Older people who have diabetes will receive specific advice about frailty as detailed in a five-year framework to revise GP contracts.
The framework will support the implementation of The NHS Long Term Plan. Research carried out by Exeter University has informed the changes regarding frailty.
The changes were overseen by Dr David Strain at the University of Exeter Medical School, who said: “I’m delighted that this new guidance puts the needs of frail patients with diabetes at the centre of GP decision-making about their care.
“We know that a single episode of hospitalisation reduces quality of life in older people by around 30 per cent and increases the cost of care by 56 per cent. It’s crucial to get this right to help our older people live as well as possible with diabetes.”
The previous GP contract had used incentives to encourage doctors to help their patients achieve tight blood sugar controls among those with type 2 diabetes, irrespective of their age or health.
Research has shown that old age can impact sensitivity to blood sugar-lowering medication, which can increase the chances of hypoglycemia and falls.
These findings have been taken into account and now the guidelines stipulate that doctors must assess frailty and, if identified, they are allowed to use their own clinical judgment to make decisions about the person’s medication.
Dr Strain added: “This change marks a shift in the emphasis for older people living with type 2 diabetes, that GPs will no longer be incentivised to treat all people the same irrespective of their circumstances. It comes as a result of significant collaboration between general practitioners, consultants working in health services for older adults, NHS England and people living with diabetes.”
Dr Partha Kar, NHS England’s Associate National Director for diabetes and Consultant Endocrinologist at Portsmouth Hospitals NHS Trust, said: “This outcome is the culmination of months of close working of the NHS England Diabetes team with the BMA GP group and we are delighted that an important issue of frailty is being looked into – with focus on individualised care – rather than a non-evidence based target driven culture. We hope this will help with issues of safety and avoid pitfalls of over treatment.”

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