Type 1 treated at Hospital or GP

[KookyCat]

We are specialist clinic for T1 and complicated T2 here, then everyone else is GP, but that’s likely to change because they’re restructuring. I’m considered very high risk still because of how ill I was at diagnosis despite being stable for some time. To be honest I don’t need much managing really, but I’m not sure I’ll ever get shipped back to the GP by force because of the risk level. They’re all quite upset when they see the test results at diagnosis, and then baffled about my control now. I could elect GP led care if I preferred but my one experience of the “diabetic” nurse was not good, we spent 20 minutes in a circular conversation about what dose I took for lunch and dinner, I told her the ratios she kept asking for units. I lost my temper in the end because she wouldn’t accept I varied the dose based on carb content. It wasn’t a very positive experience so all in all I’d rather poke myself in each eye 🙄 and then run around the car park naked...

 

[JJay]

I was seen at a hospital clinic for 3 years after diagnosis, until I was sent an appointment which happened to fall in the middle of my honeymoon (April). I rang to change it, to be told that they couldn't give me another one until October! I mentioned this to the nurse at my GP's whom I was seeing on another matter and she said, "well, you're pretty well controlled aren't you? we can look after you here". She was extremely knowledgable about T1 and I got on very well with her for years - she was certainly more helpful and pragmatic than anyone I'd ever seen at the hospital clinic. In fact I wouldn't have moved house 4 years ago had she not actually retired at around the same time!

Now I'm dealt with by a combination of GP and practice nurses, together with a Community Diabetes Team of DSNs who deal with matters such as approval of Libre, education and anything out of the ordinary. Seems to work OK.

However, it's not so much a question of one or other system being better, it all depends on the people within it!

 

[pm133]

Being seen by both hospital and GP surgery staff.
My GP is a Diabetes specialist so that helps.
In the absence of any contact from the hospital I started having my HBA1c tests done at the GP surgery.
Then the hospital started organising MS Team meetings with a Diabetes Nurse and I've had a couple of them. On the back of that I was given a Libre device which I really like using.
The hospital called me in for an appointment recently and checked my weight and blood pressure and were going to test my blood but I'd just had my latest HBA1c result the previous day from the GP surgery so it wasn't necessary and I've had my eyes tested for retinopathy there too. On both occasions, I was in the building for less than 10 minutes. Long may that continue. I am not a "wait-er" :-D

There's a bit of overlap but I consider myself very fortunate to have good cover if and when I need it.

 

[nonethewiser]

Just routine tests at gp surgery, anything to do with diabetes is handled by hospital clinic, prefer it that way as surgery are hopeless when it comes to type 1 matters.

 

[Peely66]

As far as I'm aware, all type 1s are seen by hospital staff.

Absolutely not. I haven't been seen in a hospital clinic since the 90s. I haven't seen anyone with (as far as I'm aware) any speciality in diabetes for 10 years.

I think the clue with GPs is in the name...they are generalists.

Oh and "treated" is rather an exotic way of describing what happens at my GP!

 

[helli]

I have an annual review at my hospital clinic.
They advise my GP what to prescribe to treat my Type 1.
My GP surgery appears to have an automated message that goes out once a year inviting me for my annual diabetes review. Typically, this arrives about 2 weeks after my hospital review so I decline it.

Whilst the hospital is not as convenient as my GP surgery, I am happy with this arrangement as, in my experience on other issues, I have not found anyone at my surgery who can spell "Type 1" let alone advise treatment.

And as other's have said "I treat my diabetes" - my consultant and DSN advise.

 

[rebrascora]

I get my annual foot inspection and tickle, weight and BP and blood test with the allocated nurse at the GP practice. Unfortunately the nurse in question has retired and I don't know if a replacement has been nominated and trained, so I am a little concerned about that as the previous one was good in that she was lovely and really helpful but happy to admit when she didn't know something and seek advice or refer me. I am overdue this review probably due to Covid and the staffing issue but don't feel it is a problem at the moment as I am managing things OK myself.

I then get consultant/clinic appointments at the local community hospital approx 6 monthly at the moment. Last time was a phone consultation in Nov due to Covid but it was with my Consultant and worked very well.... but then I had my best HbA1c result thanks to Libre so didn't really need much input.

I also have the option to ring the clinic helpline and leave a message if I need assistance with something in the meantime. They usually ring back the next working day and that has been OK although it is never the same DSN and generally I find the information I need here on the forum.

It does concern me that I may be signed off back to the GP practice at some point and I would be fine with that as long as I know I can request to go back to the hospital should I need to, but some of the stories you read here on the forum of GPs and practice nurses resisting referring people to the clinics makes me a bit nervous. That said I do have an excellent GP practice so I really should have faith in them to do the right thing.

 

[Robin]

It does concern me that I may be signed off back to the GP practice at some point and I would be fine with that as long as I know I can request to go back to the hospital should I need to, but some of the stories you read here on the forum of GPs and practice nurses resisting referring people to the clinics makes me a bit nervous

And it takes a long time even if they’re not resistant...
I posted further up this thread in 2019 that I was only seen at my GP's, but I’ve since asked to be referred back because I wanted the Libre, and it took ages. I asked the nurse at my review in November 2019, she sat on it for a bit because she didn’t really know where and how to refer me (and she didn’t ask one of the doctors at that stage), and she only works for one afternoon a week.
Then Christmas got in the way, then she had a training day and asked the consultant from the hospital about referrring a patient, and he told her yes of course, he’d see me. So she then filled in the wrong online form and referred me to a Type 2 dietitian! I was keeping an eye on my online notes, so realised this was wrong, and mentioned it to the GP at my meds review that January.
She then did a correct referral, and I got a 'Choose and book' letter in February, but when I tried to book, it kept saying there weren’t any appointments. I kept trying and eventually some turned up, for May!. Meanwhile covid had happened, so I had a telephone consultation in May instead, at which the doctor said, yes, she supported my quest for the Libre and would put me forward for discussion.
Long pause while I heard nothing, and I left it longer than I would have because of Covid, but eventually chased in September. No record of me being discussed for Libre prescription. Wonderful hospital secretary said she’d chase it, and did so, but even so, I ended up emailing her fortnightly, then weekly, for a progress check, and eventually this magical meeting happened, and I was approved, did a Libre webinar training session, and finally got my hands on a prescription in December 2020, just over a year since I'd first asked...
Im now back in the hospital system, and have a telephone appointment next month, but I don’t know how long they’ll keep me before they kick me back to my GP and the retired nurse who now works as a HCP and comes in once a week to do the Diabetes reviews.

 

[Sweetz]

I've had T1 for 42 years - I was seen at the hospital until 2001 - then discharged to GP surgery - I have a couple of blood tests, urine test, BP etc.a few boxes are ticked and unless there are any issues that's all my checks done until the following year and that's with the surgery nurse that also deals with everything else - sometimes think it would be nice to see a specialist in T1 but so much easier going to the surgery

 

[Steve_H]

I have only been seen by hospital consultant. Last year was told I needed an appointment at GP with DSN. I went but she didn't know why I had been told that. I have meds review with GP once a year but just a tick box exercise.

 

[Hepato-pancreato]

At first i went to the diabetic clinic at hospital to partake in various courses. Then basically see diabetic nurse at my gp for anual review. Only reffered to hospital if anything is wrong. See poditarist at my gp's surgery get my medication from chemist in gp's surgery also.

 

[rebrascora]

At first i went to the diabetic clinic at hospital to partake in various courses. Then basically see diabetic nurse at my gp for anual review. Only reffered to hospital if anything is wrong. See poditarist at my gp's surgery get my medication from chemist in gp's surgery also.

How easy is it for you to get referred back to the hospital if you need to? ie. Can you self refer (perhaps via the clinic helpline) or do you need to go through GP or practice nurse for a referral back to clinic which obviously could take some time... months perhaps?