Hey! I want to be involved – by Andy Kliman


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Involving patients in their own care is a major trend running through the NHS. People with diabetes have to be more involved in managing their condition, goes the philosophy, as it will save money, resources and improve the patient’s condition.

The way it saves money is through re-organising care. Doctors are pretty expensive as they are private businesses, small business owners with an ambition to deliver great care and make some serious money. There is nothing wrong with that, but the NHS has to save £20bn in the next few years and so money is tight.

With this in mind some of the bigger businesses involved in providing GPs such as Harmoni and Care UK are looking at how they can replace doctors with well trained nurses for certain areas – no doubt an expansion of specialist diabetic nurses will be encouraged and so will more technical aspects such as how a diabetic clinic might run, teaching us how to use testing strips appropriately so we use less, and weight management. A recent study showed that providing free access to Weight Watchers classes helped reduce obesity.

Two issues spring to mind for me, one is that the introduction of the private sector (Harmoni and Weight Watchers) could be a positive thing for patients. I much prefer to see an expert diabetic nurse than a less well informed GP (although all GPs should be better informed). The second is that when it comes to re-organisation of the health service patients are not being involved.

The 7th annual Primary Care Diabetes Society national conference is now advertising itself to GPs and I got to see the programme. There are no patients as speakers and no patient groups involved in any of the sessions. Do they honestly feel that a patients couldn’t provide some good ideas for sessions such as,’ running a diabetes clinic’ (involving issues such as, clinic times and hand held records/personal plans).

Diabetes is becoming a big industry and the customers – us – are being left out of the design of this market. Rather than us telling them what it is we want and having them meet our needs it is happening the other way around. Private sector companies and the NHS are reducing costs and the patient has to fit into that model. There are many things we can do better than the NHS – such as control our own health data.

If I had all my HbA1c, cholesterol, blood pressure and other such results emailed to me so I could upload them to a secure website that my family could access I would have a huge amount of positive pressure on me to keep my HbA1c at good levels. Too many puddings and I’d be letting my family down. And when I did hit my targets we could celebrate together. But that’s all just too complicated for the NHS. What a shame no one gets to listen to our ideas. What a shame the 7th annual Primary Care Diabetes Society doesn’t have a platform for listening to the people they are treating.

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The so-called NHS reforms will over the next few years make things far worse than now. You seem to have a totally misplaced trust in the type of private sector company who will come into the ex NHS. Cherry picking the easy profitable bits.. and us diabetics don’t fall into that category. Lower staffing standards, more on barely minimum wage temp “nurses” with short training.
Yes it would be better to re-organise trained nursing support for patients but not by selling out to mainly US managed private sector companies

I have often had the same thought, what about the patients in all of this? As with other chronic diseases patients are often very knowledgeable about their condiion
and to exclude them is to omit a very important dimension – besides causing me to suffer a few shivers of apprehension for the future.

I have often wondered if there is a longterm plan to replace doctors with nurses.
The paient is acually powerless to change he policy in their GP’s Practice so it matters little whether he patient considers one or the other to be more well informed.
In any event, to be able to judge this means that we would have to be better-informed than either.

I have reservations about Nurses taking over from GPs. They may be able to concentrate more on the disease itself and keep up to date wih the constant changes etc but might it not be dangerous to treat diseases in isolation like this.? It is natural for patients with a chronic condition to attribute all symptoms to that condition .
One would hope that a Gp would be able to see the wider picture, but I realise that this is not always the case
I worry a little about the quality of some of the nurses in Practices now just like those in Nursing Homes who seem to be able to rise to the rank of sister so much more quickly than those in hospitals,
Unless nurses have a great deal of experience [not always the case} they are far less likely than experienced doctors to treat patients as individuals .
I suppose Nurses replacing Doctors is the logical conclusion of what we have seen over the last few years _I find it frightening.

I have known one Nurse Practicioner and cannot believe that she had the intelligence or education to replace a doctor. Maybe if the system changes in the future this could work but in the meantime I feel threatened by it. I have found it a matter of great concern lately when Gps in my pracice show themselves to be almost ludicrously afraidto enter into into any discussion and avoid any mention of my diabetes on the grounds that “the nurse attends more courses”.
There is obviously no chance whatsoever that we will move towards a more holistic system.It will definitely not be patient-centred.