Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs, and nurses in the East of England.

Abstract

Background: There is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients and their GPs and nurses. Aim: To explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses. Design and setting: A qualitative interview study in the East of England Methods: Semi-structured interviews with people who have type 2 diabetes (n=24) along with their respective GPs and nurses (n=15). Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed. Results: We identified a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient participants wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes provision. A reluctant acknowledgement surfaced amongst GPs, nurses and their patients that only minimum care standards could be maintained, with aspirations for high quality provision unlikely to be met.

Conclusion: Type 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed and realistic, may be one way forward.