English v. Scottish Diabetes care

Hi

I recently moved down to England from Scotland, where I did my Dafne training, and now seem to be only under GP care for diabetes with an annual visit to the general practice nurse (unlike in Scotland where I went up to the hospital twice a year).

I was just wondering whether this was standard practice in England or whether I should push again to be seen by Diabetes specialists? (When i initially queried this I was told that they don't normally send type 1s with no complications up to the hospital).

Hi,

In England, I am under the hospital for my diabetes care (although I still have a yearly review with the GP as they sign off my repeat prescriptions, this is probably what you're getting), if you are well controlled they tend to see you every 12 months, as I'm a bit slack they tend to see me every 6 months, a looming appointment forces me to behave! There are diabetic nurses (DAFNE trained/trainers) at the hospital I can call/email or see them any time with an appointment or certain days you can just drop in.

I know PCTs are all different, this is in Nottingham, but I would have thought you should be under a consultant at the hospital and would guess you have slipped through the net.

Phil

I did the opposite to Ghostie78 - moved from England (Stockport) back to (North-East) Scotland just over 3 years ago. I suspect different PCTs (or whatever they're called this week) may have different regimes.

In England, I was seen twice a year by the Diabetes team at the main hospital, and also twice a year by nurse at my doctors, which may have been a bit OTT, though my BG levels were erratic partly as my carb-counting was rubbish. This was pre-DAFNE which I attended after moving - I believe (hoped) I would have done it in Stockport if I'd stayed as I'd recently got an Aviva Xpert meter and some info on CPs etc but not the complete picture. Here I am seen twice a year by Diabetes team at hospital but not at my doctors - I think they have a diabetes doctor, if I needed help I would probably try to see that doctor (I live opposite the surgery so don't have to travel) or eMail the main hospital, but they are usually very busy.

I find this Ok at present - BG is a bit high but I don't think there's a great deal the staff could do except suggest changes I can/should probably make myself - it's the inconsistency of juggling BG and adjustments which I find difficult.

Hope this helps,

Thanks - that's very helpful alturn and Phil. I'm based in Manchester - so not a million miles from Stockport..although poss different PCT?

I think I might try pushing again - thought it was slightly odd, but, given no complications and HbA1C is good, then thought I might get some resistance if not the norm! Actually the reason for my initial query was whilst HbA1C is good, I think it's only good because I've been going low too often so wanted to try and fix that.

I think you should ask the question to be seen at the hospital for their expertise and any support groups on offer

I am in North East England and am seen approx every 3-4 mths by diabetes consultant and nurse specialist at the hospital. My GP doesn't have anything to do with my diabetes care...other than to do my blood work and prescribe the insulin! My mum who is type 2 (tablet controlled) is ONLY under GP care, and practice nurse who runs the diabetes clinic....Essentially once you are on an insulin regime my GP isn't involved only the hospital. I would try to fight it to ensure you are seen by a specialist.

Hi Ghostie 78 I am under Salford PCT which is not far from manchester and I see Diabetes team at SRNHST yearly and my GP every six months and of course I can speak to a DAFNE Nurse at any time if I need to. My GP nurse only checks bloods and blood pressure ect. I have been going to see a specialist every year for 27 years and thought that was normal practice but obviously not. Good Luck

Hi Ghostie78,
I can understand your desire to be under hospital review. I've had type 1 diabetes for nearly 48 years and have been grateful for being provided with regular consultant care for all that time. I'm now retired but worked in general practice for 35 years. There was a pressure for GPs to take over the care of as many patients with diabetes as possible leaving the hospital to manage "complicated cases". This, I think, was because of the increasing number of patients with diabetes and hospital diabetes clinics being overcrowded and because hospital care is more expensive than GP care. My personal view is that all patients with type 1 diabetes should be followed up by hospital as well as by their GP. I seem to remember that the PCT in those days agreed that hospital care was appropriate for all patients with type 1 diabetes. I do hope you will be able to negotiate to receive some hospital review.
Every good wish,

I'm in Scotland (West Lothian), I've been Type-1 diabetic since I was 11 and I've never used my GP surgery as my Principle Care Team - it's always been a diabetic clinic at the local hospital. I started off at a hospital clinic at the Sick Kids in Edinburgh, then moved to my local hospital when I was a teenager and been there ever since.

Due to complications from not taking proper care of things when I was younger, I get seen every 3 months at the clinic, can email/phone them regularly, & they have both doctors and nurses as part of the clinic team. I can even pop in to see them on the off chance, and as I ended up living next to hospital sometimes I even just pop in to have a chat with my nurse who's been looking after me since I was 15.

I've had 3 different GP's surgeries over the years due to moving home, and had some pretty horrific experiences in getting normal GP appointments/scripts filled etc, so the idea of changing my care team over to my GP and relying on them and their availability to take care of my diabetes, especially with the complications I've caused with it would terrify me . Whilst my new GP seem to be really good at general medical care, they admitted to being relieved I was part of the Clinic as it took the responsibility off of them & they didn't have the expertise/resources to provide the level of care I would need to support/manage my diabetes. My other 2 previous GP's were of a similar opinion.

IMO the level of support/care I get through the clinic setup I have is 2nd to none, a dedicated team of diabetic focused specialists, whether it be consultants, nurses, dieticians, psychiatrists etc will always trump a GP run clinic, whilst it may 'cost' more, provided the patient is willing to listen to the advice (unlike I was in my 'youth') given, then the savings of a healthy diabetic over a poorly controlled one should surely be a no-brainer to any bean-counters in the NHS?