COVID19 - Changes To GP Services

The COVID virus has put a lot of stress on the NHS and we have to change the way we work to become more efficient. Due to the lock downs, social distancing rules and blood test tube shortages we are well behind with our diabetes reviews. We ask for your understanding and patience during these very difficult times. So what's different? How will my diabetes review change?
One stop shop
You will be offered an appointment with our healthcare assist and who will take bloods, check your feet, do your blood pressure and weigh you.

Foot Check
If you wish to limit your time in the surgery please bring along your weight, blood pressure and foot check results using the Touch The Toes test. Watch the short video to see how.

Remote review
Your bloods will be viewed by one of the clinicians who will contact you. This will be done remotely in most cases - by text, phone or video. It will the exception not the norm to be seen in person. We will discuss the management of your diabetes, focussing on issues particular to your medical conditions. If you need generic diabetes advice that is not individualised to you - e.g. general diet and exercise advice - you will be directed to the Diabetes UK website.

COVID-19 has shown itself to be particularly troublesome for diabetics. Can we take this opportunity to highlight the importance of getting control of your diabetes. Take exercise. Aim for a BMI of 20-25. Limit alcohol to 14 units a week. And finally, don't smoke!

Diabetes
Being diagnosed with diabetes can be a bit of a shock for you and your relatives. There is often a great deal of information to take on board. No doubt you have heard lots of horror stories about the condition and its treatment. These may have been true 30years ago but the management of Diabetes has moved forward incredibly fast in the last decade. These days with a good commitment to lifestyle advice and medical therapy diabetes is very treatable, or sometimes even reversible. The key to good diabetic control is just that - taking control of your condition and engaging in diabetic reviews at the surgery.
Whether you have recently been diagnosed, or have lived with diabetes for some time, we are here to help you adapt to living with diabetes, and minimise any impact that it might have on your life. There is a ton of really good information already available on the internet to help you manage your condition. We don't propose to reproduce it here. However we have provided links to the best quality information out there. Much of it is local to the Bristol area e.g. the Bristol Community Health website.

Pioneer Diabetes Care Policy

Our diabetes policy is based on the ‘Diabetes UK 15 Healthcare Essentials’ framework. This defines what every diabetic in the UK should expect as a standard of care. We aim to provide these 15 standards as a minimum of the care you receive from us.
Newly Diagnosed Diabetics
Patients who have recently been diagnosed with diabetes will need to see the doctor and practice nurse a few times in the first few months. During this time patients and carers will be given support, information and advice about managing diabetes. This will involve some blood tests being done at the surgery but these will be kept to a minimum. It is not usually necessary for patients to check their own blood sugar right away.

Patients will be offered referral to a structured diabetes education program. This involves the input of a dietician for initial dietary advice – one of the single most important parts of achieving good control of diabetes. The practice nurse can direct you to additional dietary advice.

It is also important that all diabetics are referred for an annual diabetic eye check. This is a much more detailed examination than is done at the optician and involves a high resolution photograph of the retina (back of the eye) being taken with special equipment. The doctor or Practice Nurse will arrange for this to be done.

Please be sure to access the support of Diabetes UK, an excellent charity which will send out some very useful information about managing and living with diabetes, as well as advertising local events (www.diabetes.org.uk). They offer an excellent advice line for questions or concerns about anything relating to diabetes - 0345 123 2399.
Who will be Involved In My Care?
Diabetes affects many body systems so good care needs a multidisciplinary team approach. It is important to remember that we can only support you. It is you that has to manage your own health and your own diabetes. You are the most important partner in managing your diabetes. Without your engagement and motivation we will not achieve our combined treatment goals. 

You may be offered appointments with the following professionals.
  • Podiatrist – to keep an eye on your feet.
  • Dietician – to help gain optimal control by helping you adapt your eating habits.
  • Practice nurse – to offer advice on any aspect of your care.
  • Diabetes Specialist Nurse – We have community based specialist nurses that work closely with the surgery. They are based at the John Milton Clinic opposite the Bradgate surgery.
  • Smoking advisor – to assist with stopping smoking.
  • GP – to help interpret your blood test results, give advice about your medication or diagnose and manage complications.
  • Eye screeners – to keep an eye on your eyes and prevent deterioration in your sight.
  • Endocrinology Consultants – Sometimes if we are not winning we need to make a referral to a consultant diabetes specialist for input.

The majority of patients are looked after within general practice only, and do not need to be referred to the hospital. However, patients with more specific or difficult problems may be referred to the hospital consultant or diabetic liaison nurses.
How do Diabetes Clinics work?
You will be invited to the clinic by text, phone or letter at about the same time of year each year (usually on the month of your birthday). You will be asked to see the healthcare assistant a week or so before the clinic to have blood taken (you do not need to starve overnight for the blood test) and your feet checked. You will also need to bring a sample of urine (the first time you pass water that day) to give to the healthcare assistant at your blood tests appointment. We hope to have the results of the blood tests, urine sample, foot check and blood pressure at your diabetes review clinic with the practice nurse.
How Often Do I Need To Be Seen?
We aim to review all patients with diabetes once every year. Sometimes if your condition is newly diagnosed or if poorly controlled you may be offered more frequent reviews. The diabetes team will guide you.

We will undertake to do the following annually:
  • Hba1c blood test (indicator of diabetic control)
  • U+Es (kidney function test)
  • Lipids (Cholesterol check)
  • Check your blood pressure
  • Check your feet
  • Offer lifestyle and dietary advice
  • Discuss how diabetes is affecting you psychologically and offer support
  • Give you an influenza (Flu) vaccine
  • Offer you access to our stop smoking clinic if you smoke
What Am I Aiming For?
As well as seeing you annually to give you the support, advice and medications you need to manage your diabetes effectively we aim to achieve treatment targets as set out by the NIHCE (the national institute for health and care excellence) guidelines. Sometimes these targets are neither desirable nor achievable, e.g. when tight control may lead to hypos or unwanted side effects. In that case we will agree therapeutic targets with you in the clinic.

The targets are complicated and vary according to your condition but broadly we aim for these targets in most diabetics are;
  • Blood sugar, measured with Hba1c, of less than 48mmol/mol
  • Blood pressure less that 140/80mmHg (or lower in some individuals)
  • Cholesterol less than 4mmol/L (or non-HDL drop >40%).

How do I manage my diabetes?

There is much to think about and change. These might include improving your diet, reducing your weight, getting more exercise, medications or mental health. We do not intend to re-invent the wheel here as these resources are easily accessible on the Diabetes UK website. You are encouraged to look there for the practical day to day changes you might need to make. They also have an excellent Frequently Asked Questions (FAQs) page.

What's available in our area?

Diabetes UK videos

The Diabetes UK charity has an excellent YouTube website with educational videos on just about anything you need to know about diabetes. What is it, what to eat, how to treat, watching for complications etc. Follow this link to get to see more.