8th Collaborative DiGP/UCC/HSE/IPNA Diabetes in Primary Care Conference

The Challenges of Delivering Diabetes Care in General Practice

Professor Mike Pringle

President, RCGP

First, an apology

I am a GP

I retired from clinical practice 4 years ago

I am English…

But we share similar underlying challenges and are searching for similar solutions

How did we get here?

The essential value of Generalism

The clear benefits of teamworking, integration and collaboration

Personalisation against standardisation of care

Autonomy versus regulation

What does ‘success’ or ‘best care’ look like?

The Context

The rise in numbers and complexity

Single Disease specific solutions will not work

The Impact

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Potentially preventable admission

Other emergency admissions

Ageing and multiple morbidity

• People with LTCs:29% of the population

50% of all GP appointments

64% of all OPD appointments

70% of in-patient bed days

70% of total health and social care spend

• The Number of people aged over 80 will double between 2010 and 2030

The capacity of UK general practice

In the 20 years to 2008, the primary care consultation rate increased by 75%

Over that period, consultations/pat/year rose from 3.9 to 5.5

The average GP consultation lasts 11.7 minutes

96% of patients say they want longer appointments

The capacity of UK general practice

2001-2011 the FTE number of GPs increased by 2% per year

Between 2001 and 2011 District Nurses numbers fell 34%

FTE numbers of practice Nurses peaked in 2006 since when we have lost 7%

Effect of deprivation in the UK

Health inequalities are widening

The Inverse Care Law is alive and well

• In Scotland 11% more GPs in the most affluent half of population than in the other half

• In England CCGs with highest provision had twice the numbers of GPs per capita that those CCGs with fewest GPs

• Consider English male life expectancy and GP distribution

Effect of deprivation

Multi-morbidity (esp mix of physical and mental) occurs on average 12 years earlier in most deprived vs most affluent quintiles

“More multiple morbidity in deprived areas means that the population die younger, are sicker for longer before they die and they present more complex problems to their GP”

RCGP, 2022 vision, 2013

Continuity of care

Continuity of care, a key attribute of generalism, gives:

• Earlier diagnosis

• Better health outcomes

• Patient centred care and higher satisfaction

• Cost control: less duplication, expensive interventions better targeted, better prescribing

Fragmentation of care

Multiple contacts with different parts of the health service = lack of coordination, duplication of services, increased costs

In general practice, fragmentation = loss of continuity of care

Shared decision making

This is not abdication but responsible sharing

At the centre is ‘care planning’, education and support

Average person with diabetes spends 3 hours a year face to face with a health professional; its the choices in the other 8,757 hours that really determines their outcome.

SOME SOLUTIONS

The RCGP Vision

“More GPs, with longer training, spending more time with their patients – A world where excellent patient-centred care in general practice is at the heart of health care”RCGP, 2022 vision, 2013

The RCGP’s actions

• Campaign: Putting Patients First, Back General Practice

• Simon Stevens’ Five Year Forward View

• The Political rhetoric

• Recruitment, retention, returners

• Investment?

• Building teams

Ways Forward

Promote ‘Federations’ or similar structures

Use Commissioning in England to recognise and fund primary care provision

Move care and services, and the funds, back to general practice

Recruit more of the emerging doctors into general practice

Ways forward

Improve our skill mix, especially reverse decline in practice nurses

Telephone triage and telephone/email consulting

GPs and nurses with special clinical interests

Use pharmacists better

Ways Forward

Care planning for people with multi-morbidity, with Primary Care retaining/regaining central role

Better IT and information sharing

Redesign pathways around the patient not the staff

Invest in primary care rather than secondary care

Encourage a “named doctor” and doctor-doctor-nurse-nurse pairing in big practices

Promote self care and shared decision making

8th Collaborative DiGP/UCC/HSE/IPNA Diabetes in Primary Care Conference

Update on Diabetes – delivering care

Professor Mike Pringle

President, RCGP