The ‘super six’ for the acute trust; all else under primary care?

The drive to increase skill and knowledge in primary care and move away from the traditional model of all diabetes care being delivered in a specialist setting has often created sharply polarised views. It has also created an unnecessary divide among primary care physicians and specialists, which has taken an inordinate amount of time to heal. Commissioners (traditionally non-clinical) have pushed for more primary care delivery while many GPs have continued to want access to specialist care. Finding ways out of this impasse has been an uphill struggle. Fortunately, there are examples starting to emerge of ideas and models geared to align primary and specialist care. However, the NHS is an interesting beast, where competition seems to be the mantra, rather than collaboration. Thus, a natural divide is created where PCTs (or GP commissioners in the brave new world) hold the purse strings or commission services to the acute trusts. If commissioners feel that ‘general’ diabetes does not need to go to the hospital, a scenario develops whereby it benefits no-one. Acute trusts do not get the revenue and start questioning the role of diabetologists in an acute hospital. GPs cannot get access to a specialist as every referral is seen as a ‘loss to the budget’ and, most importantly, the patient in the middle ends up suffering.