Table of contents

Current services in relation to need

Adults :: Diabetes :: Current services in relation to need

The NHS guidance encourages commissioners and service providers (community services, GPs, secondary services, public health, social care and voluntary sector) to agree local pathways for patient care to improve efficiency in care, reduce fragmentation of services and delay.[1]

Primary care

The majority of people with diabetes are managed in primary care. In general practice there is considerable variation between practices in the management of diabetes. Many people with Type 1 diabetes who can be managed in the community are being managed by the acute trust.

NHS Health Checks are offered through a Local Enhanced Service (LES) contract to all Medway General Practitioners to identify people at risk of heart disease, diabetes and stroke, supporting them in making healthier lifestyle choices and also identifying and treating those with undiagnosed conditions. Between 2010/11 to 2011/12, the programme probably accounted for a significant proportion of the 644 newly diagnosed patients with diabetes in Medway. An outreach Health Check programme was also set up to target those on job seekers allowance, people from Asian origin and manual workers, identified from the evaluation of the programme undertaken in 2010.

Evaluation of this programme showed that men and younger individuals within the target age group were less likely to attend. This suggests that, further work is required to increase awareness of the Health Check programme within the male and younger population aged 40–59 years.

Community and Specialist Diabetes Service

Adult specialist diabetes services in Medway are provided by both Medway NHS Foundation Trust (MFT) and Medway Community Healthcare (MCH). MFT provides a consultant led service with specialist nurse support for inpatients only. MCH provides a specialist nurse service. Both teams have access to podiatry and dietetic support. The care of patients provided between the community and hospital teams is not well coordinated however.

Patients requiring support from the diabetes specialist nurse in the community are referred to the consultant diabetologists at MFT. Currently, patients who need insulin pumps have to travel to London to receive this service.

Structured Education Programme

The PCT has developed a structured education programme for people newly diagnosed with Type 2 diabetes and for those with Type 1 diabetes. It is unclear how many people were seen in this programme, what proportion of them were newly diagnosed cases or what proportion were referred for dietetic support and advice in 2010/11.

Diabetes Retinopathy Screening Programme

The PCT commissioned Paula Carr Trust in April 2011 to deliver two main targets:
• 100% of people with diabetes aged 12 years and over offered screening, using only digital photography within the previous 12 months
• 80% uptake of screening

This service is offered from both static and mobile clinics in Medway and patients are referred to the service from GP practices. In Quarter 2, 2011/12, although screening was offered to all eligible patients, 81% attended the service. Uptake of this service has been on the decline since 2009. The service is working with GP practices to improve the accuracy of the screening list, promote the importance of eye screening and the key role of primary care in raising awareness amongst patients.

Podiatry services

All newly diagnosed patients have an initial assessment with a podiatrist. The recall of patients with diabetes is arranged by their GP surgery, where annual foot screening is undertaken. This will usually include: foot sensation testing, Doppler foot pulses, foot deformity and footwear inspection and foot risk assessment.


[1]   NHS Diabetes. Commissioning Diabetes Diagnosis and Continuing Care Services: Supporting, Improving, Caring 2010; NHS Diabetes.