Diabetes care

Helping patients with DIABETES to get the best out of the NHS

This web-site is about helping you to understand how you can get the best out of the practice and other resources. Terms highlighted in RED are key words that you should find in your own medical record. Staff are highlighted in BLUE. Equipment is highlighted in GREEN.

You may ask why?
The most recent patient survey has shown that patients want to be able to see the clinician sooner (ie less than 2 weeks) and on time (ie not have to wait an hour for a scheduled appointment) and feel that all their concerns have been met. It has been independently confirmed that the practice already offers more appointments than the average to its patients.

So how can we meet the demand?
Being prepared for the consultation greatly helps as does recognising the length of the appointment slot and helping the clinician to stay within the time limit. 

You may ask how?
There are some simple steps that are essential for you to understand that will help you on your journey of discovery for your health and well-being:

1. What condition do you suffer with?
   Diabetes is often described as Type 1 Diabetes Mellitus or Insulin Dependent Diabetes or Type 2 Diabetes Mellitus or Non-Insulin Dependent Diabetes. This latter category includes patients that may be diet-controlled or those who are taking anti-diabetic tablets. It is important for you to know which type of diabetes you have as this affects your management significantly. You should find this term in your GP-held record.
2. What does that condition mean?
   Here are some links and resources for diabetes that you may wish to see:
   
   
   • NHS Choices:
   • Map of Medicine:
   • Patient.co.uk type 1
   • Patient.co.uk type 2
   • Diabetes UK:
   • Healthier Asian Recipes
     
3. What help is available for you to use?
   This condition is primarily managed by the nurses. They can check your blood pressure readings, order tests and review them, check any problems you may be encountering and do a medication review for you. They can also advise on things you may wish to consider and discuss things that you may have learned during your journey of discovery. They can also check that you have had your annual retinal screening and feet checks done
   The health care assistants can check your height and weight and do any blood tests you may need as well as check your urine sample.
   Doctors can see patients whose control remains poor or if you are developing further complications that need careful management or if you are having difficulties due to possible side effects.
   Abdul Salam, our Asian Diabetes Support Worker has been trained to help those patients who prefer to speak in Bengali. He has particular expertise in showing people with diabetes how to cook Bengali food and also runs exercise classes for men too. (There are other classes for Asian women too run by women). For more information contact the Asian Healthy Living Centre
   Specialist Diabetic Nurses look after those patients who have particular poor control or those who are being started on insulin therapy.
   Pharmacists, podiatrists and opticians also have a wealth of experience and knowledge on the management of diabetes and can give you further tips and helpful advice
   There is a blood pressure machine in the waiting room for you to check your blood pressure whenever you come to the practice.
4. What does the condition mean for you?
   You need to know what your target blood pressure (140/80 or 130/70 if you have other complications too) and target cholesterol (less than 5 mmol /l or less than 4 mmol/l ideally) and LDL (less than 3 mmol/l or less than 2mmol/l ideally) and HbA1c (less than 7.5% or less than 6.5% ideally) should be and what other risk factors you have that need to be managed eg whether you smoke or not or if you are obese or whether you suffer with ischaemic heart disease or kidney disease. You also need to know what is expected of you in the course of a year even if your blood pressure and symptoms are well-controlled. Finally you can monitor your own blood pressure, weight and smoking status and blood tests and urine test as a way of seeing how you are doing. This information should be in your GP-held record for you to see.
5. What needs to happen now and in the future?
   The typical patient with diabetes which is well controlled needs the following:
   • Fasting blood tests and urinalysis once a year with the healthcare assistant– checking you are not anaemic (Haemoglobin), kidney function (Sodium, Potassium, Urea, Creatinine and eGFR), Liver function tests (ALT, AST, albumin), a measure of how your blood sugars have been on average over the previous 3 months (HbA1c),  lipid profile (Cholesterol, HDL, LDL, triglycerides). Thyroid function tests (Thyroxine, TSH) and urinalysis (dip stick urine checking for protein and blood) as well as microalbuminuria
   • Blood Pressure reading at least twice a year 6 months apart. You can do this on your own! This is the minimum needed but you are encouraged to do this more often by using the practice blood pressure machine in the waiting room or buying a blood pressure machine yourself so that you can monitor it at home / work yourself. The local pharmacies all sell reasonably priced blood pressure machines and can give you more details about them.
   • Medication Review every 6 months usually with the nurse if you have good control or every 3 months if you have poor control
6. What can you do to help?
   As this is a new way of working, it is worth discussing this with the nurse to see how this can be done the first time you decide to take control.
   • Get access to your GP-held record. Without knowing what is in your records and what you need to do, it will be very hard to know what to do when and with who. This is an essential first step for anybody with any condition or who wants the best from the practice.
   • Ideally we want you to book in with the healthcare assistant for fasting blood tests and urine test if you have not had them done for 6 months or prior to your next medication review. At the same time, ask to book in with the nurse a week later. The nurse will check your records and book you in for you. (This is because the nurse needs to check who is the most appropriate person to do the medication review dependent on what else you may also suffer with).
   • Remember to ask for a yellow topped urine bottle from the receptionist which you can bring with you when you have your blood tests. You can do this when you turn up to the surgery and are waiting for the healthcare assistant or bring it with you. This needs to be checked once a year for microalbuminuria
   • Bring your blood pressure readings and weight with you to show to the nurse or doctor if you have been checking them at home. Ideally these will be registered in HealthSpace (www.healthspace.nhs.uk). Usually your last 3 months of readings or the last 10 readings are sufficient. Printing them helps save time or we can look at your readings on-line (but the internet sometimes does not work which could waste everybody’s time – we can always go on-line if need be anyway). Also make a note of when you had your retinal screening done and had your feet checked by the podiatrist.
   • Look at the web page – pre-consultation care – and go through it prior to your review with the clinician. This can help us to understand your needs better and what you want out of the consultation. If there are no specific issues AND all the tests are normal and you are well-controlled, it may even be possible to conduct the medication review over the telephone. This must be with the agreement of the clinician and if you are happy with this. We think many people may benefit from this but we do not want to prevent anybody from coming to the surgery of they so wish.. Understanding your needs is key to a successful outcome of the medication review. See the above mentioned websites to help you to understand what your needs are. Initially you may need the clinician to help you understand how to look at the websites and what they mean for you.
   • We are developing a specific pre-consultation questionnaire for patients with diabetes. Ask the receptionist who can then print it off for you. We hope to be able to enable you to print it off at home soon
7. How are we doing?
   The Quality Outcomes Framework was set up so that practices can look at how successful they are in delivering services to their practice population and also give an opportunity to see how we compare with others around the country. This data is readily available from here (www.qof.ic.nhs.uk/search.asp). Overall we got 996 points out of a maximum of 1000 last year indicating that we are a very high performing practice across the board which is reassuring for you and us. We achieved a maximum score in the Diabetes domain gaining all 93 points that were allocated for this. Although we performed spectacularly, there is still some room for improvement. For instance, are you one of the few patients that has not had a recent blood pressure done? Or maybe you are one of the few patients whose HbA1c is more than 10%. Why is that? Perhaps you have not realsied that most patients HbA1c is less than 10% and in fact even less than 7.5%. Is there something you can do differently to help improve your diabetes especialy when you know others seem to be doing better? Perhaps you could look at your own record and check if we have done everything for you that we should and ask why not if you find a discrepancy. It’s in your interests to get the best treatment and that’s why we want you to check you are getting it!
   
   
   
8. How can you help us do even better and help other patients too?
   This is very important. In your journey of discovery about your health, you may come across odd things that do not make sense about the way the practice runs and you may have a better suggestion. Or you may come across something new that we have not considered that helps you even more. Tell us about it next time you see a clinician or preferably write it down and hand it in or send it as a comment to the Patient Participation Group (PPG) so that they can bring it up with the practice the next time we meet up. Even better, why don’t you join the PPG and become an active member. We are always on the look out for new members and new ideas.

Instead of having to come to the surgery 5 times a year to check your blood pressure (x2), check blood tests and urine test (x1) and get your results of the blood tests and have a medication review (x2 if you are lucky – x4 if this is not done at the same time), you may find that you only need to come once for the blood tests and urine test and the other things could be done over the telephone as long as everything is normal. That frees up 4 appointments that others could use! This means more appointments available for patients that are more focused for your needs within the time allocated.

Most importantly, by working together and understanding each other’s needs better, we can help you to get the best out of the practice and the wider NHS.