OBJECTIVES: In the UK, the National Health Service (NHS) is under immense pressure to demonstrate efficient allocation of funds to the treatment of patients leading to measurable improved health outcomes. To mitigate these pressures, primary, secondary and remote care systems have explored ways to effectively define the right treatment setting for patients that minimises financial burden and improves treatment outcomes. Our aim was to explore the effect of treatment settings on the costs and health outcomes of executing treatment programs such as Blood Glucose Maintenance (Diabetes) programs within the NHS.

METHODS: A targeted literature review was conducted in the last year, focussing on the costs and burden of diabetes in various treatment settings. Both patient and healthcare perspectives were included in the review process.

RESULTS: Treating patients in a primary care setting allowed specialists to provide general practitioners (GPs) treatment decisions without patient attendance at the secondary care setting; making an average cost saving of £1,800-£2,500 per patient per year. Within the primary care setting further cost savings were observed when the some operational burden was shifted from the GPs to the practice nurses. This leads to increase in workload for practice nurses, where the average number of reviews increased from 175 in 2002 to 334 in 2011 (+£6 million on nurse reviews for all practices in 2012). GP time savings were however insufficient to cover the costs of additional nurse consultation time.

CONCLUSIONS: As the population with diabetes grows each year, the pressures on the primary care setting for the treatment management of diabetes are only going to increase which is unfeasible based on current findings. Further research is required to explore the wider impact of treatment setting choices and other avenues for patient treatment to reduce cost and burden.