A Health Foundation report published in July this year (Watt et al, 2023) suggests: 9.1 million people in England will be suffering from a major health condition by 2040, which is 2.5 million more than in 2019; an increasing proportion will stem from long-term conditions like heart disease, dementia, and diabetes; the three commonest conditions – anxiety and depression, chronic pain, and diabetes – will be predominantly managed in primary care, reinforcing the need to invest in general practice and community-based services.
The report's authors considered 20 health conditions that account for 65% of the burden of illness in England, and used an epidemiological model based on existing evidence and the impact of key risk factors – such as smoking, alcohol, obesity, diet, and exercise – on rates of illness by age and other characteristics. However, ‘[t]hey are not forecasts of the future. The value of projections is to support policymakers to both better prepare for the future and to act where policy change could lead to better outcomes.’
Reaction
Sam Feltham, Director of the Public Health Collaboration (PHC) Public Health Collaboration – a UK-registered charity dedicated to promoting a society where everyone enjoys good metabolic health, and saving the NHS money – told Practice Nursing that he was ‘saddened to read the statistics in the report, but I hope that through the power of lifestyle changes we can flip these predictions on their head.’
Dr Simon Tobin Simon Tobin is a full-time GP at Norwood Surgery, Southport. He is unsurprised at the report's assertion that: ‘Much of the projected growth in illness relates to conditions such as anxiety and depression, chronic pain and diabetes, which are predominantly managed in primary care and the community.’
‘This feels like a runaway train heading towards us and it's one that's been heading our way for years,’ Dr Tobin says. ‘It's a clear message that we need to prepare to manage more people with long-term conditions in primary care. What matters most to my patients is a focus on increasing their “health-span”; that's the proportion of a person's life spent in good health rather than purely thinking in terms of lifespan.’
And Bath-based GP Dr Campbell Murdoch who is also a member of the PHC Scientific Advisory Committee, says: ‘The increase in conditions like anxiety and depression, chronic pain and diabetes is exactly what's happening on the ground, and isn't a future issue; it's a significant problem now. There's an acceleration in suffering.’
Meeting the challenge
What must happen in primary care/general practice if the challenges anticipated by the Report are to be met? ‘To get results,’ explains Dr Murdoch, ‘we must focus on immediate and long-term health benefits. People are motivated by quick results. Many patients are fed up with feeling like their body is at war with itself. They want more energy, a clearer mind and to feel better today, as well as a healthier future.’
Dr Tobin agrees: ‘More resources committed to primary care are crucial,’ says Dr Tobin, ‘both financial and personnel. Practices across the country are struggling to recruit clinical staff and surgeries across the UK are closing weekly as a result.’
Interestingly, the Health Foundation had a ‘focus on conditions where remission is absent or minimal, such as dementia and diabetes’ (Watt et al, 2023). Yet, far from type 2 diabetes (T2D) remission being ‘absent or minimal’, burgeoning evidence demonstrates that T2D remission is not only present, but is on the increase, thanks to common sense approaches
Achieving T2D remission
Tobin's Norwood Surgery has demonstrated that 97% of patients improved their diabetic control, with 51% of T2D patients achieving drug-free remission, and that ‘[d]iabetes drug savings are £68,353 per year compared with the local average’ (Unwin et al, 2023). The improvements in blood sugar control and high T2D remission rates, explains Tobin, arose because people were supported to reduce their intake of sugar and starchy carbohydrates.
Putting this in perspective, PHC's Sam Feltham observes that ‘T2D costs the NHS £10 billion per year and through the work of Drs Unwin, Tobin, and colleagues it has been shown that it's possible to help almost 50% of people achieve remission. Imagine a world where we're able to halve the number of people living with T2D.’
Furthermore, ‘if all 9,400 GP practices in the UK used this approach, it would translate to annual savings of over £600 million for the NHS’, according to The Lifestyle Club, an award-winning and QISMET-accredited online health coaching service created by the PHC. TLC helps people with T2D and prediabetes; with the aim of achieving remission. Collaborating with the University of Surrey, TLC is undertaking a study to compare its approach with existing diabetes services and be commissioned nationally. The study's objectives are to monitor 100 participants for up to two years, gathering data at baseline, and a range of time points up to two years; demonstrate T2D remission and medication reduction; determine who does best on TLC; record dietary changes made by participants; report on attrition at all stages; and quantify the feasibility of a UK-wide roll-out.
More evidence refuting the Report's assertion that T2D is ‘absent or minimal’ comes from Catherine Cassell, who has recently been appointed to a new role as a lead diabetes specialist nurse working on an NHS-funded diabetes recovery programme in Somerset. ‘As a former practice nurse of 19 years I have seen soaring numbers of people living with T2D, and the already stretched primary care services are struggling to keep up with the ever-increasing demand. My knowledge and experiences have enabled me to support practices with their diabetes care, particularly focusing on developing care plans for high-risk patients, while ensuring all patients receive a comprehensive diabetes “health check” annually which includes completion of all eight care processes.’
Despite the bleak primary care landscape projected – NOT forecast – by the report, the potential to achieve remission from T2D is undeniable. This bold approach has wider application. As Campbell Murdoch notes, ‘To address this challenge, primary care needs to make metabolic health the major focus. We can prevent and reverse most of the disease tsunami we are seeing, and it's easier than many people realise.’