View From the Ground, by Alia Gilani
The prevalence of diabetes is rapidly increasing. Currently, there are approximately 4.9 million people in the UK with diabetes, with this figure projected to increase to 5.5 million by 2030.1 The cost of diabetes care equates to about 10% of the NHS budget.1
The role of pharmacists has evolved significantly from the traditional model of dispensing medications. There is increasing integration of pharmacists into general practice, with many favourable outcomes from their delivery of medication reviews in primary care.
Close working relationships within the wider practice team are the cornerstone of managing chronic diseases—such as a joint consultation approach between a patient and, for example, both a pharmacist and a diabetes specialist nurse.
Health inequalities have been defined as ‘systematic, unfair and avoidable’ differences in the status of people’s health.2 In terms of diabetes, South Asian and Black people are two to four times more likely to develop type 2 diabetes than White people.3 Ethnic minority groups may have cultural and linguistic barriers to healthcare access and disease management; one way to tackle this is to deliver pharmacist-led healthcare services in community venues, for example, a mosque. In these outreach services, care issues can be discussed with the GP and, if appropriate, passed on to the wider health and social care team.
The current climate provides ample opportunity for pharmacists to be involved in front-line diabetes management and to have a tangible impact on patient care. Healthcare providers may need to tailor service provision to influence the wider determinants of health, in order to have a more substantial impact on health inequalities. The Inverse Care Law, which was first described in 1971 by Julian Tudor Hart, illustrated the principle that ‘the availability of good medical care tends to vary inversely with the need for it in the population served’.4 The Inverse Care Law holds true today—we know that those from more deprived communities may have greater health needs,2 and managing these needs requires more time. We should be cognisant of the wider socioeconomic factors that impact health when considering service provision.
The role of the pharmacist has evolved, and pharmacists can have a meaningful impact on the care of people with diabetes. The boundaries for a pharmacist’s job description should be pushed—we need to move away from being behind the scenes to delivering front-line patient care in active diabetes management.
Senior Diabetes Clinical Pharmacist, Primary Care Sheffield