Dr Patrick Burch, University of Manchester, School of Health Sciences, Division of Population Health, Health Services Research & Primary Care.

Working at the sharp end of an NHS initiative: Making sense of GP and nurse views on the NHS Diabetes Prevention Programme


Dr Patrick Burch, University of Manchester, School of Health Sciences, Division of Population Health, Health Services Research & Primary Care.

Date: 07 February 2018

The NHS Diabetes Prevention Programme (NHS DPP) is a large, ambitious project to help prevent type 2 diabetes in those high risk patients identified with pre-diabetes. Through its Health Services and Delivery Research (HS&DR) programme, the National Institute for Health Research (NIHR) has commissioned a team of researchers at the University of Manchester to study the effectiveness of this programme. There are several strands to our planned evaluation as detailed in this post on the topic.

I am a practicing GP who has recently returned to academic work after several years solely in clinical practice. After carrying out some part-time research work within the Centre for Primary Care in the University of Manchester, I was successful in gaining an NIHR In-Practice Fellowship. I joined the NHS DPP evaluation team in Manchester in September and have been funded to carry out the part of the project that evaluates health care professionals’ attitudes towards the NHS DPP. I will carry this out alongside my clinical work as a GP in Buxton.

We anticipate the majority of referrals to the programme to come from primary care professionals who have identified patients as being pre-diabetic. I will be interviewing selected primary care clinicians (i.e. GPs and nurses) and groups of clinicians to understand how and why they are referring patients into the programme, whilst my colleagues in the wider team will analyse the number and types of patient referrals around the country. Our approach is designed to help understand the human factors involved in the interaction between professionals, patients and the NHS DPP.

We know from previous research, and I know from personal experience, that some clinicians are sceptical about the validity of pre-diabetes and the benefits of diabetes prevention(1,2). It can be frustrating and seem fruitless as a GP to try to get some people to change behaviours. Health promotion and disease prevention often requires working with a lot of patients, many of whom are unable or unwilling to change unhealthy behaviours. My work is going to explore these topics, in relation to diabetes prevention, with health care professionals and come to an understanding as to how clinicians’ attitudes and behaviours might be influencing patients’ access to and interaction with the programme.

Among the questions we are interested in answering are:

  • How have practices identified patients to refer to the NHS DPP?
  • What are the views of clinicians of the NHS DPP and diabetes prevention in general?
  • Are there some groups of patients that clinicians think are not suitable for the programme?
  • What are professionals’ views and experiences of discussing diabetes risk and prevention with patients?

We aim to start recruitment of clinical staff to interview in the next few weeks. When our interviews are completed and data are analysed, we hope to have a rich overview of how primary care staff view and interact with the NHS DPP. Along with other strands of our evaluation, this will help inform commissioners and policy makers in deciding the future direction of NHS diabetes prevention.

More information on how to sign-up to the study is available on the NHS DPP website

*Dr Burch's blog was originally published on the Collaboration for Leadership in Applied Health Research and Care - Greater Manchester (CLAHRC GM) website.

1. Lawlor DA, Keen S, Neal RD, Orrell M, Rance J, Belcher S. Can general practitioners influence the nation’s health through a population approach to provision of lifestyle advice? Br J Gen Pract. 2000 Jun 1;50(455):455–9.
2. Lehmaan R. Richard Lehman: Pre-diabetes: can prevention come too soon? [Internet]. 2016 [cited 2017 Nov 16]. Available from:

The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health and Social Care.
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    Patrick Burch explains how an NIHR-funded study is evaluating health care professionals' attitudes towards the NHS Diabetes Prevention Programme (NHS DPP)
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    Dr Patrick Burch, University of Manchester, School of Health Sciences, Division of Population Health, Health Services Research & Primary Care.

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