Fifteen or Nine?

[manofkent99]

I have understood that there are fifteen tests which should be addressed at an annual review although not all of these might be relevant, eg at age 77 and male, it is unlikely that I will be pregnant.
In a news bulletin this morning Sky News, et al, referred to the nine basic tests which should be applied.
Is it fifteen (with some exceptions) or is it nine? Clarify please.

 

[Northerner]

Hi, as you say there are some checks that will not apply to everyone. You can read Diabetes UK's full list of 15 checks here:

https://www.diabetes.org.uk/upload/About us/15 measures checklist.pdf

I would imagine that 11, 12 and 13 on the list would not apply to many people and some of the checks would only need to be done once, like 8 and 10. Certainly 1-6, 9, 14 and 15 should be done at each review 🙂

 

[trophywench]

Yes, you've correctly identified the 9, Alan! LOL

I always giggle when I see the one about 'no smoking' advice.

When you do smoke, you get told you really ought to give it up. Because of all the reasons we already know anyway - and of course the chances of having a CV event are X% greater when you have D anyway.

And then they identify that you've lst feeling in part of a foot. So they tell you that you have (which you already knew anyway) No advice about what you could do about it. That's my current hobby-horse.

But they've ticked the boxes - see you in 12 months .......

But no, wait. There are patients who don't get these checks. God knows how these surgeries get away with it - I'm more interested in that aspect actually than I am that eg mine or yours may be a bit late this year because of holidays intervening at the time we would normally be going.

The point about DUK issuing this list was that they identified from the huge survey they did, that a lot of people weren't getting them. But DUK can't MAKE the checks happen. Yes they can bring pressure to bear at a great height, but not in my or your surgery or PCT.

It's alright the NHS saying to GPs 'We will pay you X ??? if you do these checks' - but where oh where, is the bit that says 'And we'll take Y ??? off you if you don't.' ?

 

[DeusXM]

In a sort of defence of the NHS, there's another issue here.

NHS diabetes management appears to be based on an assumption that people with diabetes don't have jobs.

I am basically stuck in a never-ending cycle of appointments because there's no one-stop-shop approach to managing diabetes. For example, in February, I had my clinic appointment.

That means, the week before, I need to go to my GP and get my blood drawn (and they only do this weekdays between 10am and 12pm).

Then the following week, I have to go to the hospital for my clinic (only on weekdays, 10am-3pm).

Following that, I then have a retinopathy scan in April (only on weekdays, 9am-5pm).

Then I have a podiatry appointment (only on weekdays, afternoons).

And then I've got a dietician's appointment (weekdays only, 9am-12pm).

So in other words, for my diabetes to be monitored properly by the NHS, I have to essentially take 5 days off - for one bunch of six months tests! Usually I need to end up rescheduling appointments because of work commitments, and so what usually happens is I just about get everything done and then have to start the cycle all over again. Oh, and every single one of these appointments is held at a different place, just to keep my on my toes.

So it's very, very hard to maintain this image that diabetes doesn't affect my life or my ability to work because pretty much every four weeks, I need to take time off to get things done. I genuinely don't understand why the NHS can't put ALL of these appointments together in one visit, or even better, actually work on you know, a Saturday once in a while? 90% of the time, I end up just cancelling these appointments because I feel there is no point me wasting an entire day just to see a dietician who'll then suggest I need to eat more bran and then gives me a wry smile when I say I do much better when I eat LESS bread. Or a consultant who has managed to not read my records and then tries to prescribe me an insulin that simply doesn't work for me. And then I get labelled as 'non-compliant', which irritates the hell out of my care team because I then show up with a better A1C than they'd expect.

So yes, I'm sure in some PCTs, some people with diabetes don't get offered the support they need. But frankly, no-one really does enough to even bother to make that support accessible. I work and I have a life, I can't afford to waste over a week of my life ferrying round across London to get half-arsed advice. I'm sure most of us also have jobs and a life that we'd all rather be getting on with.

 

[Abi]

Agree
My work has been quite flexible but am starting a full time position soon. luckily have generous annual leave allowance so will schedule retinal screening then and possibly blood tests at GP surgery

Another valid point which has been made in a different thread is that it matters not one jot if you get all the tests done and still can't/ won't manage your diabetes properly
I think the GP quality outcomes framework should have "adequate test strips prescribed" as one indicator, and "absence of severe hypos- fit to drive!" as another

 

[Northerner]

There's also the problem that QOF payments are made in full if only 60% of the expected targets are met

 

[richardq]

With regard to the medical appointments etc. and taking time off work for them, I believe that I read somewhere (can't remember exactly where) that they would count as disability leave rather than sick leave or annual leave, so by law they should be paid and can't be refused, and not taken into account with your sick days or taken off your annual leave. Unfortunately as I can't remember where I heard this or read this I'm not sure how correct this is.

R

 

[DeusXM]

It's not really a question of whether or not they would be refused - it's the fact that it takes up time, which I don't really have to spare. And even if it's not 'official' sick leave - come on, if I have to disappear for a day every few weeks, unofficially everyone's going to think I'm extremely delicate or something.

 

[everydayupsanddowns]

Not sure how long you've been Dx DeusXM, but in the old days my 'annual review' used to be the kind of composite appointment you are describing (though not always dietician/podiatry tbh).

Not sure why you are still routinely seeing a dietician - I've not seen one since the late 1990's (though I could have been referred if I wanted to). Similarly my pulses/toe tickling are still part of my AR, rather than a separate pod appointment.

The duplication in my appointments is down to my GP's practice nurse 'needing' to see me for a med check (and presumably QoF box ticking for GP budget) once a year, while I get my *actual* diabetes care at the hospital clinic.

There seems to be another push towards decentrtalised care, but sadly, as you point out, they do not seem to realise that 5 different appointments = 5x the time spent in waiting rooms + 5x the travel arrangements + 5x the faff for arguably very little if any benefit to the patient.

This kind of thing: http://www.everydayupsanddowns.co.uk/2012/03/all-too-familiar-qic-awards-2012-guest.html