SECTION 2:

The Diabetes UK 15 Healthcare Essentials

The Diabetes UK (DUK) guidance includes more suggestions about key areas of care.1 The 15 Healthcare Essentials checklist can be downloaded here: https://www.diabetes.org.uk/resources-s3/2018-07/15-Healtcare-essentials.pdf and can help to support quality care in practice. As well as the areas covered in QOF, DUK suggests that the following areas should be addressed in the diabetes review.

Retinal screening: retinopathy is another microvascular complication of diabetes and annual screening can identify whether retinopathy is present and if so, whether background changes are deteriorating.1,2

Kidney checks: via a blood test for estimated glomerular filtration rate (eGFR) and the albumin/creatinine ratio (ACR) urine test for microalbuminuria.3 This test is not explicitly included in the QOF guidance, although the importance of ensuring that anyone with an abnormal ACR result is treated with an ACE inhibitor or ARB is covered.4

Dietary advice: this is not just for weight loss but also to support healthy eating. Diabetes UK updated its nutritional guidance in 2018.5

Emotional support: this can be accessed via local services such as the Improved Access to Psychological Therapies (IAPT) programme or via online services and forums. Diabetes UK offers a dedicated diabetes helpline with trained advisers who can explore the emotional, social, psychological or practice difficulties of living with diabetes.6

Smoking cessation support: again, this is not specifically mentioned in QOF in relation to diabetes but smoking cessation is regarded as central to holistic well-being in any patient.7 In diabetes, smoking will increase CVD risk,8 and GPNs should ensure that PLWD can access appropriate and timely smoking cessation interventions. More advice on smoking cessation training can be found from National Centre for Smoking Cessation and Training.9

Help with sexual problems: this is likely to be an area for specialist input, and where the multi-disciplinary team can offer further support.

On that note, DUK states that people with diabetes should be able to access care from a specialist healthcare team.1 This care may still be from a suitably qualified and experienced GPN but may also include clinicians with a special interest in specific aspects of diabetes care, such as diabetes specialist nurses or podiatrists.10

Other areas that DUK describes as ‘Healthcare Essentials’ are in-patient care and antenatal care.1 By definition, these will come under the remit of specialists, but GPNs should recognise the important role that they have to play in supporting people to be clear about what should happen in these circumstances and to seek clarification if they feel that they are not getting the appropriate level of care.

Job code: UK/DIA-19020e DOP: April 2020

References

  1. Diabetes UK. Your 15 diabetes healthcare essentials; 2018 https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/15-healthcare-essentials [Accessed April 2020]
  2. Diabetes UK. Diabetes and eye problems (diabetic retinopathy). https://www.diabetes.org.uk/guide-to-diabetes/complications/retinopathy [Accessed April 2020]
  3. Diabetes UK. Preventing kidney failure in people with diabetes: Position statement; August 2016. https://www.diabetes.org.uk/professionals/position-statements-reports/specialist-care-for-children-and-adults-and-complications/preventing-kidney-failure-in-people-with-diabetes [Accessed April 2020]
  4. NHS England (2019) 2019/20 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF) https://www.england.nhs.uk/wp-content/uploads/2019/05/gms-contract-qof-guidance-april-2019.pdf [Accessed April 2020]
  5. Diabetes UK. Evidence-based nutrition guidelines for the prevention and management of diabetes; 2018 https://www.diabetes.org.uk/professionals/position-statements-reports/food-nutrition-lifestyle/evidence-based-nutrition-guidelines-for-the-prevention-and-management-of-diabetes [Accessed April 2020]
  6. Diabetes UK. Diabetes UK Helpline https://www.diabetes.org.uk/how_we_help/helpline [Accessed April 2020]
  7. Public Health England. Health Matters: Stopping Smoking – what works? 2018 https://publichealthmatters.blog.gov.uk/2018/09/25/health-matters-stopping-smoking-what-works/ [Accessed April 2020]
  8. Fagard RH. Smoking amplifies cardiovascular risk in patients with hypertension and diabetes. Diabetes Care 2009;32(Suppl 2):S429-S431
  9. National Centre for Smoking Cessation and Training. Training resources. https://www.ncsct.co.uk/pub_training.php [Accessed April 2020]
  10. Diabetes UK. Meet your healthcare team. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/interactions-with-healthcare-professionals