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| 01 Mother teacher, father executive. Privileged education. Chose medicine – practical application of science. | |
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02 Birmingham University, 1982. Less than third female. Traditional – 2 years theory, 3 years on wards.
Learnt re diabetes – less than renal disease. Saw people with diabetes have renal transplants. Early pancreas transplant. | |
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03 In 1987, house job, gastroenterology, General Hospital. Occasionally covered diabetes – made consultants nervous. Saw ketoacidosis, sickle cell plus diabetes. Good guidelines & teaching.
Seemed Type 1 to be treated by specialists, Type 2 considered less serious. | |
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04 A & E. Training scheme in market town. I didn’t choose diabetes - disagreed with hospital’s approach .
After house jobs, maternity leave, then trainee GP - practice with diabetes clinic – stayed on a few months to do it. 1992, became part-time partner in nearby town – specialised in diabetes with nurse. | |
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05 Consultants provided good advice. Insulins more sensitive, diet relaxed. Consultants ran GP meetings.
Practice grew. New contract – chronic disease clinics – we continued as before. Early 1990s, computerised prescriptions, appointments etc. By late 1990s, fitted appointments round patients. | |
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| 06 In 1992, computers enabled audit. Also had dietitian & counsellor. Dietitian temporary, later got another – now obesity more time-consuming. Still have medical counsellor. | |
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| 07 By 1990s, DCCT Trial showed Type 1 need for control. Type 2 seen as GPs’ province – hospital for complications or starting insulin. Children always hospital-led. | |
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08 By late 1990s, ran retinal photography scheme for 3 practices.
Began actively to look for diabetes. Knowledge improved. Insulin-dependent & complications still went to hospital. | |
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| 09 Good retinopathy. More nurses trained & doctors interested in diabetes. By 2001, paper-light, better audit. Chased people. Retinopathy for homebound. By late 1990s, some PCTs had supported doctors & nurses to get diabetes qualification. With DSNs, I set up Certificate – half of county practices have doctor & nurse with Certificate. | |
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10 New contract & QOF – shows how good control is. More expertise. Diabetes liaison nurses. Can help Type 1s. De-medicalising.
Better education re educating patients. Better resources where English 2nd language. Dietetic advice – normal healthy diet. Choice of staff with knowledge – at any time – no specific clinic. | |
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| 11 Test people at risk. Warn re risk - stay thin. Good information from Diabetes UK. General public more aware. Diabetes led way in multidisciplinary teams. | |
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12 Would like to employ diabetes liaison nurses – currrently hospital-based. Consultants starting to come into community.
Horror stories from non-diabetic wards – not allowed to administer own insulin. Students meet our patients.
District nurses support housebound.
More research. New drugs. | |
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| 13 UKPDS - importance of control for Type 2s. Began to look at physiology of diabetes. Exenatide, new gliptins. Hospital care pathways. Podiatrists better trained. Warn re possibility of insulin – not failure. Older people have other conditions. | |
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| 14 Dietitian sees family’s main cook – constant support – healthy diet for all. Obesity increasing – everyone needs to know re diabetes. | |
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15 Knowledge better, but I have eye on computer for what needs measuring. Continuity of care eroded. People living longer to get other diseases.
GPs get points for tests. We did well because computerised – used money for extra staff. Penalises inner-city practices with greater needs. | |
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| 16 For pregnant women, in 1992, consultant-only care. Now GP must do pre-conceptual counselling. Multidisciplinary team at hospital, looking for diabetes, avoid neonatal death. In late 1980s, most Caesarian – now normal delivery possible. | |
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