Diabetes in the new NHS.

Following the controversial structural changes incorporated in the 2012 Health and Social Care bill, both health care professionals and patients could be forgiven for thinking that a quieter time of consolidation would be a good idea. However, this is the NHS where the mantra ‘change is good’ seems to be its mission statement. With much less fanfare than the structural changes, new models of care are being introduced across the country which potentially could see radical change to how care is delivered as a way of facing up to an ageing population with increasing long term conditions and at the same time trying to save £22bn over this parliament. In England, supported by £200m from the transformation fund, a series of 29 vanguard areas have been announced where new care models will be introduced. Examples include integrated primary and acute care systems (Pacs) which will bring together GP, hospital, community and mental health services. Multispecialty community providers (MCPs) will bring specialist services, such as chemotherapy and dialysis, out of the hospital and closer to people’s homes in parts of the country where this is considered useful for patients. All of these changes have the potential to impact on diabetes care by influencing the way care is delivered in the acute and primary care sectors as well as nursing homes, an area traditionally hard to reach and with poor outcomes.

Simon Stephens, chief executive of the NHS sees the future of the NHS not just as a service to treat ill health but increasingly on disease prevention. This includes an attempt to significantly reduce the four million people in England otherwise expected to have Type 2 diabetes by 2025. In keeping with this, along with the Vanguards the NHS diabetes prevention programme (DPP) is being piloted. This is a joint commitment from NHS England, Public Health England and Diabetes UK, to deliver at scale, an evidence based behavioural programme to support people to reduce their risk of developing Type 2 diabetes. Guided by an expert reference group, seven demonstrator sites will initially pilot the programme to develop the programme and give local perspectives before a national procured programme is rolled out. Individuals who are eligible for inclusion on a behavioural intervention will have ‘non-diabetic hyperglycaemia’, defined as having an HbA1c 42 –47mmol/mol (6.0-6.4%) or a fasting plasma glucose (FPG) of 5.5 –6.9mmol/mol. Behavioural intervention will be based on  evidence based studies such as the US diabetes prevention programme and the Finnish diabetes prevention programme. Recommendations about weight loss, diet and physical exercise are defined in the service procurement guide with advice proposed to be given face to face to groups of 10-15 people. According to Diabetes UK, England will be the first country to implement a national evidence based diabetes prevention programme.

So, just as the NHS in England continues to adjust to changes from the 2012 bill, another series of changes are being worked through which potentially will have a greater impact on the working of the NHS and the way in which patients (and potential patients) will interact with it. It is worth noting that these changes are confined to England but the development of the DPP in particular is likely to be closely watched by other countries in the UK and around the world.

Dr Mark Freeman