Clinicians working within primary care services tend to do so in isolation and without direct access to investigative resources. This places emphasis on the clinician’s abilities to perform a focused clinical examination and employ sound clinical decision-making processes to reach a definitive diagnosis. This article looks at the case history of a patient presenting to a GP out-of-hours service with an acute, undifferentiated illness, and explores the decisionmaking processes used by the author, a trainee advanced nurse practitioner at the time, to support a working diagnosis and justify a clinically suitable management plan.
Diabetes care takes up around 10% of the total NHS budget (Diabetes UK, 2015), and as type 2 diabetes mellitus (T2DM) makes up around 90% of all diabetes, it could be argued that prescribing for this largely preventable condition is the main culprit responsible for these costs. However, most of the money spent on treating diabetes is for managing its complications (Kerr, 2011). The key to preventing these complications is through effective prescribing aimed at reducing them. Possibly as a result of more clinicians thinking this way, prescribing costs for diabetes have been rising steadily (Health and Social Care Information Centre [HSCIC], 2014). So, how can clinicians be sure that newer and more expensive therapies are both clinically and financially effective? And crucially, how do clinicians ensure that patients are kept at the centre of all consultations and are fully involved in the decision-making process?
