Questions from the HI Diabetes Support Group, answers from Marie Rouse, Firs House Surgery
HOW FIRS HOUSE DEALS WITH PATIENTS WITH DIABETES – PRE-COVID 19
Several years ago you saw a nurse+GP for annual check, and nurse for 6 months, with test results sent afterwards by letter. Now it seems that it is just yourself as Advanced Practitioner Nurse that sees patients. No one was complaining about this, but it would be useful if the process was explained and if it is permanent. Also are there ever circumstances when we will see a GP for diabetes issues?
A The diabetes monitoring is shared by myself and Dr Bastiani. You could see or speak to either one of us for your diabetes review. Currently Dr Bastiani is on maternity leave.
I have a dual role and title as Diabetes Specialist Nurse/Advanced Nurse Practitioner and have had extensive training with qualifications in the management of diabetes.
It is unlikely you would see another GP for your diabetes management as Dr Bastiani and I have developed further expertise in Diabetes and would be the most appropriate member of the team to provide your care.
Dr Bastiani and I attend regular updates in relation to diabetes in the form of meetings, courses and online training. We also meet on a regular basis with Hospital Consultants with expertise in diabetes and Community Diabetes Specialist Nurses.
DEALING WITH PATIENTS WITH DIABETES – DURING THE COVID 19 PANDEMIC
Some have had blood tests but no results by phone or letter. The blood test invitation letter says a follow up call will occur.
Also some of the group are not contacting the surgery for minor issues or questions in the expectation that they can mention these during a follow up call.
Are the interim 6 month blood tests happening as several in the group have not been called for tests. There is a reluctance to disturb the surgery unnecessarily.
Everyone appreciates that at present we are in a special situation, but if the standard letters sent by the surgery explained the process it is felt that everything would be clearer. For instance if a blood test result will only be followed up if there is concern then please say so.
A The process at present is as follows and may change throughout and after the pandemic;
You should receive an invite letter or phone call asking you to book a double, face to face appointment with our HCA Lynn. She will take your blood (HbA1c, kidneys, liver, cholesterol, thyroid, full blood count and B12 if taking metformin) and check your weight, blood pressure and feet. You should also bring an early morning urine sample to this appointment.
Once I have received the results, our diabetes administrator Alison Toulson will contact you and book you a telephone consultation with me or Dr Bastiani for a review of your diabetes. At present this may take a little longer to arrange so we appreciate your patience.
All annual reviews will receive a follow up so if you have not heard anything within a few weeks or not received your annual invite when you think it is due then please contact the surgery.
The telephone review is for matters relating to your diabetes only due to time constraints and other appointments. If you have concerns about other areas of your health then we would encourage you to contact the surgery where you can be added to our phone list and receive a call back from one of our clinicians. If the ‘minor issues’ are diabetes related, then of course we can discuss them during the review.
Interim/6 month review
There is not a 6 month or interim recall system in place. We advise at the annual review when the interim review is next due and ask that you make a note in your diary or on your calendar to book a blood test for your HbA1c only nearer the time (at present you can only book a blood test 2 weeks ahead).
If the HbA1c at your interim blood test is stable or lower, you will not hear anything. If it has increased then we will contact you by phone or letter and advise accordingly. This is in line with NICE guidance.
How long do you have to be in remission and off medication before you don’t need to declare T2D for travel insurance etc.?
Is there a ‘remission’ diagnosis code for medical records?
A The ‘official’ definition of remission is two consecutive HbA1c’s under 48mmol/mol at least 2 months apart whilst on no diabetes medication.
You should liaise with your insurance provider and inform them that you have been diagnosed with Diabetes Type 2 in remission.
Yes! We do have a remission diagnosis code for the medical records which is a joy to add!