Practice Nursing

National Service Framework for Diabetes

The Department of Health has published the long awaited diabetes National Service Framework which emphases patient empowerment and a greater role for nurse prescribing.

But the there is no extra direct funding for delivering the strategy - the DoH says the extra work needed to achieve the targets will have to be financed from PCTs’ baseline budgets.

The blueprint says that the 1.3 people diagnosed with diabetes must in future receive better care, more support and services, including eye screening.

Patients will be encouraged and educated to manage their condition themselves to help them to prevent complications.

Local diabetes networks will be established whose members will include people with diabetes who will champion the views of people affected by this disease and determine local services and priorities. Local and national audits will be carried out to ensure standards are being maintained and a National Clinical Director for Diabetes will be appointed.

Key targets of the NSF are:

  • By 2006 a minimum of 80% of people with diabetes must be offered screening for the early detection of (and treatment if needed) of diabetic retinopathy as part of a systematic programme that meets national standards, rising to 100% coverage of those at risk of retinopathy by the end of 2007.

  • In primary care practice-based registers must be updated so that patients with CHD and diabetes continue to receive appropriate advice and treatment in line with NSF standards. By March 2006 practices must ensure that registers and systematic treatment regimes including appropriate advice on diet, physical activity and smoking, also cover the majority of patients at high risk of coronary heart disease, particularly those with hypertension, diabetes and a body mass index greater than 30.

  • The priority from day one is to focus on those at greatest risk of developing complications indicated by poor diabetes control and those newly diagnosed with diabetes after April 2003. These patients are to be offered information, psychological support, structured group education, an agreed care plan, a personal diabetes record and a named contact

The Diabetes NSF delivery strategy can be downloaded Department of Health website or ordered from Department of Health Publications, PO Box 777, London, SE1 6XH, fax 01623 724 524 email [email protected] A guide for people with diabetes, 'Diabetes Care - Your future health and wellbeing' is available from Department of Health Publications, PO Box 777, London SE1 6XH, phone 08701 555 455 or email quote 29335 and the title.

New asthma guidelines

New national guidelines on the management of asthma have been published by the British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN.)

The evidence-based guidelines encourage nurses to offer educational materials and individual ‘Asthma Action Plans’ to help patients take control of their condition - by monitoring and managing their own symptoms.

Asthma trained practice nurses are also encouraged to:

  • Keep and regularly review a list of asthma patients using a structured questionnaire system

  • Understand the needs of diverse asthma patients – including those from ethnic communities and those from socially excluded backgrounds.

The guidance recommends breast feeding for asthmatic mothers and smoking cessation for both parents and children. It addresses for the first time treatment of asthma by non-drug methods such as complementary medicine, acupuncture, homeopathy and immunotherapy to help nurses when patients ask for advice on alternative treatments.

There are sections on the practical steps for diagnosing asthma in both adults and children, risk factors that should be taken into account and drug management.

New developments include:

  • changes in the sequencing of treatment, with a new emphasis on administering other treatments before a patient is given higher doses of inhaled steroid

  • advice on intravenous magnesium and the potential use of continuous nebulisation of beta-agonist as treatments for severe or life-threatening attacks.

The guidelines can be downloaded from the BTS website at and the SIGN website at

Bridging the Gap

More than 15,000 primary health care professionals – mostly practice nurses – now have the skills to treat asthma but they need better training in COPD, spirometry, smoking cessation and allergy says a new report from the Respiratory Alliance.

The Alliance, a coalition of medical charities, organisations and professional bodies, calls on primary care trusts to invest further in education, training and medical interventions for respiratory disease.

Its report ‘Bridiging the Gap’ outlines the considerable burden that respiratory diseases places on patients and calls for further improvements in services. This investment would offset future costs on the NHS from long term ill health.

‘Despite the considerable burden imposed on patients, the health service and society, respiratory diseases are not currently a priority in the national strategy for health and there is no national service framework to guide those responsible for providing the respiratory services,’ says the Alliance.

Mental health report

People with mental health problems need much more support from primary care services says a new report from the Sainsbury Centre for Mental Health (SCMH) in association with the NHS Alliance.

‘Primary Solutions’ argues that overstretched general practices are frequently unable to offer the level of care needed by people with mental illnesses.

Only two per cent of practice nurses have received any formal mental health training and links with specialist services are often poor.

The result is that too many mental health problems are not diagnosed properly and some patients receive inappropriate medication.

The SCMH calls for an increase in the number of practice nurses and an increase in their skills in order to help general practice provide better mental health services. It says practice nurses with their training in chronic disease management are well placed to help patients with mental health problems.

Some innovative approaches to primary mental health care are highlighted such as the work of practice nurse Sally Gardner who advises and treats patients diagnosed with mental illnesses at her Ipswich practice.

The report says district nurses and health visitors receive mental health training targeted at the specific needs of their client groups who need help with post-natal depression and bereavement. But both these groups of healthcare professionals should receive more training in the management of schizophrenia and the identification of people with depression. The report says district nurses should receive specific training on the identification and management of people who are bereaved and all nurses should receive training on understanding how mental health problems can present and influence physical illness.

The SCMH has developed a training package for practice nurses. Further information from or phone 020 7827 8300.

Practice development nurse e-group

An electronic chat group has been set up for practice development nurses on the Practice Nurse Association website. The aim is to establish a database, help practice development nurses to keep in touch and share ideas. Nurses are registered after logging their details via email on the site