A survey of diabetes care in general practice in England and Wales

Background. The focus of care for people with diabetes has shifted from hos pital to general practice. Many practices now offer diabetes care via dedic ated mini-clinics, shared care schemes or opportunistically. There has neve r been a national survey of the organisation of diabetes care in general pr actice. Aim. To describe some key features of diabetes care in primary care in Engl and and Wales. Method Descriptive postal questionnaire survey to one in five (1873) random ly sampled general practices. Results. Seventy per cent (1320) of practices responded. Of these, 96% had diabetes registers identifying 1.9% of their population as having diabetes; 71% held clinics run by a general practitioner (GPI and a nurse (64%) or a nurse alone 134%); 80% felt adequately supported; and 54% shared patient m anagement protocols with the local secondary care team. Overall, practices provided most of the routine diabetes care for 75% of their diabetic patien ts. The majority of GPs and practice nurses had received some recent, albei t brief, diabetes education. Conclusion. A large proportion of diabetes care now takes place in the comm unity, much of it delivered by practice nurses. The organisational infrastr ucture necessary for delivering good care is in place. Many practices have a special interest in diabetes with the majority feeling adequately support ed by secondary care. However, there are concerns about the educational nee ds of those providing care. More work needs to be done to ensure seamless c are across the primary-secondary care interface.