Friday, 6 July 2012

Adding to the Super Six of Diabetes?

The Super Six of Diabetes recently won a Health Service Journal - Integrated Care Award for Diabetes Care where the caseload in diabetes is split between specialists (covering the so-called super six) and primary care covering the rest. Importantly there was a stronger link to the specialist diabetes teams allowing support for grey cases. It involved redefining the job plans of the consultants and, in the words of Partha Kar from Portsmouth:

"As a specialist body, we could either continue to wish for what could happen, or we could pick up the gauntlet and join up with primary care to create a way of working which just might suit all."

The Super Six was defined in the same paper as:

"In general, there was broad agreement on the 'super six': antenatal diabetes, diabetic foot care, renal (estimated glomerular filtration rate <30), insulin pumps, type 1 / adolescent diabetes (unstable control), and inpatient diabetes."

I negotiated a similar division of labour between my NHS Trust and the Local Health Board in South Wales in 2004-5 (but admittedly without the agreed change in job plans).

Caterham 7 Supersport, 1.6 K series 140 bhp
Being a driver of a Caterham Seven Supersport I'd be an advocate for adding at least one super service to the six - which we were developing at the time. The older person with diabetes. A geriatrician with an interest in, and training in diabetes, should lead the service for the frail elderly and liaise closely with primary care colleagues. A key advantage would be to reduce harm from over-medication and reduce admissions to hospital.

I'm catching up with the innovative Dr Kar next week so I shall press my case.


  1. Dean - have you taken a look at the integrated diabetic care pathways in Tower Hamlets Primary Care Networks? This is a good example of how networks of GP practices working together in the same geographical location using a structured care approach with regular MDT meetings have made a significant improvement to diabetic care in the area. An important contribution to this improvement has been the primary care contract and the use of incentives through hitting targets based on network achievement as a whole.


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