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Practice nurses face tough new diabetes target for HbA1c control

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Practice nurses look likely to carry much of the burden of a new quality and outcomes framework target for diabetes control that comes into force in April.

The target calls on GPs to lower blood glucose levels in half of all older adults with type two diabetes to below 7% to earn the financial rewards they currently receive for achieving a target of 7.5% in half their adult patients.

But the current primary care team approach means practice nurses will take on much of the work to achieve this target – while benefiting little personally for their efforts. Both practice nurses and doctors have spoken out against the target, which they say is too tight.

Gwen Hall, vice chair of the Primary Care Diabetes Society, a former practice nurse who is now a diabetes specialist nurse with Surrey PCT, said: ‘The trouble with QOF targets is that they are funding targets not metabolic targets and are not necessarily what is best for a person.

‘Practice nurses are the ones this is going to fall on but I’d like to think it is not just put on them to achieve the target,’ she added.

She cited NICE guidance, which puts emphasis on clinical judgement so that clinicians work with the patient to set and achieve treatment goals.

She said her fear was that the target may encourage some GPs to try to obtain the rewards through glucose-control regimens that could prove detrimental to their patients. Control that was too tight could lead to hypos, falls and breakages, she said.

Writing in the BMJ this month, Oxfordshire GP Richard Lehman agreed that treating to such a tough target – possibly through insulin initiation – could actually result in adverse effects on a patient’s lifestyle. He highlighted that people who drove for a living could lose their job if they started having to be treated with insulin.

Lynn Young, primary care adviser for the RCN, said the problem with the target was more one of clinical conflict not workload, with some doctors backing the target and others not. Practice nurses will have to follow what is decided locally, she said.

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