Saturday, 11 June 2011

Diabetes and Doctors

I work for a company that uses data produced by the NHS to provide people with information and knowledge about the NHS. I recently had the opportunity to produce a guide for GPs highlighting some of this data http://www.drfosterintelligence.co.uk/newsPublications/article168.asp . I chose to look at the variation in the numbers of people with diabetes who end up in hospital in an emergency because of their diabetes. If your diabetes is treated well in the community you should not end up in hospital because of it.

So you can open up the ‘GP Practice Index’ and look for your Primary Care Trust (PCT) area and see that there may be one GP practice in the whole area (take Middlesbrough PCT for example) where more people than were expected to are ending up in hospital because of their diabetes. In Middlesbrough this one GP practice shows 127% more people going into hospital than were expected. The one GP Practice who has fewer people being admitted to hospital has 68% fewer people ending up in hospital. I know which GP practice I would want to belong to in Middlesbrough, or rather which one I wouldn’t!

These findings, that there is variation between different GP practices, beg a number of questions;

• How good is your GP at giving you advice, doing check-ups and giving you access to important information and support? Does the GP explain things to you clearly and helpfully and does the practice have a diabetic nurse who can help you? If you are not happy – switch practices or if you feel comfortable, demand a better level of service at your practice.

• Is the local PCT investing in public health awareness campaigns? I remember seeing the ‘Diabetes: A silent killer’ posters around the streets which helped trigger me into getting the test done.

• What are the barriers to you understanding the information you are given? Are there leaflets and support groups with different language options?

Alternatively it may be, as with hardened smokers, that there are always going to be people who will ignore advice and not look after themselves, and they might all live in one particular area. If this is the case and you read my previous post about the latest public health strategy of ‘nudging’ , are these people a lost cause?

I don’t want to have any part of me amputated and I really don’t want to go blind and so I try to do the best I can. I recognise – and so now do doctors – that my sugar levels won’t ever be 100% normal because I have an illness. But this map http://www.guardian.co.uk/news/datablog/2010/nov/25/health-health shows that amputations for diabetic patients are higher in the South West than in London, and the GP Index tells me that Devon PCT has at least three GP surgeries – probably more – where the worst rate of diabetic patients ending up in emergency treatment in hospital is 223% higher than expected.

Data can only tell us so much, but what it shows in this instance is that people in the South West tend to do poorly with managing their diabetes and GP practices aren’t being effective –for whatever reason. Where as in Middlesbrough the area as a whole has high amputation rates but only one GP practice that is seeing high levels of emergency admissions for diabetes.

It is difficult to draw conclusions but I would like to know more. I want the Government, through the Public Health Laboratories http://www.apho.org.uk/, to find out what is going on and why there is so much variation. If you live in the South West and have diabetes or know someone who has the disease you should want to know too – drop them a line and ask.

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