Person-centred planning and making the most of diabetes reviews

This chapter reviews the so-called diabetes ‘annual review’, which is an opportunity to check that a person with diabetes has received elements of care such as screening for complications, self-management skills such as blood glucose monitoring, and a review and revision of their diabetes knowledge (National Institute for Health and Care Excellence (NICE), 2011, 2015a; Diabetes UK, 2016a). The aim of this review is to prevent, delay or detect acute and longer term complications of diabetes by considering metabolic control and associated risk factors (NHS England, 2014). The elements of care which are recommended for inclusion in an annual review are identified in Diabetes UK’s 15 Healthcare Essentials Guidance (2016b). Targets for carrying out many of the measures necessary to fulfil these recommendations appear in the Quality and Outcomes Framework of the GMS contract (NICE, 2011; British Medical Association, 2016).
It is important that all people with diabetes consent to be included on a practice diabetes register, so they can be monitored regularly (Rankin and Best, 2014). Anonymised data can then be aggregated for a district-wide register, which may be used for epidemiological and auditing purposes (Haynes et al, 2007; Rankin and Best, 2014), such as monitoring the prevalence of diabetic complications to plan future services or to improve standards of diabetes care through audit (Health and Social Care Information Centre, 2016).