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 longerterm
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).