Friday, 6 July 2012

Adding to the Super Six of Diabetes?

The Super Six of Diabetes recently won a Health Service Journal - Integrated Care Award for Diabetes Care where the caseload in diabetes is split between specialists (covering the so-called super six) and primary care covering the rest. Importantly there was a stronger link to the specialist diabetes teams allowing support for grey cases. It involved redefining the job plans of the consultants and, in the words of Partha Kar from Portsmouth:

"As a specialist body, we could either continue to wish for what could happen, or we could pick up the gauntlet and join up with primary care to create a way of working which just might suit all."

The Super Six was defined in the same paper as:

"In general, there was broad agreement on the 'super six': antenatal diabetes, diabetic foot care, renal (estimated glomerular filtration rate <30), insulin pumps, type 1 / adolescent diabetes (unstable control), and inpatient diabetes."

I negotiated a similar division of labour between my NHS Trust and the Local Health Board in South Wales in 2004-5 (but admittedly without the agreed change in job plans).

Caterham 7 Supersport, 1.6 K series 140 bhp
Being a driver of a Caterham Seven Supersport I'd be an advocate for adding at least one super service to the six - which we were developing at the time. The older person with diabetes. A geriatrician with an interest in, and training in diabetes, should lead the service for the frail elderly and liaise closely with primary care colleagues. A key advantage would be to reduce harm from over-medication and reduce admissions to hospital.

I'm catching up with the innovative Dr Kar next week so I shall press my case.