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The conflict between specialist diabetes services and acute-general internal medicine for consultant diabetologists in the UK in 2006

Peter H Winocour, Charlotte Gosden, Chris Walton, Bridget Turner, Dinesh Nagi and Richard IG Holt
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DOI: https://doi.org/10.7861/clinmedicine.8-4-377
Clin Med August 2008
Peter H Winocour
Queen Elizabeth II Hospital, Welwyn Garden City
Roles: Consultant Physician; Chair of the Association of British Clinical Diabetologists (ABCD)
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Charlotte Gosden
Diabetes UK
Roles: Information Analyst
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Chris Walton
Hull Royal Infirmary
Roles: Consultant Physician
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Bridget Turner
Diabetes UK
Roles: Head of HealthCare Policy
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Dinesh Nagi
Pinderfields General Hospital, Mid-Yorkshire NHS Trust, Wakefield
Roles: Consultant Physician
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Richard IG Holt
University of Southampton
Roles: Reader in Endocrinology and Metabolism
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Abstract

An online survey of consultant diabetologists in the UK examined the interface between specialist services and acute-general internal medicine (acute-GIM). Out of 592 consultants, 289 (49%) responded. Of these, 94% contributed to acute-GIM, devoting equivalent time to acute-GIM and specialist diabetes services. Of the respondents, 10% provided a single-handed specialist service and 78% provided endocrine services. The survey found the input to acute-GIM was increasing, partly because other specialties were opting out. The increased commitment to acute-GIM compromised specialist diabetes activity through reduced consultant and training-grade time for outpatient activity and service development. The shift to primary care of chronic disease led to further conflict between acute-GIM and delivery of a specialist service, given the current systems for provision of consultant-led care. The large number of specialist trainees in diabetes and endocrinology will require innovative commissioning mechanisms that reflect the need to sustain and develop specialist diabetes and endocrine care in the appropriate settings as well as the continued input in acute trusts for acute-GIM.

KEY WORDS
  • acute-general internal medicine
  • community shift
  • consultant physicians
  • diabetes
  • endocrinology
  • specialist training
  • © 2008 Royal College of Physicians
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The conflict between specialist diabetes services and acute-general internal medicine for consultant diabetologists in the UK in 2006
Peter H Winocour, Charlotte Gosden, Chris Walton, Bridget Turner, Dinesh Nagi, Richard IG Holt
Clinical Medicine Aug 2008, 8 (4) 377-380; DOI: 10.7861/clinmedicine.8-4-377

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The conflict between specialist diabetes services and acute-general internal medicine for consultant diabetologists in the UK in 2006
Peter H Winocour, Charlotte Gosden, Chris Walton, Bridget Turner, Dinesh Nagi, Richard IG Holt
Clinical Medicine Aug 2008, 8 (4) 377-380; DOI: 10.7861/clinmedicine.8-4-377
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