On 2008-03-07 00:18:57 +0000, "The Medway Handyman"
said:

Andy Hall wrote:
On 2008-03-06 01:01:09 +0000, Frank Erskine
said:

On Wed, 05 Mar 2008 22:12:07 GMT, geoff had this
to say:

In message , Huge
writes
On 2008-03-04, Rod wrote:
Ed Sirett wrote:
snip

I have no idea what units blood cholesterol is measured in I just
know that 5.5 is pretty bad and 2.5 is pretty good.

5.5 ain't so bad. 8.6 is bad. (Don't ask me how I know...)

The year before last, 6.0 was OK

it isn't now

So a change of goalposts gives me a high cholesterol level now

This is usually the case with NHS staff, who are noted for job
creation.

I'm pretty certain that NHS GP practices are given large cash
allowances determined by their supposed 'at risk' patients, so they
tend to exaggerate such to maximise their profits.

Indeed. There is large bunce to be had here and negotiation can be
made. This time last year (getting towards the end of the financial
year) I was able to agree with my GP an increase in test strip
prescription to an appropriate level in exchange for agreeing to have
a couple of tests done before the end of March.

Which makes a complete mockery of the NHS. You shouldn't have to do 'deals'
with your GP. You get better healthcare if he gets better 'target meeting'
help from you?

The NHS is a mockery and always has been. The thought that
healthcare can be provided for free and forever to all at the point of
use and be uniform regardless of geography, is a socialist wet dream
belonging to the 1940s.

None of those things are achievable or even desirable - certainly not
national uniformity.

The way to get better healthcare is to take responsibility for it
oneself. The doctor should be a professional advisor and not the
determinant of all that happens to the patient. That is the patient's
responsibility.

On the specific subject of blood glucose measurement there is a long
running saga where NICE have said that patients should be prescribed
test strips if it will help them with their diabetic management.
However, they are expensive. Retail price is around 50p a strip, NHS
price probably around 30p. To use them in order to manage BG
effectively on an ongoing basis, one might need to test 8-10 times a
day initially and perhaps 2-3 times a day once one knows the effect of
eating particular things, amounts and combinations.

Many PCTs prefer an alternative, which is a quarterly or twice yearly
blood test known as HbA1C. This "measures" the result of how
effective BG control has been or the previous 6 weeks or so. It's of
some use to the medical professionals in that they can know if it's
been good or not. It doesn't help the patient to manage their diet
and exercise on a daily basis. Needless to say, the test is cheap -
something like £7, so obviously appealing to PCTs.

The figure obtained from the test is a percentage and for non-diabetics
generally less than 5-6%. NICE have given a guideline of 7.4% as a
target for GPs to use, and it is one of the contributory factors to
their getting bunce for diabetic management. They have even gone as
far as to say that getting under this figure represents "good control"
for diabetics. One is immediately suspicious of such numbers. Why
not 7.3% or 7.5%? The answer is simply taken from across a broad
group of diabetic patients (not the population as a whole) and
represents a relatively easily achieved target that can be achieved for
most patients. It has little to do with outcome.

I had a "discussion" with the PCT about this, after they attempted to
remove strip prescriptions and they relented. I suspect that man
people won't have bothered, but then they may not test anyway,
preferring to pop a white pill and have the doctor take care of the
quarterly HbA1c measurement. Unfortunately, it's not a very good
measure of outcome and is useless as a management tool to the patient.

The agreement was to include extra HbA1c tests if strips were
prescribed. It's somewhat irrelevant because my HbA1c figure is
always in non-diabetic range of 6% anyway. However, these tests
are one of the check boxes for GP diabetic care. The question is
not so much one of doing a deal, but rather that the NHS measuring and
treatment regime is based on cost and not outcome. Put a different
way, HbA1c tests plus white pills are substantially less expensive than
test strips. I want to have the regime that works for me, based on my
taking prime responsibility rather than subcontracting to the quack.
He doesn't disagree with that notion, and also believes that the
targeting system is ridiculous.