SCA practice case · Telephone consultation
“So I haven’t got diabetes — I’m fine then?”
Telephone consultation
Adult patient
Straightforward
Long-term conditions & cancerInvestigations & results
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Wesley Grant · 52 years · male
Setting
Telephone — a borderline HbA1c result.
Past history
- Nil significant
- FH: father — T2DM, early MI
Medication
- Nil
Allergies
NKDA
Recent notes
⚠ NHS Health Check: HbA1c 47 mmol/mol (non-diabetic hyperglycaemia range 42–47). BMI 33. BP 146/90 (single reading). No ABPM, no QRISK3 or diabetes-prevention referral on file.
Reason for contact
Phoning about results. “Reception said it’s not diabetes — so I’m fine?”
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
An HbA1c of 47 mmol/mol is non-diabetic hyperglycaemia (pre-diabetes), NOT "the all-clear" — it is a modifiable fork in the road with real progression risk to type 2 diabetes that intensive lifestyle change can substantially reduce (and sometimes reverse). The trap is the relief-driven "I’m fine, leave it, recheck next year"; the task is to reframe it as a warning that can be acted on, refer to the NHS Diabetes Prevention Programme with realistic lifestyle advice tailored to the patient’s actual life (here a sedentary taxi driver), and treat the WHOLE cardiometabolic risk — raised BP (146/90, confirmed by ambulatory or home monitoring before treatment — NICE NG136), weight, QRISK/lipids (NICE NG238), family history — not just the glucose number, with an active monitoring plan (NICE PH38: at least annual HbA1c; BP follow-up; the 48 = diabetes threshold). The examinable hidden agenda is that the relief masks fear and fatalism from watching his father decline and die early with diabetes; convert that into motivation ("this is the warning that lets you avoid his path"), build the plan around his real day without lecturing, and safety-net hyperglycaemic symptoms. Prevention framed as agency, not passive waiting.
The guidance behind it
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