SUMMARY OF THE 5 AUGUST 2009 DIABETES MEDICAL WORKSHOP
A very successful workshop was organised by the Diabetes Clinical Stream for medical staff from Area
Diabetes Services and the Divisions of General Practice. The workshop was chaired from Tamworth
by Dr Sergio Diez Alvarez, the Diabetes Stream Clinical Leader and video-linked to Newcastle, with
this site facilitated by Dr Sham Acharya, Staff Specialist and to a GP in Taree via teleconference. The
workshop aimed to provide feedback on how diabetes patients are currently cared for across the area,
and to provide an opportunity to raise points of view about how we should move forward, in line with
the HNE Health Diabetes Services Plan 2008-2012.
A recent survey of the Divisions of General Practice provided information about perceived gaps in
diabetes services across the area, and the workshop participants explored these further and
discussed what works well and what improvements are needed to ensure integrated service delivery
and equitable professional development opportunities. There was also discussion around patient
outcome targets and possibilities for data collection and data sharing among clinicians. Differences
between access to services for patients and to training for clinicians in rural and urban areas were also
highlighted. However, outside these areas there are so few resources that most patients are managed
in general practice most of the time, and when needed travel to Tamworth, Newcastle or Sydney. Dr
Steve May does a great job in Tamworth, but some towns are more than 4.5 hours even from
Tamworth and Aboriginal people, in particular, tend not to travel. It was agreed that Aboriginal
diabetes care needs more detailed discussion at a later forum.
One workshop participant noted “we need to develop a working relationship between GPs and
specialists, and we need to sort out how people get into specialist clinics, what happens in the clinic,
and how they get back.” Another noted that “the diabetes population needs to be seen in general
practice as it is too massive to be reliant on specialists in clinics and hospitals. High risk, particularly
vascular patients, should be cared for by the latter, with the endocrinologist providing a leadership role
and modelling best practice.”
DISCUSSION POINTS
1. Perceived service gaps
Timely access to Diabetes Educators (DEs) and Specialist referral/advice - bottleneck due to 5
FTE Staff Specialists and 10 FTE DEs for 750 GPs.
 Regional-wide system of data collection and consensus on what patient goals we can work on and
what achievable targets should be set
 Gap costs for patients accessing allied health and transport issues for patients
 Consistency in information provided in referrals to and discharge letters from Specialist Services –
referral information not always adequate to facilitate triaging and care and discharge information
not always adequate to allow completion of the Diabetes ACC (Annual Cycle of Care)
 Consistency of competency in general practice - GP education needed so specialists have
confidence to discharge patients back to GP’s care – acknowledged that there is a wide variety of
skill among GPs
 Workforce - with inadequate allied health and DEs, it is a struggle in some areas to provide a
quality service and in some areas a one-off consultation only can be arranged with DEs, with no
follow-up or ongoing care
Recommendations and agreed actions
I. Increase utilisation of SIP scheme (Commonwealth Service Incentive Payments)
II. Facilitate conduct and recording of the Diabetes ACC - 20% of patients in HNE, recorded as
receiving ACC, and though higher than other regions, is inadequate
III. Facilitate systematic patient management by GPs, with HNE Health diabetes services helping
to achieve these targets and goals
IV. Facilitate appropriate data collection tools - such as the PEN tool successfully used by GP
Access
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2. What works well
Specialist clinics (Medical, High Risk Foot, Young People’s, Antenatal/Gestational), the inpatient
services and the group education programs in GNC and LH Cluster work well. Those conducted at
Royal Newcastle Centre are able to link with John Hunter Hospital subspecialties.
 Weekly clinics are conducted in Armidale and Inverell, and the MAHS program works well. In
addition, the North West Slopes Division employs a dietitian.
 In the Lower Mid North Coast the general physicians act as diabetes specialists and patients can
access private allied health providers and because the private and HNE workforce is stable, there
is a good relationship between them and the GPs.
Recommendations and agreed actions
I. Need to ensure GPs do not become deskilled in diabetes care, due to over-reliance on
specialist services
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3. What we could do better
 Communication between groups – need to share data more effectively. Patients turn up without a
clinic letter, referral, test results, and this leads to duplicate tests and investigations being ordered
 Communicate who staff are and where they work
 More timely referral to speciality high risk foot clinic - not seeing patients with Charcot’s,
neuropathy or arthropathy early enough
 Need a clarification of the role of the GP and the role of the endocrinologist – HNE services should
be seen as short term consultancy only, which can then be extended as needed.
Recommendations and agreed actions
I. Need to discharge patients from the specialist clinics in a more timely manner
II. Audit clinic referrals from general practice and feedback/discharge letters to referring GPs
to review the quality of information.
III. Investigate the NZ web-based program, which can extract clinical notes from GP programs
(such as Medical Director) for referral
IV. Develop a user-friendly website – Scottish website could be a model for this
V. Investigate use of paediatric endocrinologists’ GP management plan template for adults
VI. Attach Specialists to one Division and DEs to General Practices in their area
VII. Expand foot clinics to other areas, outside of GNC
4. What training is on offer and what opportunities should be provided
 Diabetes Australia, HNE staff, Hunter Post-graduate Medical Institute, National Prescribing Service
and the GP Divisions offer training programs
 Web-based training available – though some deem that not so useful
 Web based training is offered – with scholarship programs for GPs covering the basics
 GP attachments are helpful, but the volume of GPs able to experience this is extremely low
 Reinforcing back to GPs about their individual patients is good, as the specialist is acting as a true
consultant, not a total management specialist
 The distances between and clustering of GPs in urban and rural regions is very different. Trainers
will not come for 5 doctors face-to-face and there is no specialist available
 Many HNE Health community nurses work in speciality areas, sometimes supporting local GPs
who average 2,000-3,000 patients. It is difficult to attract/recruit allied health staff into some
rural/regional areas.
Recommendations and agreed actions
I. Offer at least an annual workshop locally (conducted by endocrinologists, nephrologists etc).
II. Embed education systems – in communication from specialists in management plans
III. A stratified approach with some GPS wanting more, some wanting basics only, with perhaps followon for insulin initialisation etc
IV. Lunchtime meetings and videoconferencing could be considered
V. Provide education for HNE Health community nurses working with diabetes patients