T1D care: NHS vs Down Under
On the NHS’s 70th birthday, I’ve been feeling grateful for the care I’ve received since returning to the UK four years ago after living in Australia for eight years. I was diagnosed just after moving to Australia and received first class care there so I was apprehensive to be moving back to the UK to face unfamiliar people, systems and processes for diabetes management. I’m glad to say that it has worked out fine (burnout aside) with no major dramas, but for anyone interested in how it works in other countries, or anyone planning to move in either direction, this is what I found.
Treatment approaches are fundamentally the same: set you up with the stuff you need to manage your T1D day to day, check ups 3-6 monthly for HbA1c and full bloods, foot checks as needed, annual retinal screening, dietician review, appointments with diabetes nurse and endocrinologist…
…as is the kit (pump and consumables, meter, testing strips, insulin etc).
But how you get them, who’s involved and what it all costs is completely different!
In Australia, this is how it worked for me.
Getting referred: GP tells me I’m probably diabetic (long story). He refers me to a local endocrinologist at a private clinic. I never speak to a GP about managing my diabetes again* (nothing personal, I just don’t need to – my endocrinologist organises everything and just reports back to him).
Seeing an endocrinologist: Become a direct patient of the endocrinologist the GP sent me to. I’m free to book my appointments direct with the clinic whenever it suits. I have to pay for the appointments (>$100 a time) but get some money back from Medicare. I have to queue up at the Medicare office in my lunch hour to get the money back. Repeat every few months for the next 8 years. If I choose, I can find another endocrinologist elsewhere if I’m not happy with my care, for whatever reason. I love my endo and never want to think about someone else looking after me. Her mobile number’s in my phone and I ring her the night I give birth for advice on my crazy blood sugars. The effect of consistent, quality, long term care.
Seeing a diabetes nurse: My endo’s sidekick sees me for 30 minutes before my 15 min endo appointment to do detailed reviews of my downloads and make tweaks to my rates. Have to pay for this appointment too. She’s also awesome and available whenever I need her. The only time I cried in an appointment was in front of her, after I’d been seeing her for about three years.
Other diabetes checks: My endo centralises everything: my prescriptions, blood work requests, referrals to the ophthalmologist, podiatrist, dietician, liaises with my health insurance company to organise my pump, writes me a “travel” letter to take to the airport. Everything diabetes related goes through her and her clinic. The clinic receptionist knows my name and is the one who tells me Michael Jackson is dead when I show up for my morning appointment one day.
Prescriptions: I get my insulin on prescription but the prescriptions aren’t free.
Getting other supplies: The National Diabetes Services Scheme (NDSS) administers the provision of glucose testing strips (not free), insulin pen needles (free), insulin pump consumables (not free). You have to register with the NDSS (which my endo sorted for me) and once you have a membership number you can fill in a form and take it to the chemist or order supplies online, and pay for what you use.
Blood tests: one of my favourite things about Australia (well, apart from the weather, people, beaches …) is that you can show up at any pathology centre with your blood work request and queue up to have your blood test done. No need to make a separate appointment, and the cost was covered by Medicare so no need to pay extra on top.
*GP: I forgot – I needed to see the GP to put together an annual care plan which stated which services I needed to see as part of my diabetes routine. I had to pay for this appointment and care plan but it meant I got a bigger rebate from Medicare on the services I was using throughout the year in managing my T1D.
Meanwhile, now that I’m back in the UK…
There’s loads of diabetes related post! It was one of the first things I noticed.
Letter from the hospital to invite me to an appointment at the insulin pump clinic. I came back to the UK wearing a pump and the NHS picked up the support of this without missing a beat. I’m thrilled and delighted to have this expertise and support on my doorstep. I don’t always see the same people at the clinic but they know their stuff and they’re nice to me.
Letter from the GP to say it’s time for my annual diabetes appointment. Feels strange because we don’t talk about my T1D management – my pump is the realm of the consultant at the hospital, but the GP has to issue the prescriptions for test strips and insulin. I have to do the repeat prescription admin but it’s easy online now and gets sent straight to my lovely local pharmacy. I don’t have to pay a penny for my prescriptions.
I get letters from the hospital calling me in for retinal screening each year, and (so far) letters afterwards that tell me my eyes are looking OK.
I get my pump supplies direct from the pump company via an account number issued by the hospital (no letters this time, it’s all on the phone).
I have to make an appointment to get a blood test at the GP surgery. I wish I could just cruise in when it suits me but now I have to be a bit more organised.
I’ve just worked out whose realm my feet are in (the GP surgery at the annual diabetic check up)…it’s been a bit confusing working out who is responsible for overseeing what in my diabetes management under the NHS and sometimes feels like a bit of a disjointed inefficient faff compared with the Aussie system but do you know what? I have cut out a lot of faff that used to come with my Aussie routine like dealing with all the medical costs admin and the Medicare rebates and I know that part of my frustration has been just because it’s a new and unfamiliar routine. And it’s the diabetes faff that I am annoyed about really…the NHS is fab.
So I hope that’s been helpful to any T1Ds thinking of moving from Australia to the UK (or the other way) to give a flavour of how things work.
And it goes without saying but I’ll say it anyway – because we should never take it for granted – that I am incredibly grateful that all of the care I’ve had under the NHS for the last four years hasn’t cost me a thing. What an incredible privilege. Happy 70th Birthday to the NHS.