The NDPP is borne from the NHS Five Year Forward View and its commitment to help us halt or delay conditions and diseases developing. The push for prevention calls for a radical upgrade within the NHS. The NHS Diabetes Prevention Programme is a good start and will be very welcome in primary care.
In developing our capacity for prevention it makes a lot of sense to start with diabetes. It is a major cause of premature death and disability, particularly from heart attack and stroke, but also from blindness, kidney failure and amputations.
Diabetes accounts for a large proportion of our workload as GPs and nurses, and is very expensive for the NHS, currently accounting for around 10 percent of the health service budget. And this figure is predicted to rise substantially in the coming years as the prevalence of diabetes grows.
We understand the risks of diabetes very well in primary care. Every day we see the evidence that overweight and obesity is becoming the norm among our adult and child patient. The inevitability is that this will lead to an increase in diabetes and its complications, and the increasing risk that younger people will not outlive their parents.
At the same time we know that diabetes is very preventable. There is robust evidence from international studies that identifying people at high risk of diabetes and offering them intensive behaviour change support can significantly reduce the risk of diabetes developing.
Reflecting this, NICE guidance recommends that all our patients with HbA1c between 42 and 47 mmol/mol are offered intensive interventions to reduce weight, improve diet and increase physical activity.
Despite the clear guidance, however, most of us in general practice do not have access to this kind of service.
We may compile registers of patients at high risk of diabetes, identified opportunistically or through the NHS Health Check. But in general, the best we have to offer is a brief intervention from ourselves and perhaps an annual follow up by the health care assistant who will do her best in a single consultation to encourage weight loss and increased physical activity.
But as the NHS Diabetes Prevention Programme rolls out across the country over the next year or so we will have a high quality local service to refer our high risk patients into. This will provide them with comprehensive and intensive support to modify their behavioural risks, based on evidence of what works. And the evidence is impressive with a 30 to 60 percent reduction in incidence of diabetes being achieved.
So, at a time of burgeoning workload in general practice, this will be a very welcome new resource to support us in managing our patients at high risk of developing diabetes, and will help us to make prevention in the NHS a reality.
- Dr Matt Kearney, is a Runcorn GP and National Clinical Advisor to NHS England and Public Health England