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GP pay for diabetes ‘must be reviewed’

National Audit Office shows only half of people receive proper diabetes care

Louise Prime

Wednesday, 23 May 2012

GPs should be paid for diabetes care only when they ensure that all nine of the recommended care processes are delivered to people with diabetes, the National Audit Office has said. The NAO says that the current incentives system must be reviewed because “it is failing to ensure sustained improvements in outcomes for people with diabetes”. It has called for the threshold for GPs’ remuneration to be reviewed – and increased at regular intervals.

Only half of adults with diabetes receive the recommended standard of care in England, today’s NAO report has revealed (up from 36% in 2006-07). It found that in 2009-10 fewer than a fifth of patients achieved recommended standards for controlling their blood glucose, blood pressure and cholesterol levels, to reduce their risk of developing diabetes-related complications. And investigators found that strategic health authorities were not holding commissioners to account for local performance in delivering the recommended standards of care.

No primary care trust delivered all nine basic care processes to all people, but this varied enormously between trusts across the country, from the highest score of 69% of people down to the lowest of just 6%.

The NAO accuses the Department of Health of failing to manage effectively PCTs’ performance in delivering diabetes care. The report’s authors said: “The NHS does not clearly understand the costs of diabetes at a local level, and so lacks clarity about the most effective ways to deliver diabetes services.” Its researchers found a variety of different approaches to delivering diabetes care, with GPs taking the lead in some areas, hospitals and specialist services in others, and intermediate community services in others.

The NAO estimates that diabetes services used about 4% of the entire NHS budget in 2009-10 – or at least £3.9bn – more than double the Department of Health’s “substantial underestimate” of £1.3bn for that period. It also claims that £170m is wasted on hospital care every year, because avoidable diabetes complications are not detected early or managed well enough.

Head of the NAO Amyas Morse said: “The Department of Health has failed to deliver diabetes care to the standard it set out as long ago as 2001. This has resulted in people with diabetes developing avoidable complications, in a high number of preventable deaths and in increased costs for the NHS.

“The expected 23% increase by 2020 in the number of people in England with diabetes will have a major impact on NHS resources unless the efficiency and effectiveness of existing services are substantially improved.”

The Rt Hon Margaret Hodge MP, chair of the Committee of Public Accounts, said: “My Committee will want the Department to commit itself to improving its understanding and control of diabetes services, and set out what action it is going to take to ensure that we see much stronger improvements over the next few years.”

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