Primary diabetes care: yesterday, today and tomorrow

Starting in the early 1970s general practitioners (GPs) in the United Kingdom developed diabetes clinics in their practice. Momentum was initially slow, but following the 1990 GP contract and the St Vincent Declaration, GPs were encouraged to take more responsibility for diabetes care. The 1997 contract provided further impetus for this, and primary care organisations were developed. Throughout this time there was a realisation that it was important to apply best evidence to primary diabetes care. The United Kingdom Prospective Diabetes Study was an impetus for GPs to improve care and changed the emphasis of care from solely blood sugar management to a wider cardiovascular risk assessment in people with diabetes.

At the beginning of this decade the Scottish Intercollegiate Guideline Network, National Institute for Clinical Excellence and American Diabetes Association guidelines for diabetes management were published setting out best practice. Each of the four nations in the United Kingdom then published national service framework (NSF) documents outlining best practice. In 2003, GPs voted for a new General Medical Services contract. This will introduce formalised payments for quality work in practice and will encourage GPs and their practice nurses to follow protocols adapted from these guidelines and NSFs and apply best evidence to their patients.

In the future, the numbers of patients with diabetes will increase as will the workload. Further innovative measures will have to be adopted to cope with this epidemic. Primary care will remain vital for information gathering, follow up, management and probable screening for diabetes, with patients encouraged to be empowered to understand and manage their condition. Copyright © 2004 John Wiley & Sons, Ltd.