www.mddus.com


Q&A Dr Peter Livingstone, Locum GP with a special interest in diabetes


the University of Bradford. The part-time course comprises a large element of work-based and shared learning. Warwick Medical School also provide a certifi cate in diabetes care while Cardiff University off er a postgraduate diploma in diabetes.


In practice GPwSIs are most likely to work in the community, normally with links to the specialist care sector. The core activities of a GPwSI diabetes will vary depending on local needs and resources. Examples of the types of clinical services that practitioners could deliver include:


• Addressing the needs of hard-to-reach patient groups, e.g. household / care home residents


• Working within a multidisciplinary team environment under locally agreed protocols for the management of non-urgent / routine / ongoing care diabetes


• Dealing with patients with new or progressing problems, including starting insulin and GLP1 medication


• Providing primary care input into local policy and guideline development.


Practitioners may also be commissioned to provide relevant elements of diabetes care such as specialist eye and foot care and a specialist dietetic service. Complications from diabetes aff ect every organ in the body making it a potential area of interest for doctors with interests in a range of specialties, from cardiology to neurology. A big feature of primary care diabetes clinical services is


the focus on multidisciplinary team work, so if you are the type of person who enjoys working in this way then taking an interest in this fi eld presents an ideal opportunity.


Links: • The Primary Care Diabetes Society www.pcdsociety.org


• Association of British Clinical Diabetologists www.diabetologists-abcd.org.uk


What attracted you to a career as a GPwSI in diabetes? I found the science of diabetes extremely interesting from the cellular level. With the use of insulin or medication I found I could make patients better and prevent secondary complications. The area is so vast and the management is constantly changing and I enjoy the challenge that presents.


What do you enjoy most about the job? Team work! Prior to the commencement of each clinic the team, which consists of me, the consultant, diabetic specialist nurses, dietician and podiatrist, all sit down together and discuss each individual patient, refl ecting on their previous attendance and glycaemic control and what further options are available.


Are there any downsides? Some patients are in denial in relation to their diagnosis of diabetes and therefore do not take any responsibility for their diabetes. I struggle at times watching people being admitted with diabetic ketoacidosis or developing secondary complications such as severe retinopathy knowing full well that if they had accepted their diagnosis they would not be in that situation.


What do you fi nd most challenging? The management of diabetes is constantly changing, whether it is insulin pumps, pancreatic islet cell transplantations or medication. It can be diffi cult keeping up-to-date with new medications and technology so there is a lot of reading to be done.


What about the role has most surprised you? It is nice to fi nd yourself in a position where you can actually make a diff erence to individuals’ lives by doing something simple such as slightly adjusting a patient’s medication or insulin as this can have a major improve- ment on their glycaemic control.


What is your most memorable experience so far? Watching a gentleman who I thought was going to have a below-knee amputation due to a severe neuropathic ulcer walk again after intensive treatment from the multi-disciplinary team.


What advice would you give to a trainee GP considering a career as a GPwSI diabetes? I did my postgraduate diploma in diabetes and would recommend this to anyone. This is a two-year, long distance course which critically evaluated the evidence on the management of diabetes. This is not essential for the job but sets you in good stead. If you show interest in this area you should fi nd you are almost certain to get a job somewhere!


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