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Veronica and husband, 1987

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Veronica and husband, 1987 Veronica`s purpose-built practice Veronica, 2008
 
 
Interview 96 Veronica Wilkie

General Practitioner
Born in Windsor in 1963.


Overview: When Veronica Wilkie became a GP in Droitwich Spa in 1992, she was expected to specialise in gynaecology. Instead she chose to specialise in diabetes - `the best decision I made`. She eventually set up courses for GPs and practice nurses to gain a Certificate in Diabetes Care. Now her practice no longer needs to run a diabetes clinic – because patients can choose to see any one of four doctors and three nurses with the Certificate in Diabetes Care, at a time to suit them. She is also a Senior Clinical Teaching Fellow at the University of Warwick Medical School.

Please note that Overview relates to date of recording 04 April 2008

 Short samples

1 By the mid-1990s, there was growing awareness that sight loss could be prevented by screening people with diabetes for retinopathy. Veronica’s practice started one of the earliest retinal photography schemes on behalf of three local practices. [ 64 secs ]

2 Nowadays, the practice doesn’t wait for patients to appear with symptoms of diabetes, but actively seeks out people who are at risk, in order to work with them to delay the onset. [ 63 secs ]

 
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01 Mother teacher, father executive. Privileged education. Chose medicine – practical application of science.
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02 Birmingham University, 1982. Less than third female. Traditional – 2 years theory, 3 years on wards.
Learnt re diabetes – less than renal disease. Saw people with diabetes have renal transplants. Early pancreas transplant.
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03 In 1987, house job, gastroenterology, General Hospital. Occasionally covered diabetes – made consultants nervous. Saw ketoacidosis, sickle cell plus diabetes. Good guidelines & teaching.
Seemed Type 1 to be treated by specialists, Type 2 considered less serious.
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04 A & E. Training scheme in market town. I didn`t choose diabetes - disagreed with hospital`s approach .
After house jobs, maternity leave, then trainee GP - practice with diabetes clinic – stayed on a few months to do it. 1992, became part-time partner in nearby town – specialised in diabetes with nurse.
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05 Consultants provided good advice. Insulins more sensitive, diet relaxed. Consultants ran GP meetings.
Practice grew. New contract – chronic disease clinics – we continued as before. Early 1990s, computerised prescriptions, appointments etc. By late 1990s, fitted appointments round patients.
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06 In 1992, computers enabled audit. Also had dietitian & counsellor. Dietitian temporary, later got another – now obesity more time-consuming. Still have medical counsellor.
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07 By 1990s, DCCT Trial showed Type 1 need for control. Type 2 seen as GPs` province – hospital for complications or starting insulin. Children always hospital-led.
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08 By late 1990s, ran retinal photography scheme for 3 practices.
Began actively to look for diabetes. Knowledge improved. Insulin-dependent & complications still went to hospital.
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09 Good retinopathy. More nurses trained & doctors interested in diabetes. By 2001, paper-light, better audit. Chased people. Retinopathy for homebound. By late 1990s, some PCTs had supported doctors & nurses to get diabetes qualification. With DSNs, I set up Certificate – half of county practices have doctor & nurse with Certificate.
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10 New contract & QOF – shows how good control is. More expertise. Diabetes liaison nurses. Can help Type 1s. De-medicalising.
Better education re educating patients. Better resources where English 2nd language. Dietetic advice – normal healthy diet. Choice of staff with knowledge – at any time – no specific clinic.
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11 Test people at risk. Warn re risk - stay thin. Good information from Diabetes UK. General public more aware. Diabetes led way in multidisciplinary teams.
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12 Would like to employ diabetes liaison nurses – currrently hospital-based. Consultants starting to come into community.
Horror stories from non-diabetic wards – not allowed to administer own insulin. Students meet our patients.
District nurses support housebound.
More research. New drugs.
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13 UKPDS - importance of control for Type 2s. Began to look at physiology of diabetes. Exenatide, new gliptins. Hospital care pathways. Podiatrists better trained. Warn re possibility of insulin – not failure. Older people have other conditions.
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14 Dietitian sees family`s main cook – constant support – healthy diet for all. Obesity increasing – everyone needs to know re diabetes.
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15 Knowledge better, but I have eye on computer for what needs measuring. Continuity of care eroded. People living longer to get other diseases.
GPs get points for tests. We did well because computerised – used money for extra staff. Penalises inner-city practices with greater needs.
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16 For pregnant women, in 1992, consultant-only care. Now GP must do pre-conceptual counselling. Multidisciplinary team at hospital, looking for diabetes, avoid neonatal death. In late 1980s, most Caesarian – now normal delivery possible.
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