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
