I recently attended the Middle East and North Africa (MENA) Diabetes Forum, which was held in Dubai in December 2010. The countries in the MENA region have amongst the world's highest prevalence of diabetes, driven by rapid changes in income, lifestyle, diet and physical activity. The forum covered a range of issues, from prevention, early diagnosis, and effective treatment. There were also sessions in which policies from other countries, such as the UK, USA and Italy, were discussed so that these policies from other health systems could be examined to see what lessons they might offer the countries of the MENA region. Amongst the speaker were Professor Tawfik Khoja, Professor Jean-Claude Mbanya, Professor Salman Rawaf, Professor Ala Alwan and former US President William (Bill) Clinton. I spoke about the UK experience of implementing screening programmes for diabetes and the UK pay for performance framework that encourages primary care physicians to provide high-quality care to people with long-term illnesses such as diabetes. You can view articles on diabetes prevalence, diabetes management and on risk factors for diabetes in the Gulf in the journals PLoS One, PLoS One and JRSM Short Reports respectively.
NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...

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