Reinstate public funding for diabetes service in Hawkes Bay
The GPSI (General Practitioner with Specific Interest) Diabetes Service in Hawkes Bay is concerned that the local District Health Board has stopped public funding of its service despite its outstanding clinical outcomes.
The GPSI Diabetes Service has had exceptional success with improving people’s diabetes care as well as success in removing the ethnic gap in health status between Maori and European New Zealanders over the 8 years it has been seeing patients. However, its contract with the District Health Board has not been renewed.
Dr Janet Titchener, clinical director of the GPSI Diabetes Service said, “The District Health Board claims that it is saving money by stopping its funding for the Service yet the Service is saving the Health Board tens of thousands of dollars. These savings are immediate and exponential over time”
“Anyone who attends GPSI Diabetes has a substantial reduction in their likelihood of developing kidney disease, having a heart attack or stroke, and experiences an equally significant reduction in their risk of going blind or losing their legs – all very expensive conditions to manage. This service is extraordinarily cost effective and an efficient use of taxpayers’ money.”
But the District Health Board claims that the GPSI Diabetes Service is a duplication of the current hospital service, that it is expensive, that it does not serve the whole community and that it is not well embedded within mainstream diabetes care.
“We received legal advice from Chen Palmer law firm that the District Health Board’s claims are based on incorrect facts.“ said Dr Titchener. “The Service is not only cost effective but cost saving, is well embedded within primary care where mainstream diabetes management currently sits and we operate from multiple locations within the community."
The GPSI Diabetes Service has had referrals from 128 out of 130 General Practitioners in the Hawkes Bay. Many of these GPs have expressed outrage at the service coming to an end – particularly as the decision was made by the DHB without any consultation with general practice.
“The referrals we are getting are from general practitioners throughout all of Hawkes Bay supporting excellent ease of patient accessibility and availability for anyone who lives within Hawkes Bay.” said Dr Titchener. “This is further supported by the over representation of Maori and Pacific Island people being seen. Indeed, the GPSI Diabetes Service appears to work particularly well for this sector of the population who achieve even better clinical outcomes than European New Zealanders, essentially closing the ethnic gap in diabetes care.”
The GPSI Diabetes Service is seeking to renew its contract with the Hawkes Bay District Health Board.
Dr Titchener said, “We are concerned that people with diabetes will be losing the opportunity for a lifetime of improved diabetes care and health. We have provided the District Health Board with evidence of the value of our service, and make multiple requests for an explanation from them as to why they cannot continue to fund something that is working.”
The GPSI Diabetes Service has been supported by the Hawkes Bay District Health Board for the past 8 years. The service is provided from multiple locations within the community.
Patients are referred into the service by their general practitioner. Using a patient centred model of care, each person is seen for a series of appointments in quick succession with the goal of empowering each person with the skills to self-manage their own diabetes. The patient is then discharged from the service back to the care of their GP.
Anyone with type 2 diabetes who attends the GPSI Service has both immediate and long-term improvements in their diabetes control as measured by a blood test called an HbA1c. Based on international data, a person who reduces their HbA1c by 10 mmol/mol will cut health care costs by over 37%. Patients who attend the GPSI Diabetes Service experience, on average, a decrease in HbA1c twice this – 20 mmol/mol.
For every year that a person holds a 10 mmol/mol reduction in their HbA1c they are 30% less likely to develop kidney disease, have a heart attack or a stroke and have a 22% reduction in their risk of going blind or losing their legs. At the GPSI Diabetes Service we don’t just have a 10 mmol/mol reduction in HbA1c but a 20 mmol/mol reduction.
Maori and Pacific Island people seen in the GPSI Diabetes Service do even better, essentially closing the ethnic gap in diabetes care. Maori referred to the GPSI Diabetes Service start out with HbA1c values 20 mmol/mol higher than European New Zealanders. However, immediately after they have attended the service, this ethnic disparity in HbA1c disappears.
Community based, patient centred care that empowers patients to self-manage their own disease are all the healthcare parameters the Ministry of Health espouses to ensure that care is successful for all patients regardless of ethnicity, cost effective and accessible to all patients. The GPSI Diabetes Service fulfils all of these parameters, yet the Hawkes Bay DHB chooses to discontinue the service