Frontline NHS doctors and nurses believe that a combination of cost-cutting measures and a perceived
lack of local and national leadership are contributing to poor outcomes for diabetes patients.
This is the finding of a new report,
A Diabetes Snapshoti, published by the ABPI Pharmaceutical Diabetes Initiative (PDI) today.
A Diabetes Snapshot brings together research from clinicians, policy makers, and patient representatives. The collection of 50 in-depth interviews, commissioned from independent market research firm ComRes*, reveals a confused picture for diabetes care. Respondents talk of:
Diabetes being a lower national priority caused by a perceived local and national leadership vacuum.
Diabetes grouped with other “long-term conditions”, resulting in the dissolution of valuable representative groups, such as NHS Diabetesii
Tensions between GPs and commissioners, as GPs are faced with the pressure of reducing costs while managing the condition in a holistic way. Often the two contrast starkly and the report points to clinical decisions being overridden by short-term cost-cutting
A confused state of clinical guidance, resulting in a lack of support for GPs treating people living with diabetes
The report reinforces that despite national guidance and innovative treatments and technologies being made available, people diagnosed with diabetes in 2015 may not receive the care they need. Some GPs claimed that they are being prevented from prescribing clinically effective newer agents due to pressure from CCGs and local prescribing bodies to prescribe the cheapest treatments. If ignored, type 1 and type 2 diabetes will cost our society £39.8 billion by 2035iii, and when poorly managed it is the cause of 24,000 early deaths each yeariv.
The system is not working as it should for patients, and the PDI is calling on Government to ensure that diabetes patients get the appropriate treatment at the right time in their patient pathway. The report also calls for more support for GPs in managing the condition, through a clear and integrated community pathway for diabetes care and greater local and national leadership.
Dr David Miller-Jones, Chair of the Primary Care Diabetes Society (PCDS), who contributed to the report, said: “GPs are now carrying more responsibility for managing diabetes than ever before. The PCDS provide education and national leadership, but our aims of supporting GPs should be strengthened by a renewed national NHS policy commitment to tackle diabetes.”
A Diabetes Snapshot comes during the consultation period of a number of type 1 and type 2 clinical NICE guidelines. The latest type 2 guideline consultation, due to close this week, is proposing changes to the current guidelines of care, which would take diabetes care back by a decade, according to diabetes specialists and healthcare professionals alike. Leading clinician Professor Anthony Barnett and a collection of diabetes specialists from across the country concur that whilst the proposed type 1 guideline is sensible, in contrast some of the recommendations included in the type 2 guideline are ‘paradoxical in the extreme’ and demonstrate a ‘distinct failure of common sense’.v
The ABPI has submitted a response to the consultation raising a series of concerns:
The section on “Blood Glucose Management” is flawed, as it calls for “patient-centred care”, but instead guides prescribers to take a restrictive and linear approach that does not consider the holistic needs of individuals with type 2 diabetes
Guidance is inconsistent with the NHS England and Department of Health medicines optimisation agenda, and runs counter to NICE’s own guidance and focus on promoting high quality care within the NHS
Short-term drug acquisition costs fail to acknowledge the longer-term impact of the effective use of medicines in reducing avoidable complications associated with type 2 diabetes, which are responsible for an estimated £8 billion per annum of NHS spend
Suzie Collett, Director of Policy, Communications and External Affairs at MSD and Chair of the ABPI PDI said, “A Diabetes Snapshot indicates GPs are already facing major issues dealing with this condition. This matters because keeping the growing number of diabetes patients well is not just good for them, it also saves costly acute hospital care. The draft guidelines produced by NICE unfortunately outline a short-sighted approach, ignoring and restricting the use of modern therapies, just at the moment where the NHS needs to get on top of diabetes care at every level.”
The NICE type 1 and type 2 diabetes guideline consultations close on Wednesday 4 March 2015 and the Diabetes Snapshot is available upon request.
A Diabetes Snapshot – a report from the ABPI Pharmaceutical Diabetes Initiative, (2015)
NHS Diabetes was a programme linking diabetes strategy and frontline improvements for patients. NHS Diabetes has now closed
N. Hex et al, Estimating the current and future costs of type 1 and type 2 diabetes in the UK, including direct health costs and indirect societal and productivity cost, Diabetic Medicine, p855, 2012
Diabetes UK – report shows each year 24,000 people in England with diabetes suffer avoidable death
The new NICE guidelines for type 2 diabetes– a critical analysis, J PAUL O’HARE, DAVID MILLER-JONES, WASIM HANIF, DEBORAH HICKS, MARC EVANS, DAVID LESLIE, STEPHEN C BAIN, ANTHONY H BARNETT (2015)
The ABPI represents innovative research-based biopharmaceutical companies, large, medium and small, leading an exciting new era of biosciences in the UK.
Our industry, a major contributor to the economy of the UK, brings life-saving and life-enhancing medicines to patients. Our members supply 90 per cent of all medicines used by the NHS, and are researching and developing over two-thirds of the current medicines pipeline, ensuring that the UK remains at the forefront of helping patients prevent and overcome diseases.
The ABPI is recognised by government as the industry body negotiating on behalf of the branded pharmaceutical industry, for statutory consultation requirements including the pricing scheme for medicines in the UK.
This research has been fully funded and commissioned by the members of the ABPI PDI. Members of the group include Abbott, AstraZeneca, Boehringer Ingelheim, Janssen, Lilly, MSD, Novo Nordisk and Sanofi.
The stakeholder interviews were conducted by a third party (ComRes). The ABPI PDI proposed the areas to be covered in the interviews. The quotes expressed in this report represent the views of the research participants, and not necessarily those of the ABPI PDI.
The intended audiences for this report are policy-makers; officials within NHS England and Department of Health; and healthcare professionals. This document includes a summary of findings with a series of quotes in support of those findings. A more detailed summary of responses and analysis is available on request.
*ComRes were commissioned by the ABPI PDI and interviewed 50 senior opinion formers and healthcare professionals in diabetes care by telephone between July 2014 and October 2014. Interviews lasted between 20 and 40 minutes and were conducted personally by ComRes Consultants. The ComRes lead for this research was Rachel Britton, Associate Director, who can be contacted on +44 (0) 20 7871 8646, or
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