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CCG diabetes care variation revealed

CCG diabetes care variation revealed

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Exclusive The world’s largest diabetes audit has revealed wide variation in services across England. 

Breaking the information up by clinical commissioning group (CCG), the Health and Social Care Information Centre’s (HSCICs) report presents the highest and lowest performers in a table.  

The HSCIC has called on the lower performers to learn how the top 25% achieved their results, and told them to ensure all practice data is recorded. 

Information on the three National Institute for Health and Care Excellence (NICE) recommended treatment targets and eight care processes for just under 2.3 million people in England with diabetes was recorded by 87.9% of GP practices. 

The nine care processes are: blood glucose level measurement, blood pressure measurement, cholesterol level measurement, retinal screening, foot and leg check, kidney function testing (urine), kidney function testing (blood), weight check and a smoking status check.

However, no figures are available on retinal screening this year, and so the HSCIC has only presented figures on eight care processes. 

Nationally, just a tenth of patients diagnosed with type 1 diabetes (11%) and a fifth of patients with type 2 diabetes (21%) received the relevant checks. 

For all patients in the audit, blood pressure targets were achieved in 48% of cases, slightly higher than last year’s achieved rate of 44%. 

And across England 60% of patients received all care processes. 

Knowsley CCG was among the top 25% of performers in the latest audit. 

‘Improving outcomes’ 

Figures show that more than half of all diabetes patients in the locality are achieving their blood pressure targets and 70% of diabetes patients are hitting the blood glucose target of ≤58mmol/mol. 

However, a CCG spokesperson said there is “much to do” to further improve outcomes for patients. 

The spokesperson said: “Knowsley is committed to improving the quality of primary care and supports the development of practice teams. Knowsley CCG has commissioned a community specialist diabetes service which works with, supports and educated practices in the care of people with diabetes.” 

The organisation is also engaged with a regional diabetes clinical network, working with local partners to develop a dashboard to help inform practices where they can focus on further improvements. 

‘Integrated service’

Bedfordshire CCG was in the bottom 25% of performers, despite having done extensive work around diabetes care. 

The HSCIC figures show that only 18% of diabetes patients received all three treatment targets recommended by NICE. 

Only 30% of people with type 1 diabetes living in Bedfordshire received all of the care processes. This figure was higher for people with type 2 diabetes, at 56%. 

A Bedfordshire CCG spokesperson was keen to point out work being done in their area to improve diabetes care. 

The spokesperson said: “We commissioned an Integrated Community Diabetes Service (ICDS) providing an equitable service that is delivered across Bedfordshire by our two main acute service providers, Bedford Hospital Trust and the Luton & Dunstable Hospital Trust. They work together to ensure it is fully integrated across the acute sector.

“ICDS is a clinically supervised team led by acute diabetologists. The team care for our patients in the most appropriate setting – so this could be in the community, in their homes, in the GP practice, or in the acute health sector.

“The ICDS team up-skill primary care services in diabetes care and run regular educational sessions. They jointly run the long term care clinics in general practice alongside the primary care team and are responsive when called to homes, care homes and residential homes to avoid admissions.” 

The group also has a local diabetes implementation group, an annual diabetes conference and a specialist diabetic nurse. 

And North Kirklees CCG was found to be underperforming in almost every category of the audit. 

‘High prevalence’

A third (33%) of people with type 1 diabetes received all eight care processes.  Blood sugar targets were met in 55% of cases for people with type 1 or type 2 diabetes. 

Blood pressure targets were met in 46% of cases, which is average for the UK. But only a fifth (19%) of patients with type 1 or type 2 diabetes met all of the treatment targets. 

The spokesperson said: “Traditionally, our locality has a higher than national average prevalence for type 2 diabetes and we have launched a successful structured education programme, with uptake from patients higher than the national average, to help alleviate this. 

“We will also be working directly with practices in the coming months to review the national diabetes audit results and will develop appropriate action plans in response.” 

Diabetes UK chief executive Barbara Young said: “It is concerning that there is still a considerable variation in the percentage of people getting the checks they need to help them manage their condition. If the NHS in one area can achieve this then why can’t it do so in others? 

“While there is some good news in the increase in the proportion of people who are managing their condition, this is increasing much too slowly and, alarmingly, the proportion of people with diabetes who meet the recommended level for blood glucose levels has gone down. 

“This is hugely worrying, as having high blood glucose levels over a long period of time increases a person’s risk of health complications that have a devastating impact on people’s quality of life and are extremely expensive to treat.”

Full results for every clinical commissioning group are available to view on the HSCIC website

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