A survey of diabetes care in general practice in England and Wales.

BACKGROUND: The focus of care for people with diabetes has shifted from hospital to general practice. Many practices now offer diabetes care via dedicated mini-clinics, shared care schemes or opportunistically. There has never been a national survey of the organisation of diabetes care in general practice. AIM: To describe some key features of diabetes care in primary care in England and Wales. METHOD: Descriptive postal questionnaire survey to one in five (1873) randomly sampled general practices. RESULTS: Seventy per cent (1320) of practices responded. Of these, 96% had diabetes registers identifying 1.9% of their population as having diabetes; 71% held clinics run by a general practitioner (GP) and a nurse (64%) or a nurse alone (34%); 80% felt adequately supported; and 54% shared patient management protocols with the local secondary care team. Overall, practices provided most of the routine diabetes care for 75% of their diabetic patients. The majority of GPs and practice nurses had received some recent, albeit brief, diabetes education. CONCLUSION: A large proportion of diabetes care now takes place in the community, much of it delivered by practice nurses. The organisational infrastructure necessary for delivering good care is in place. Many practices have a special interest in diabetes with the majority feeling adequately supported by secondary care. However, there are concerns about the educational needs of those providing care. More work needs to be done to ensure seamless care across the primary-secondary care interface.