chapter  23
19 Pages

Reorganising Chronic Disease Management

Diabetes and bureaucratic technologies in post-war British general practice
WithMartin D. Moore

Using a case study of non-insulin-dependent diabetes mellitus, this chapter examines the emergence of chronic disease management model in post-war Britain. By 1993, subsequent Conservative governments had introduced distinct incentives for 'chronic disease management' clinics, issued protocol to outline process measures required for chronic disease payments, and incorporated a number of chronic diseases in new target-based public health programmes. Diabetes mellitus provides an effective case study for many of the key developments in post-war service changes in relation to chronic disease. By the early 1950s, diabetes was considered a metabolic disorder or syndrome, primarily caused by a deficiency of, or insensitivity to, insulin. Nonetheless, the equation of managed chronic disease care with good general practice underlined both the extent to which general practice was reforming around new sets of disease, and how far end-of-the-century visions of general practice had shifted away from earlier interest in facilities, practitioner intelligence and time management.