Older people with Type 2 diabetes, including those with chronic kidney disease or dementia, are commonly overtreated with sulfonylurea or insulin therapies.

Aim: To evaluate potential overtreatment with sulfonylurea and insulin therapies amongst older people with Type 2 diabetes, including those with chronic kidney disease or dementia.

Methods: Using the ECLIPSE Live software tool, we developed a search to examine data on older people (age ≥ 70 years) with Type 2 diabetes, who were prescribed sulfonylurea or insulin therapies over the previous 90 days. Sixteen Norfolk general practices participated, representing a population of 24 661 older people, including 3862 (15.

A case study exploring employment factors affecting general practice nurse role development.

Aim: The aim of this study was to explore the factors affecting role development in practice nursing in the United Kingdom.

Background: General practice is currently central to National Health Service reform, producing favourable conditions for the practice nurse role to be further strengthened and developed. However, the literature has continued to describe evidence that practice nurses are a disempowered, isolated group with many constraints reducing their ability to respond to opportunities to develop their role.

The reconfiguration of hospital services: is there evidence to guide us?

Many argue that the solution to the NHS's quality and financial problems lies in the continuing reconfiguration and centralisation of hospital services. However, an ageing population requires good local access to care. This paper reviews the evidence that is available to help guide the reconfiguration of hospital services.

Integrating care across a challenged local health economy: the West Norfolk Health and Social Alliance.

A Health and Social Care Alliance established in 2012 and selected as a national 'Integration Pioneer' site is exploring how integration can address local system challenges faced in many health economies across the UK. The original programme focused on data gathered from the evaluation of the national Integration Care Organisation pilots - there were three in West Norfolk - about patient experience, aiming to develop stronger early community interventions in a more coordinated way to keep people independent longer. The early programme initiatives have created a firm partnership, innovative services and a good foundation on which to build, which has been a strength as the local health economy now faces a huge financial and clinical sustainability challenge in its current configuration.