since I was diagnosed last Sept 2017

 

[Deleted member 308541]

I have a health care plan from my GP for five free podiatrist visits a year.

I had a COPD action plan given me by a COPD Nurse Practitioner when I was discharged from Bundy hospital, which I promptly threw in the bin when I got home.

 

[Rachox]

I have had brilliant service from my GP since diagnosis. At my first appointment on diagnosis my GP went way over the 10mins appt slot explaining everything very methodically and checking I understood it all. Referrals were done very quickly, I’d had my eye check and Diabetes course within a month. I have to say I’ve received over and above the recommended HbA1c tests, the first two were at two months intervals, then three months and my next is three months. The only bit of the recommended care pathway I don’t like is the repeated mentions of Statins

 

[Bluetit1802]

I haven’t had any since I was diagnosed last Sept 2017

Haven't had any what?

 

[Deleted member 308541]

Haven't had any what?

I am keeping my mind in neutral here...

 

[yakudueye1]

I am tired of fighting diabetes once and for all I will let it win as I have lost social mix,my boyfriend ,driving licence, worn out my family and lost my job cause of it hence it can screw me anymore and am not ungrateful but will go and tell my diabetic team in the hospital well done as I have reached the point where a zombie has a better quality of life than me

 

[NewTD2]

Haven't had any what?

No follow up from GP or DN since September

 

[Bluetit1802]

No follow up from GP or DN since September

Your profile says you are on tablets. Which tablets? What was your HbA1c on diagnosis?

The care pathway laid down is for a further set of blood tests and a medication review with nurse/GP 3 months after initial diagnosis. Thereafter blood tests and reviews at least 6 monthly until medication is stable and HbA1c is within acceptable targets, moving to 12 monthly once all is well.

The nurse normally does the foot checks, and these must be done annually. Your BP should be monitored at every visit. She should also refer you for the retinal screening and an education course, although there are waiting lists for these, and the screening unit may only visit your area annually so you may have to wait for this.

You need to chase all these up and make sure your details have been entered on the diabetes register. You may just have slipped through the net, so you need to be firm about all this. Or change surgeries.

 

[Bluetit1802]

This is what NICE say

https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management

(scroll to top)

 

[Guzzler]

You say you have had to chase them for everything but then say you have had none of the checks that are normally done at or very soon after diagnosis of T2. So when you chased them what did you get?

 

[wiflib]

You said you are pre diabetic.

 

[Rachox]

You said you are pre diabetic.

Oh yes I remember now, he had his last HbA1c around the same time as me in Dec and said he’d got it down from diabetic to prediabetic.
So @NewTD2 at least you’ve had a blood test. Did you not see your GP or nurse to discuss the result? My GP at each appt tells me when to book the next blood test and then I have to book a GP appt a week later.

 

[DavidGrahamJones]

How come the NHS, GPS or DNs does not provide any care plans for individual patients?

I'm being generous to your surgery, but if mine is anything to go by, admin staff do a lot of the donkey work. My GP will do a lot of things there and then, while I'm sitting in front of her, but even referrals are done by voice with someone in the admin team typing up a written request. There are problems with that system as I've recently discovered.

Maybe the best thing to do is just ask "What about eye screening, regular HbA1c, foot care etc etc". It might be that at six months after diagnosis in February sometime, it might all happen automatically. Wouldn't hurt to ask.

We justifiably expect a lot from our health carers and I think sometimes their procedures aren't what we expect. As I said, I'm being kind to your surgery, let's face it, there's nowhere else to go, so keep them sweet, it works well.

 

[Sue192]

Maybe the best thing to do is just ask "What about eye screening, regular HbA1c, foot care etc etc". It might be that at six months after diagnosis in February sometime, it might all happen automatically. Wouldn't hurt to ask.

That's what I'm doing in March (third three-month check which I'm going to ask for), if nothing appears before then. I'm in same situation as @NewTD2, having been offered none of that, although hbA1c is now pre-diabetic. I really don't want to change surgeries but if I don't get anywhere, I will. I'd think about doing that too @NewTD2, if possible.

 

[DavidGrahamJones]

third three-month check

I have an annual HbA1c, maybe because I'm an "old hand". In the beginning (1997) I used to have bi-annual HbA1c checks which is why I thought that maybe the original poster might get a surprise when he is asked to have a checkup as he is just coming up to 6 months since diagnosis. My own surgery just phone to get me to make an appointment, but only annually.

I have never had the opportunity for foot care and that's always something I've had to self fund. Eye screening is annual for me as well although I did fall off the list once and had to chase them up, sorted out very quickly, so no problem.