The Diabetes Cycle of Care, a service for type 2 patients with medical cards/GP visit cards has recently been launched, amid concerns that much more needs to be done to ensure a properly resourced shift of chronic care from hospitals.

The new diabetes service, which was announced earlier this year in tandem with agreement on the under sixes GP scheme, officially commenced on October 1.

It allows qualifying adult patients with type 2 diabetes to have their condition reviewed twice a year. The Department of Health estimates around 70,000 medical and GP visit card patients with type 2 diabetes will be eligible. The registration process commenced on September 8 and well over 30,000 patients had been registered by mid-October.

According to the Department of Health, approximately 5.6% of the adult population in Ireland, or 190,000 people, have diabetes, with type 2 accounting for over 85% of these cases. It is estimated that 35,000 of type 2 diabetes cases remain undiagnosed.

As part of the new cycle of care, qualifying patients will have two annual visits to their GP for a structured review of their condition. This will include a review and recording of blood results since registration, a review of their medication and lifestyle factors, a foot review, continuing participation in the retinopathy prevention programme, assessment of BMI, and further education about their diabetes.

The new payments scheme for GPs providing this service marks the first time that the State has formally invested in a nationwide chronic care programme at primary care level.

Prof Hilary Hoey, chairperson of Diabetes Ireland, said the ability to have two diabetes management reviews each year will help detect any related health issues much sooner, enabling earlier intervention, thus improving quality of care. “We see the cycle of care as a first step in the provision of a structured diabetes service that must be extended to all people with type 2 diabetes as soon as possible”.

Launching the new scheme at the Thomas Court Primary Care Centre in Dublin, Health Minister Leo Varadkar said under the new cycle, people who have type 2 diabetes will be looked after locally by their GP and practice nurse in their local primary care centre, rather than being treated in hospitals.

“I believe that’s a step forward in shifting healthcare from hospitals to primary care and more towards prevention. I would hope as well that this will result in more people with type 2 diabetes being diagnosed earlier. 

“I hope that the Diabetes Cycle of Care service will be used as a model for more chronic diseases to be looked after in the community, including COPD, asthma and heart failure.” 

The Minister said it was planned that negotiations on a new GP contract (which is expected to facilitate the expansion of GP chronic disease management) would be concluded by next March.

General practitioner Dr John Latham, who is based at the Thomas Court centre, said staff were delighted to welcome the newly resourced cycle of care. 

“In our practice and within the South Inner City Partnership in Primary Care we have been passionate about improving care for patients with diabetes with a shared care and structured care programme in liaison with St. James’s Hospital in place since 1998.”

John Latham said throughout Ireland, GP practices have for some time been providing superb care for diabetes and other chronic conditions, without any added resources. He said primary care-based chronic care would save thousands of visits to hospitals, will reduce complications and slow the advance of these diseases.  

“So the new cycle of care is welcome. It is however just a start. General practice requires a completely new contract, a contract fit for the purpose of ensuring that these very vulnerable patients are cared for in their community in well equipped, well staffed and efficiently administered GP practices linked with appropriate multidisciplinary teams. At present (except for this new initiative) there is no recognition by the DOH or HSE that chronic illness management, screening and prevention should be encouraged in general practice.”

Limerick GP Ray O’Connor, who also has a special interest in diabetes care, said he welcomed the recognition by the HSE that GPs have a vital role to play in looking after patients with type 2 diabetes.

“This recognition is also being backed by resources which can only be welcomed. While the scheme only covers people with a medical card or GP visit card for two visits a year, at least it’s a start.”

He said there will be a significant number of people who will not be covered by the medical card scheme, and thereby the new diabetes scheme, on income grounds.

“Most of these people in my experience do not mind paying for a quality service where they get their clinical examination, routine diabetes bloods and a clinical review regularly. If this can be delegated to the practice nurse it can be done even more cost effectively.”

However he felt that ideally, the new scheme should be extended to all patients with diabetes, and he was certain that as part of a HSE chronic disease strategy this option would be seriously considered.