Needed: a national community pharmacy diabetes screening service

With type 2 diabetes becoming increasingly prevalent across the UK, what role can community pharmacy play? The answer: a massive one. 

Company Chemists’ Association (CCA) modelling shows that a community pharmacy type 2 diabetes screening service could deliver huge benefits to patients, primary care and the NHS.  A national screening service, along with targeted interventions, could save the NHS £50m in recurring costs every year, prevent 7,000 cardiac events annually and stop almost 15,000 people developing severe sight loss over their lifetime. 

Devastating impact 

Type 2 diabetes is one of the most common chronic diseases in the UK and its prevalence, unfortunately, is rising. The recent Darzi investigation into the state of the NHS mentions diabetes several times. Already, more than 4 million people have been diagnosed with the condition. Concerningly, another 2 million-plus are at high risk of developing it. 

Type 2 diabetes and its complications account for a tenth of the NHS’s annual budget. By 2035/36, this is projected to increase to 17 per cent. The loss of productivity and diabetes-related disability costs the UK more than £20bn annually. 

Nearly a third of people with type 2 diabetes have cardiovascular disease. One in three adults with diabetes will suffer with kidney disease. Alarmingly, diabetes is the most common cause of non-traumatic amputations in the UK, accounting for 180 procedures every week. 

It is important therefore to get a grip of the disease and its devastating impact on patient outcomes. 

Priorities and patient journeys

Keeping people healthy and in work, wherever possible, is central to the new Government’s mission to drive economic growth. As many as 25 million GP appointments a year are estimated to be dedicated to managing type 2 diabetes. Freeing up capacity within general practice is critical to this mission and better management of type 2 diabetes is an obvious first step. 

A national screening service would firmly place type 2 diabetes management within the NHS on a ‘prevention’ footing – a key shift highlighted by the Darzi review and expected in the forthcoming 10-year health plan. Such a service could screen 1.5 million adults and identify 180,000 prediabetes patients each year. It could identify 45,000 undiagnosed cases and, with appropriate treatment, prevent them from developing serious complications that require specialised care. 

It is no secret that diabetes is linked to deprivation. Prevalence of type 2 diabetes is 40 per cent higher in the most deprived communities than the least deprived. There is also a wealth of evidence that shows national commissioning of care through community pharmacy provides greater access in deprived areas. Screening for diabetes via pharmacies tackles health inequalities – a key aim for any government or commissioner. 

The basic pathway for a diabetes screening service could replicate that of the Community Pharmacy Blood Pressure Check Service launched in England in 2021. People would be identified in pharmacies and offered testing. Simple body measurements and point-of-care testing (PoCT) would take place.

Depending on the results, patients would be offered simple healthy living advice, support with lifestyle changes underpinned by continued PoCT or referral for treatment initiation from their GP. Over time, treatment could be initiated by a prescribing pharmacist. 

Greater Manchester example

Like many others, Greater Manchester Integrated Care Partnership (ICS) has identified diabetes as a key priority. Current prevalence in the region stands at 7.4 per cent higher than the national average. 

If the 600-plus pharmacies in Greater Manchester were commissioned to deliver a diabetes screening service, almost 2,000 people with undiagnosed diabetes and nearly 11,000 with prediabetes would be found. 

The successful management of such a large cohort of people at risk of diabetes-related complications could, for example, prevent 500-plus cardiac events each year. All in all, this would save the Greater Manchester economy £45m in just five years. With ICSs under increasing financial pressures, savings such as these would allow much better use of finite resources.

Innovative solution

A community pharmacy diabetes screening service really is a no-brainer. Ubiquitous screening could find people with poorly controlled disease and initiate action to support their diabetes control. It could also find those with undiagnosed diabetes and start treatment before symptoms begin, while those with prediabetes could be stopped from developing the disease altogether.

With the NHS facing the challenges highlighted by Lord Darzi and the need to find innovative solutions to better manage chronic disease, policymakers should look no further than pharmacy. A community pharmacy diabetes screening service makes sense for patients, the NHS and wider economy. 

Find out more

The CCA was commissioned by BHR Biosynex, a supplier of point-of-care diagnostics, to examine how community pharmacies could be commissioned to deliver a national type 2 diabetes screening service and what its potential benefits might be. You can read and download the CCA’s report – Increasing Access to Diabetes Screening and Prevention Through Community Pharmacy – here.