Association of British Clinical Diabetologists (ABCD) and Diabetes-UK survey of specialist diabetes services in the UK, 2006. 1. The consultant physician perspective

• Published in: Diabetic medicine 2008-06, Vol.25 (6), p.643-650
• Main Authors: Winocour, P. H., Gosden, C., Walton, C., Nagi, D., Turner, B., Williams, R., James, J., Holt, R. I. G.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; commissioning; consultant diabetologists; Delivery of Health Care - standards; diabetes; Diabetes Mellitus - therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Guideline Adherence; Health Surveys; Humans; Medical sciences; Medicine - standards; Medicine - trends; National Service Framework; Physicians; Practice Guidelines as Topic; Societies, Medical - standards; Societies, Medical - trends; specialist services; Specialization; United Kingdom; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2008.02449.x

Aims  To identify the views and working practices of consultant diabetologists in the UK in 2006–2007, the current provision of specialist services, and to examine changes since 2000. Methods  All 592 UK consultant diabetologists were invited to participate in an on‐line survey. Quantitative and qualitative analyses of responses were undertaken. A composite ‘well‐resourced service score’ was calculated. In addition to an analysis of all respondents, a sub‐analysis was undertaken, comparing localities represented both in 2006/2007 and in 2000. Results  In 2006/2007, a 49% response rate was achieved, representing 50% of acute National Health Service Trusts. Staffing levels had improved, but remained below recommendations made in 2000. Ten percent of specialist services were still provided by single‐handed consultants, especially in Northern Ireland (in 50% of responses, P = 0.001 vs. other nations). Antenatal, joint adult–paediatric and ophthalmology sub‐specialist diabetes services and availability of biochemical tests had improved since 2000, but access to psychology services had declined. Almost 90% of consultants had no clinical engagement in providing community diabetes services. The ‘well‐resourced service score’ had not improved since 2000. There was continued evidence of disparity in resources between the nations (lowest in Wales and Northern Ireland, P = 0.007), between regions in England (lowest in the East Midlands and the Eastern regions, P = 0.028), and in centres with a single‐handed consultant service (P = 0.001). Job satisfaction correlated with well‐resourced service score (P = 0.001). The main concerns and threats to specialist services were deficiencies in psychology access, inadequate staffing, lack of progress in commissioning, and the detrimental impact of central policy on specialist services. Conclusions  There are continued disparities in specialist service provision. Without effective commissioning and adequate specialist team staffing, integrated diabetes care will remain unattainable in many regions, regardless of reconfigurations and alternative service models.