Primary care data
The data for several indicators in this profile come from two major sources in the NHS:
- the National Diabetes Audit (NDA)
- the Quality and Outcomes Framework (QOF)
The NDA is a national clinical audit of primary care data, which measures the effectiveness of diabetes healthcare against NICE clinical guidelines and quality standards. The audit is used to allow local services to benchmark their performance, identify where they are performing well, and improve the quality of treatment and care that they provide.
The QOF is a routine collection of primary care data that is used to improve the care patients are given by rewarding practices for the quality of care they provide to their patients, based on several indicators across a range of key areas of clinical care and public health.
The differences between the data are:
- NDA data is collected over a 15-month period, between 1 January and 31 March the following year whereas QOF data is collected over a 12-month period between 1 April and 31 March the following year
- NDA data contains data for patients of all ages whereas QOF data only includes data for patients aged 17 and over
Action to tackle diabetes
Improvements in the care and outcomes for people with diabetes are possible. Below is a summary of the key recommendations for healthcare providers and healthcare professionals working directly with patients, including people with diabetes and people at risk of developing type 2 diabetes.
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1. Work to limit the risk of developing diabetes by:
- educating people on the risk of uncontrolled diabetes and other common high-risk cardiovascular diseases, including hypertension, atrial fibrillation, high cholesterol and heart failure
- ensuring that people know what services are available, and appropriately refer to the NHS Diabetes Prevention Programme if they are eligible and would benefit from it
- ensuring that education programs meet the local cultural, linguistic, cognitive and literacy needs of the population
- encouraging a healthier diet and more physical exercise
- providing information on how to plan on producing healthier meals and snacks
- identifying and recording patients with non-diabetic hyperglycaemia and ensure they are receiving annual fasting plasma glucose and BMI checks, and delivering early interventions to reduce the risk of ill health further down the line when checks indicate worsening condition
2. Risk assessment:
- encourage people to have a risk assessment for type 2 diabetes by offering a validated self –assessment questionnaires or signposting people to web-based tool such as the Diabetes UK Know Your Risk tool
- if a patient is identified as low or intermediate risk from the self-assessment questionnaire, give them advice on how to have a healthy lifestyle by exercise regularly and eating a healthy diet
- inform low or intermediate risk patients that the risk assessment needs to be repeated in 5 years
- if the patient is high risk, consider doing HbA1C and cholesterol levels and advise on healthier lifestyle as mentioned above
- encourage employers to include risk assessments in their occupational health service contracts
- keep updated records of patient’s level of risk and create a recall system which will allow patients to be contacted and invited for regular reviews
3. Improving monitoring of care and needs. This can be done by:
- ensuring people with diabetes are receiving the recommended care processes and checks annually, so changes in condition can be identified early
- asking about additional health problems associated with diabetes when they come for a consultation
- accurately record information about patient consultations appropriately so that the data gathered gives a true representation of the population
- instating routine diabetes data reviews to track progress and compare care and treatment targets to benchmarks using available tools, to understand where improvements can be made
4. Involve patients more in the planning of their care. Encourage patients to engage more and be better motivated to achieve better control of their health. This can be done by:
- ensuring patients are educated about their condition at a level that suit their needs
- referring to structured education that is delivered by trained staff within 12 months of diagnosis
5. Encourage patients to take up the offer of a Health Check review, particularly those from Asian, black African and black Caribbean ethnic groups.
6. Improving access to healthcare for people who are less likely to receive appropriate care processes. This can range from people with severe frailty, a learning disability or suffer from severe mental illness. This can be done by:
- ensuring there is effective integration of different clinical groups, in the community and with different specialist expertise
- ensuring early expert assessment when foot disease is detected, with access to a local multi-disciplinary foot care service
7. Engage with the public and patients to find out about needs and demands, obtaining feedback on quality of care to improve the current system and engage patients more.
8. Regularly perform searches on the GP database to look at patients to frequently fail to collect repeat prescriptions or attend follow-up appointments.
9. Identify which health promotion strategies are working well and implementing this in your area. This can be done by:
- considering whether the highest performing services and commissioners are doing something that you might adopt
- considering joining one of the Quality Improvement Collaboratives