8th Collaborative DiGP/UCC/HSE/IPNA Diabetes in Primary Care Conference The Challenges of Delivering Diabetes Care in General Practice Professor Mike Pringle President, RCGP

First, an apology I am a GP I retired from clinical practice 4 years ago I am English… But we share similar underlying challenges and are searching for similar solutions

How did we get here? The essential value of Generalism The clear benefits of teamworking, integration and collaboration Personalisation against standardisation of care Autonomy versus regulation What does ‘success’ or ‘best care’ look like?

The Context

The rise in numbers and complexity

Single Disease specific solutions will not work

The Impact

Ageing and multiple morbidity People with LTCs: 29% of the population 50% of all GP appointments 64% of all OPD appointments 70% of in-patient bed days 70% of total health and social care spend The Number of people aged over 80 will double between 2010 and 2030

The capacity of UK general practice In the 20 years to 2008, the primary care consultation rate increased by 75% Over that period, consultations/pat/year rose from 3.9 to 5.5 The average GP consultation lasts 11.7 minutes 96% of patients say they want longer appointments

The capacity of UK general practice the FTE number of GPs increased by 2% per year Between 2001 and 2011 District Nurses numbers fell 34% FTE numbers of practice Nurses peaked in 2006 since when we have lost 7%

Effect of deprivation in the UK Health inequalities are widening The Inverse Care Law is alive and well In Scotland 11% more GPs in the most affluent half of population than in the other half In England CCGs with highest provision had twice the numbers of GPs per capita that those CCGs with fewest GPs Consider English male life expectancy and GP distribution

Effect of deprivation Multi-morbidity (esp mix of physical and mental) occurs on average 12 years earlier in most deprived vs most affluent quintiles “More multiple morbidity in deprived areas means that the population die younger, are sicker for longer before they die and they present more complex problems to their GP” RCGP, 2022 vision, 2013

Continuity of care Continuity of care, a key attribute of generalism, gives: Earlier diagnosis Better health outcomes Patient centred care and higher satisfaction Cost control: less duplication, expensive interventions better targeted, better prescribing

Fragmentation of care Multiple contacts with different parts of the health service = lack of coordination, duplication of services, increased costs In general practice, fragmentation = loss of continuity of care

Shared decision making This is not abdication but responsible sharing At the centre is ‘care planning’, education and support Average person with diabetes spends 3 hours a year face to face with a health professional; its the choices in the other 8,757 hours that really determines their outcome.

SOME SOLUTIONS

The RCGP Vision “More GPs, with longer training, spending more time with their patients – A world where excellent patient-centred care in general practice is at the heart of health care” RCGP, 2022 vision, 2013

The RCGP’s actions Campaign: Putting Patients First, Back General Practice Simon Stevens’ Five Year Forward View The Political rhetoric Recruitment, retention, returners Investment? Building teams

Ways Forward Promote ‘Federations’ or similar structures Use Commissioning in England to recognise and fund primary care provision Move care and services, and the funds, back to general practice Recruit more of the emerging doctors into general practice

Ways forward Improve our skill mix, especially reverse decline in practice nurses Telephone triage and telephone/ consulting GPs and nurses with special clinical interests Use pharmacists better

Ways Forward Care planning for people with multi-morbidity, with Primary Care retaining/regaining central role Better IT and information sharing Redesign pathways around the patient not the staff Invest in primary care rather than secondary care Encourage a “named doctor” and doctor-doctor- nurse-nurse pairing in big practices Promote self care and shared decision making

8th Collaborative DiGP/UCC/HSE/IPNA Diabetes in Primary Care Conference Update on Diabetes – delivering care Professor Mike Pringle President, RCGP