Health and Social Care Committee

Inquiry into the contribution of community pharmacy to health services in Wales

CP 41 – Diabetes UK Cymru

Submission to Inquiry into the Contribution of Community Pharmacy to Health Services in Wales: Diabetes UK Cymru

Diabetes is now one of the most pressing health issues in the Wales. There are 160,000 people diagnosed and an estimated 66,000 undiagnosed with the condition. The number of people living with diabetes in Wales grows by 7,000 every year. Diabetes is a major cause of amputation, heart disease, blindness, kidney failure and stroke.  It cost NHS Wales £500m last year (10% of its entire budget)

Diabetes UK is the sole charity working with and for people with both Type 1 and Type 2 diabetes. Our goals are practical. We aim to reduce the rate of increase of diabetes and ensure earliest possible diagnosis; half the rate of complications; increase the quality of life for people with diabetes, and reduce premature deaths.

The Inquiry is a timely one. We appreciate that the Health and Social Care Committee will be working through many submissions. Diabetes UK Cymru feels the following issues are pertinent to the Committee’s considerations. We have aimed to be concise.

The Role of Pharmacy and Enhanced / Additional Services

For many, pharmacy is the most accessible health interface in their community. Many people can be intimidated by doctors and nurses who they see as authority figures. They will not present at a health centre unless they are unwell. Whilst simplistic, appointments at health clinics tend to be quite short and goal orientated – diagnosis and treatment recommendation.

With an increased focus on the benefits of preventative and patient-centred health, creative approaches need to be considered if progress is to be made in an environment of reduced health spending.

Diabetes UK Cymru believes consideration of an expansion of the role and duties of pharmacy is sensible. Areas that could be considered with recommendations follow.    

1. Risk awareness and screening

In June 2011, Diabetes UK Cymru in partnership with Community Pharmacy Wales, the Royal Pharmaceutical Society and Public Health Wales delivered a risk assessment campaign across all pharmacies in Wales as part of the community pharmacy contract. It screened 17,500 people, nearly 1,500 of whom were classified as high risk and referred to GPs for further diabetes testing.

Collaborative work involving pharmacy and the statutory/third sector should be encouraged. No single partner would be able to achieve the impact that the coalition of bodies was able to achieve. The initiative was successful but only identified around 2% of people estimated to be living with undiagnosed diabetes in Wales. Early identification of diabetes would save considerable money by reducing the costs of complications that would otherwise arise

Recommendations

· Pharmacies to offer diabetes risk assessment and screening all year round.

· Continuous screening for other long term health conditions should also be considered   

2. Provision of support to those living with long term conditions

People with diabetes have around 3 hours of contact time with a health professional (doctor, nurse or specialist) each year. They are expected to self manage for the remaining 8,757 hours. 80% of people with diabetes do not follow their management plan and 60% of people do not understand their diabetes diagnosis or the medicine prescribed to them. The repercussions are clear. People with diabetes make up 5% of the population and 15-20% of hospital inpatients in Wales.

Opportunities to better enable people with diabetes to understand the condition and how to manage it effectively are clearly required but increasing contact time significantly with GPs or Diabetes Specialist Nurses is simply not viable. Pharmacy staff could play an important role in the provision of increased access to support and advice.

Recommendation

· Pharmacies offer general diabetes advice, support and information to assist people living with diabetes understand and manage the condition more effectively. Where appropriate referrals are made to a local GP or health centre.

3. Behaviour Change

Diabetes UK Cymru estimates that there are 350,000 people in Wales with elevated blood glucose levels. Many will go on to develop diabetes and heart disease or experience a stroke. It is not melodramatic to say it is a ticking time-bomb. The Welsh Government and Public Health Wales acknowledge that rising numbers of people classified as obese is an increasing problem. Behaviour change across large population groups is extremely difficult. Previous public health campaigns have unfortunately made little impact.

Recommendations

· Pharmacies provide good opportunities for the provision of information and advice on diet and lifestyle to hard to reach groups in their communities.

· Dedicated diet and lifestyle expertise and coaching should be delivered through pharmacy clusters.