The IMO welcome the launch of the ICGP clinical guidelines  “A Practical Guide to Integrated Type 2 Diabetes Care” today and call upon all political parties to commit to resourcing Chronic Disease Programmes in General Practice which are not covered under the existing GMS Contract or under the Diabetic Cycle of Care agreed between the IMO and HSE/Department of Health. The IMO is committed to negotiating adequate resources for the delivery of Chronic Care Programmes, including Diabetes, in the context of the negotiations on the new GP Contract.

The Diabetic Cycle of Care which was agreed with the Department last year is not a chronic care programme and provides a specific and limited range of clinical activity relating to patients with Type 2 Diabetes. 

Under the Diabetic Cycle of Care, the GP is required to establish and maintain a patient register and reminder system and implement the defined cycle of care. The Cycle of Care consists of two review consultations annually .

During the annual review the GP is required to review and record blood results (HBA1C, Lipids, Basic Renal Function to include Creatinine, ACR (or Microalbuminuria where AACR is not available). They are required to review preventative lifestyle factors, review medication, carry out symptomatic foot review, check participation in eye prevention programme, record and assess BMI, Blood Pressure, Immunisation Status and provide education to the patient about Diabetes. The GP may refer newly diagnosed patients to the Patient Education Service where appropriate.

The second visit is less comprehensive and requires that there is a review of patients HBA1C and Lipids, review of preventative lifestyle factors, BMI, Blood Pressure and a review of medication.

The payment rates associated with the Cycle of Care are as follows:  €30 per patient registered and €100 capitation in addition to the standard capitation for the patient. Both payments are superannuable.

The model of care outlined in the ICGP document is a Chronic Care Management Programme as opposed to a Cycle of Care. The IMO believe that the model of care as set out in the document is the best clinical approach to managing Type 2 Diabetes. However, this model must be appropriately resourced and GPs must be given the appropriate payment to provide this level of service. At present this is not the case.

We would like to commend our colleagues in the ICGP on this document and we look forward to the State fully resourcing integrated Type 2 Diabetes Care.