NHS reorganisation is changing the way Diabetes is managed

(Published July 2006)

Sue Knox, Business Development Director of Health Direction looks at how the ongoing NHS reorganisation is changing the way Diabetes is managed and what this means for the pharmaceutical industry.

Since the launch of the Diabetes NSF in December 2001 and the Delivery Strategy published in November 2002 there has been real progress in the earlier identification of those with diabetes and at risk of diabetes and the implementation of management plans that include achieving much tighter glycaemic control on type 1 and type 2 diabetes.

Alongside this has been significant change in health service organisation and how diabetes care is commissioned and delivered, with many more diabetic patients being managed in primary care at less cost to the NHS and greater convenience to the patient:

Under the GMS Contract all practices have an obligation to provide essential medical services including the management of chronic diseases such as diabetes. Through the Quality Outcomes Framework (QOF) element of the GMS Contract practices are rewarded for optimum management of diabetic patients. PCTs can commission Local Enhanced services for diabetes, which might include glucose tolerance testing, management of complex diabetes and initiation of insulin. Providing such services in primary care reduces inappropriate referral into secondary care. In order to provide the expertise required to deliver such services in primary care the implementation of the GPs with Special Interest scheme and development of the Diabetes Specialist Nurses ensures that suitably experienced practitioners are available to take on the management of diabetes in primary care. The implementation of Practice Based Commissioning and Payment by Results further encourages the provision of cost effective diabetes management in primary care.

This shift in the management of diabetes has meant that what was once a condition predominantly managed in secondary care will become for the majority of cases a primary care managed condition. For those pharmaceutical companies with an interest in diabetes, the reorganisation of the NHS means there are a number of key questions that need to be answered for successful NHS engagement. These are:

How many diabetes GPwSI are there in the PCT and where do they practice?
(e.g. Bassetlaw PCT has nine diabetes GPwSI while Blackburn with Darwen PCT only has one)

What progress is being made with insulin initiation in primary care?
(e.g. Cannock Chase PCT has set up a diabetes LES where Insulin Initiation Training programme for GPs and Practice Nurses has been implemented

What is the structure of the local diabetic network?
(e.g. The North-East Essex diabetes network is a partnership of Colchester Primary Care Trust PCT (who host the network), Tendring PCT and Essex Rivers Healthcare Trust.)

Which PCTs does the NHS Trust provide diabetes services for?
(e.g East Lancashire Hospitals NHS Trust provides diabetes services for the following PCTs; Blackburn with Darwen PCT, Burnley, Pendle and Rossendale PCT, Hyndburn and Ribble Valley PCT (all responsible for primary care and other community health services)

What are the Practice Based Commissioning arrangements?
(e.g. The practices of Adur, Arun and Worthing PCT have formed into three clusters; Adur PBC locality, Arun PBC locality and Worthing PBC locality)

Answering the above questions provides pharma with a greatly enhanced understanding of how diabetic services are commissioned and delivered across the local health economy and who the key influencers in primary care are which is vital to successful delivery of their business strategy.