Part two of the NSF has brought no new funds with it, placing PCTs under even greater pressure says Dr Matthew Lockyer

As a doctor with a special interest in diabetes, I can see that the NSF for Diabetes (News, January 2003) is a missed opportunity. There can be few areas with such an abundance of evidence to suggest that money spent will pay great dividends in terms of individual patient outcomes and health economics.

Complications often disable patients during their working lives. Simple interventions performed effectively using a combination of prevention and early diagnosis could greatly reduce the number of complications. This is dependent as much on investment in staff as in sophisticated technology.

The first part of the NSF for Diabetes1 described the mission statement for achieving improvements in diabetes care. Most healthcare professionals had hoped for a recognition of the need for ring-fenced funds to increase staffing levels, especially following the improved allocation of funds to the NHS, in the long-awaited second part.

When the delivery strategy2 was finally published in January there was little publicity for its launch, which, with a Government that loves to trumpet new initiatives, aroused suspicion. The reason was apparent. There is no ring-fenced funding to increase staff levels. PCTs are to make provision from their existing budgets. Some PCTs may be able to do this but the principle of a national service framework is immediately defeated if some areas cannot fund services.

In my own area, the PCT is struggling with a big overspend. Already, a successful retinal camera screening service has been implemented, and that suggests an innovative trust. However, this year, economies in expenditure have seen specialist nurses being made redundant in cardiac rehabilitation, ischaemic heart disease, stroke care, community diabetes and smoking prevention. I can envisage trusts being able to obtain NSF money to buy retinal cameras but being unable to staff the service.

As an ordinary GP, I can see no sign of the extra millions our service is supposed to be receiving. I think many GPs have become disillusioned with the NSF system which, from its inception, has set targets without support funding.

Most of us have been caught between the rock of the ischaemic heart disease targets and the hard place of drug budget overspends. (Our PCTês reward for achieving NSF targets was to have our disability access budget cut because of an overspent drug budget.)

Several national service frameworks have appeared in fairly quick succession. That may cause many GPs to be thankful that the diabetes framework is comparatively short on targets.

Despite some good initiatives, this NSF seems to me to be another in which the question of funding has been fudged. The care of diabetes is probably one of the major problems for clinicians to tackle in the 21st century. Diabetes, especially type 2 diabetes, is increasing in prevalence at an alarming rate. By 2010, some 3 million people in the UK are expected to have the disease.

The Audit Commission in its publication Testing Times3 highlighted the low staffing levels in most parts of the UK. All specialties were below recommended levels but dietician and chiropody services were universally sparse.

This NSF has failed to deliver the potential expansion of staff needed to tackle the epidemic. Its timing does little to give doctors confidence in the Government as new contracts are negotiated.

Dr Matthew Lockyer, GP, Suffolk, and clinical assistant in adult diabetes medicine

Phasing out traction feed printers

I refer to the question on tractor feed printers published in •Your problems solved: ITê (Guidelines in Practice, December 2002).

The Department of Health first advised GPs in October 2000 that tractor feed prescriptions (FP10C) would eventually be withdrawn, and to bear this in mind when selecting replacement printers. In August 2001, in the •2001 prescription forms and other informationê letter, we notified GPs that FP10C would be withdrawn by March 2004 at the latest. This is still our intention.

Advice about this can be found at: (General Practitioners: Tractor feed printers and FP10C).

Christine Clark, Business Manager, Prescriptions and NHS Forms, Department of Health


  1. Department of Health. National Service Framework for Diabetes: Standards. London: DoH, 2001.
  2. Department of Health. National Service Framework for Diabetes: Delivery Strategy. London: DoH, 2003.
  3. Audit Commission. Testing Times. A review of diabetes services in England and Wales. London: Audit Commission, 2000.


Guidelines in Practice, February 2003, Volume 6(2)
© 2003 MGP Ltd
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