CONFERENCE REPORT

Primary Care Diabetes Conference,1997: Delivering Sensitive DiabetesCareM.S. Hall*

Chairman Board of Trustees British Diabetic Association,Institute of General Practice, Postgraduate Medical School, Exeter, UK

Introduction

In November 1997 the newest section of the BritishDiabetic Association, Primary Care Diabetes (PCD),held its annual conference, entitled Delivering sensitivediabetes care. Like the previous year’s conference, themeeting consisted of a mixture of small group seminarsand keynote lectures and was characterized by enthusi-astic participation by both guest speakers and delegatesfrom a range of different disciplines in primary care.

It was perhaps a good omen that the conferenceopened on the day of publication of the NHS Executive’slong awaited guidelines entitled Key Features of a GoodDiabetes Service.1 This document had its genesis in thework of the St Vincent Task Force2 which had identifiedstrategies for preventing many of the complications ofdiabetes. The guidelines underlined the importance forall those involved in the planning and delivery of localdiabetes services to work in partnership. The key role ofgeneral practitioners and their community colleagues inproviding a structured programme of care was high-lighted.

We must remember that good control of diabetes,perhaps more than any other condition, requires a highlevel of understanding, lifestyle modification and co-operation with treatment by patients and their families.People with diabetes need to be experts in their owncondition and a very important role for the GP andpractic nurse is to try to help them gain knowledge andunderstanding about the disease, how it affects them,and what care they should expect and, if necessary,demand. This is an enormous challenge and one whichcan be seen as threatening by health professionals. Apartfrom a shift in the culture of health care, such anapproach requires that listening and teaching skills mustrank equally with clinical skills.

The Programme

The conference started by giving an update of ourknowledge of clinical effectiveness. Presentations under-

* Correspondence to: Dr Michael Hall, Institute of General Practice,Division of Community Health Science, Postgraduate Medical School,Barrack Road, Exeter EX2 5DW, UK

S5CCC 0742–3071/98/S300S5–02$17.50 1998 John Wiley & Sons, Ltd. DIABETIC MEDICINE, 15 (suppl. 3): S5–S6 (1998)

lined that although much work is being done to producegood evidence for clinical practice, we still have a verylong way to go. The important message is that the NHSand organisations like the BDA need to invest moreresources in identifying the evidence base for clinicalpractice as it becomes available, and then to facilitatethe production of evidence-based guidelines as a resourcefor clinicians.

The Master Classes of the conference covered most ofthe areas of concern which primary health teams haveto face. They ranged from providing culturally sensitivecare for ethnic minority groups to the special needs ofelderly people with diabetes, managing problems ofweight, sexual dysfunction, the difficult task of addinginsulin treatment to oral medication and the practicalchallenge of organizing diabetes registers and ensuringpeople do not get lost to follow-up. There were alsoopportunities to listen to patients’ views and to talkabout research opportunities in primary diabetes care.

The first day closed with a presentation by the Womenin Theatre Group on The Tools for the Job—a Messagefor Tomorrow. This was a humorous and interactivedrama piece which highlighted the difficulties patientsexperience in being understood by busy professionals.The professionals’ expectations and hope for the patientare often way beyond what can be realistically achieved.Good interaction between health professional and patientrequires that the objectives of care and personal targetsare properly understood before they are set. Building theautonomy of the patient is a difficult but important partof the professional’s responsibility.

The second day of the conference started with a livelyAGM during which the new edition of Recommendationsfor the Management of Diabetes in Primary Care3 waslaunched. The programme then treated us to the patientview, helping us understand how difficult we, theprofessional, can be and how sometimes our objectivesare very different to the patient’s objectives. The daywent on to discuss diabetes education and was followedby further practical workshops. These included:

I Designing a personal continuing education pro-gramme for diabetes knowledge and skills

I Constructing a baseline assessment and plan ofmanagement for patients with diabetes

CONFERENCE REPORTI Assessing our own performance as diabetes educatorsI Hands-on advice for those who intend to run

diabetes groupsI Strategies for consulting with patients who do not

use English as their mother tongueI Health promotion diabetes prevention in the UKI Providing and evaluating information on diabetesI Computer programmes for diabetes care

The conference ended with a special presentation byGP Trisha Greenhalgh and diabetologist Sue Roberts,which explored ways of developing a true partnershipbetween primary and secondary care teams. If we areto make progress in providing better care to people withdiabetes then we must work towards more effectivecollaboration between all health care professionals.There are many examples of successful collaborativeprogrammes around the UK.

Exhibitions and Posters

The successful launch of PCD depended heavily oncollaboration with a consortium of pharmaceutical com-panies. The friendly and non-promotional links whichhave been developed with the pharmaceutical industrywere certainly demonstrated at this meeting. Posters fromprimary care research projects were exhibited along withindustry stands, and a wonderful Gala Evening at theOld Swan Hotel was enjoyed equally by conferencedelegates and their sponsors from the Diabetes IndustryGroup.

S6 M.S. HALL

1998 John Wiley & Sons, Ltd. Diabet. Med. 15 (suppl. 3): S5–S6 (1998)

PCD UK: A New Professional Section

The British Diabetic Association has been accused ofhaving been slow to develop links with primary care.Certainly, creating this new professional section did taketime. The essence of good primary care is teamworkand the organisation of the section properly reflects themix of health professionals in the community. It is to behoped that the long gestation of the section has enabledus to build a strong and vibrant new primary care groupwhich will become a major contributor to improving thecare of people with diabetes.

Ending 1997 with such a successful conference marksthe end of a good year for PCD, but it is only a start.Over 90 % of general practices are signed up for theChronic Disease Management programme for diabetes,but less than 10 % were represented at the meeting. Animportant aim for next year must be to increase this andalso to involve more of the other key professionals suchas pharmacists and optometrists, as well as patients andtheir lay carers.

References

1. NHS Executive. Key Features of a Good Diabetes Service.HSG (97) 45, 1997.

2. The Report of the Department of Health/British DiabeticAssociation St Vincent Joint Task Force for Diabetes.London: Department of Health/British Diabetic Associ-ation, 1995.

3. Recommendations for the Management of Diabetes inPrimary Care. London: British Diabetic Association, 1997.