I relayed the question to Dr Gordon Caldwell, Consultant Diabetologist
at Worthing Hospital, where they've had an excellent DR service for some
years. Here's hos response:
>I think that it is fair to say that in type 2 diabetics those who have
had a completely normal retinal screening in a well planned and quality
controlled and assured process, have no clinical need for a further
screening in a year (maybe even 2, or 3 years). However as you know
clinical need is a low priority in the NHS today! The Diabetes UK
charity raises patients' expectations that screening will be annual, so
you have to deal with patients' fears if it is not done (I'll go blind
if I do not have my screening, they told me it was important"). Somehow
I also suspect that GPs get extra dosh, if there is annual screening (to
line their pockets, not those doing the screening!), and all sorts of
"authorities" who have never worked in a retinal department pontificate
about risk etc. In addition administratively it is easier sometimes just
to do everything for everyone!
>So if your Derby person is willing to forge ahead based on clinical
need, clinical evidence and clinical expertise, all power to his elbow -
most of us have bowed our professional heads and been obedient servants,
rather than robust radical professionals!
>Such is the NHS today.
The point about GPs' QOF points may be significant. You'll have a job
getting past your GPs anything which might cost them money.
Meic Goodyear
Public Health Intelligence Specialist
The honourable Physicians will confesse themselves beholden to the
science of Arithmetike - John Dee 1570
Cantilever House,
Eltham Road
Lee
London SE12 8RN
Tel: 020 7206 3273
Fax: 020 7206 3201
>>> Bruce Laurence <[log in to unmask]> 11/15/06
5:14 pm >>>
Hello colleagues
We are considering using a 2 year screening interval for diabetic
retinopathy screening for those who have had a normal result. This is
somewhat controversial, and not in line with NSC guidance, but there
isn't
really much evidence that it is less effective than an annual screen,
and
it is obviously cost saving where funding for these programmes is being
squeezed.
I would be very interested to know from any of you in pcts, or
otherwise
involved in DR screening, if your programme has considered this option
or
is actually choosing it.
regards
Bruce Laurence
Bruce Laurence
Consultant in Public Health
Derbyshire County PCT
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