NHS is losing diabetes specialists

NHS hospitals are losing specialist diabetes consultants and nurses, with negative results for patient care, experts writing in the BMJ have said.

The editorial argues that poor management of diabetes by the NHS is due not only to patient lifestyles but also to financial pressure on hospitals.

It points to a major increase in the death rate of young women with type 1 diabetes as evidence that specialist NHS treatment capacity is declining.

Reports on the crisis of NHS diabetes care tend to focus on the increasing prevalence of type 2 diabetes, most cases of which are related to obesity.

However, according to the National Diabetes Audit, the death rate among women aged 15–34 with type 1 diabetes increased ninefold from 2007 to 2011. Obesity is rarely a factor in such cases.

The authors note that financial pressures on PCTs has led to a growing pattern of diabetes specialist teams being reduced or dropped altogether.

Hospital teams of diabetes specialist nurses are tending to be replaced by practice nurses who have less expertise in this complex treatment area.

Specialist diabetes consultants are being replaced by acute physicians. A recent survey showed that 30% of diabetes specialist registrars were unable to find a consultant position within a year of qualifying.

The authors argue that the payment by results tariff is “a barrier to integration” that “deprives patients of access to a specialist team”.

Some areas have “informally” bypassed PbR to make more integrated care of diabetes affordable, they note – and this approach “needs to be introduced nationally” to facilitate patient movement between primary, community and secondary care.