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Bedfordshire

First response from the diabetes lead

​Dear Nick

Thank you for your email;  I have forwarded to the CCG Medicines lead for a reply.  We already have limited access to the Libre along RMOC lines and anticipate adopting the new guidance in full.

Yours

Final Response
Comprehensive reply from Bedfordshire CCG (original letter) :


Dear Mr Cahm
FreeStyle Libre®Glucose Monitor
Thank you for your letter regarding the availability of the Freestyle Libre® Glucose Monitor on the NHS in Bedfordshire.
In June 2018, the Bedfordshire and Luton Joint Prescribing Committee (JPC) agreed to support the prescribing of Freestyle Libre® in adults and children in line with the recommendations produced by the East of England Prioritise Advisory Committee (EoEPAC). In addition Bedfordshire CCG agreed to fund Freestyle Libre® subject to minor amendments in line with the JPC recommendations and criteria outlined in the bulletins below:
·Bulletin 266: FreeStyle Libre ® (Flash Glucose Scanning {FGS}):- Locally agreed J…

Ashford

Here is Ashford CCG confirming that they are treating my letter as a FOI request.

Dear Mr Cahm,

RE: Freedom of Information Request

I am writing to formally acknowledge your request for information regarding Freestyle Libre Policy Update, which will be processed under the Freedom of Information Act 2000. I can confirm your request was received on 14 March 2019 by NEL on behalf of the Clinical Commissioning Groups (CCGs) listed below. The references for your requests are shown alongside.

EK125.FOI.18.ASH281      NHS Ashford CCG

An initial investigation is currently taking place into whether the information you have requested is held by the CCGs and if so, whether it can be released in accordance with the legislation.

Any fees applicable to this request will be detailed in writing as soon as they can be determined. Your request will then be placed on hold and you will have the choice of whether to proceed with your request. Should any clarification of your request be required we will adv…

Calderdale

First response 13/03/19 - passed to another contact for further comment.

Nick

Thanks for getting in touch.

I am the Planned Care SRO for the West Yorkshire and Harrogate STP. Within my programme, heads of medicines management are working together to produce a commissioning position statement and policy for freestyle libre. We already have a consistent approach to this across the Kirklees Wakefield and Calderdale CCG areas. <name removed> is the pharmacy lead in Calderdale and part of the pharmacy leadership group doing the work. I really would be anxious that we do not set off several pieces of work all intending to do the same thing, and would be keen to ensure that your work is aligned to the broader policy work that we are doing.

Best Wishes

Coventry, Rugby & South Warwickshire

Response:

Dear Mr Cahm,
Thank you for your recent email.  I can confirm that following discussion at a meeting of the Governing Body today, it has been agreed that South Warwickshire CCG will be commissioning in line with the national eligibility criteria from 1st April 2019.  Please see Annex A in the attached NHS England document for the appropriate criteria.
Yours sincerely
I replied:
Dear ,
Thanks for this information.  As it is not stipulated in the national eligibility criteria, please can you confirm how prescribing will be initiated?  The original S Warks/Cov & Rugby policy said that the initiation needed to be via the Cov & Rugby IFR team.  I presume that this will no longer apply?
Thanks,
and received this reply:
The current arrangements of specialist referrals will continue until  1st April and then from April onwards prescribing will be via GPs, and there is currently some work in progress involving liaison with the Diabetes network relating to the specifics of the impl…

Bromley

From Meds Management:

Dear Nick

Please could you answer the following two questions: 1)Your plans for meeting the NHS England Libre policy
Bromley CCG is part of the SEL Area Prescribing Committee and we have agreed our own guidance which is very similar to the NHSE guidance, available here, but in recognition of this NHSE guidance the SEL guidance will be updated to incorporate any details, missed.  These meetings are taking place in April. Moving forward the SEL guidance will reflect all recommendations in the NHSE guidance
2)How the Libre prescribing process will be handled? Will it be Red, Amber or Green listed
The prescribing of Flash Glucose monitoring will be Amber listed in Bromley, SEL .  This means that it will be initiated under the care of the specialist diabetes clinics and once the patent is stable prescribing will be transferred to their GP. Patients will be seen at their next routine appointment.

Herts Valley

Response from Meds Management:

Dear Mr Cahm,
Thank you for your letter dated 21st March 2019.
Following publication of NHS England’s guidance on funding arrangements for Flash Glucose Monitors (issued 7 March 2019) https://www.england.nhs.uk/publication/flash-glucose-monitoring-national-arrangements-for-funding-of-relevant-diabetes-patients/there are ongoing local discussions. Nationally it is expected that starting these products will be done for the selected groups via the patient’s existing diabetes specialist with continuation by their GP.  Before prescribing can take place we need to agree how to prioritise patients for starting treatment and howeducation and training for patients is offered.
Progress is being made and further discussions will take place at the Hertfordshire Medicines Management Committee (HMMC) meeting on 4 April 2019. Currently, FreeStyle Libre® is not advised for prescribing in primary care; we will continue to follow existing HMMC guidance, where FreeStyle Libre®…

Darlington

FOI acknowledgement:

Our reference: D1437 - Acknowledgement 
Thank you for your Freedom of Information (FOI) request, received at Darlington CCG.
Your request is being dealt with under the terms of the Freedom of Information Act 2000 and will be answered within twenty working days.
In some circumstances a fee may be payable. If that is the case, I will let you know. A fees notice will be issued to you if appropriate. You will be required to pay the relevant fee before we will proceed to deal with your request.
If you have any queries about this request or wish to contact us again, please email the address above and the message will be forwarded appropriately. Please remember to quote the reference number above in any future communications.

Portsmouth

Reply from Medicines Optimisation

Dear Nick,
Your letter has been passed to me to answer the questions you raise regarding the prescribing of FreeStyle Libre.
Portsmouth CCG along with South Eastern Hampshire and Fareham and Gosport CCGs work together with the specialists at Portsmouth Hospitals Trust and recommend guidance around prescribing through the Area Prescribing Committee. The FreeStyle Libre guidance was approved in May last year and can be found at the link below.
https://www.portsmouthccg.nhs.uk/Downloads/Meds%20management/Portsmouth%20FreeStyle%20Libre%20Information%20for%20Primary%20Medical%20Care%20Teams%20v2.pdf

As you can see from the schematic the initial 6 months is provided by the diabetes centre in Portsmouth. This results in the first 6 months of any prescribing not being included in the prescribing data for the CCG. So while FreeStyle Libre is not Red it is considered Amber for secondary care initiation.
The Portsmouth Area Formulary status can be seen at the fol…

Birmingham/Solihull CCG

Response from Medicines Management

You are perfectly correct that the national intent is of no great surprise and I am sure that you aware that we have advanced plans to release our policy statements on both Flash and Continuous Glucose Monitoring.  We have always aimed to release them in advance of April and they are largely there bar final sign off from our providers, which we do not anticipate to be a major problem.
The guidance issued last week by NHSE has introduced some delay into the process as we now need to update both of our policies to reflect the revised cohort of eligible patients – they are actually a bit different from the original RMOC criteria and are certainly wider.  I am sure you will agree that it would be improper to release guidance based on the RMOC criteria when these have been superseded with what we should probably term NHSE criteria.
As I am sure you are aware, although we have not formally released our guidance, our providers have been working to the document…

Hastings & Rother

Meds Management response:
Dear Mr Cahm
Thank you for your letter. I can confirm that from 1st April 2019 Hastings and Rother CCG shall be commissioning FreeStyle Libre in line with the NHS England guidelines published on 7th March.
Unfortunately I am unable to provide a more detailed update at present  as we are currently working with our specialist diabetes service to develop the process. However, I can advise that the specialist diabetes team will be identifying suitable patients for a trial of FreeStyle Libre and will write to their GP asking them to prescribe the sensors for the duration of the trial period. FreeStyle Libre will therefore have orange status on the East Sussex Formulary (for specialist initiation only).
I hope this provides you with sufficient assurance that this matter is in hand.

Dudley

Response from diabetes team:
[1] we already an existing policy with Dudley CCG that meets RMOC [2] we do not have a traffic light system – suitable patients meeting clinical and educational criteria will be put on Libre following diabetologist assessment.
and a second email after I asked about how they were planning to prescribe
GP continue prescription of sensors for 6 months if improvements are confirmed.
I'm awaiting a response from the Meds Management team too.

East Surrey

Information from Meds Management:

Dear Nick Cahm,
Thank you for your  enquiry on ESCCG’s Freestyle Libre policy.
The CCG's  current decision remains the same until the 1st April 2019 (see ESCCG updated position statement from November 2018: https://surreyccg.res-systems.net/pad/Search/DrugConditionProfile/5674).
East Surrey CCG are in the process of implementing the national arrangements as described by NHS England, in readiness for the 1st April 2019. An update to the position statement and prescribing information will be made available on the Surrey PAD from this date.
I hope this helps with your query.

Milton Keynes

FOI Acknowledgement

ACKNOWLEDGEMENT OF FREEDOM OF INFORMATION REQUEST
FOI Reference: 000323
Dear Sir/Madam
I acknowledge receipt of your FOI request on behalf of Milton Keynes CCG which we received on 22 Mar. 19 A response to your request will be sent within 20 working days after receipt, the date being 19 Apr. 19
Yours faithfully

East Leicestershire & Rutland

Prize for the most complete answer - (Link to Original Letter)

Dear Mr Cahm

Freestyle Libre

I write further to your letter of 21st March 2019 in which you asked the following two questions:

1. Your plans for meeting the NHS England Libre policy
2. How the Libre prescribing process will be handled? Will it be Red, Amber or Green listed?

In February 2019 a Leicester, Leicestershire and Rutland prescribing position statement was issued onto the Leicestershire Medicines Strategy Group (LMSG) website. This took effect from 1st February 2019 to 31st March 2019.’Freestyle Libre® is approved for use in Leicester Leicestershire and Rutland from 1st February 2019 where a patient meets the following criteria detailed in the RMOC guidelines for the use of this product.’

This was issued following the RMOC guidance and further to this, the necessary documents to support this were made available on LMSG website. The link to the most current guidance is below.
https://www.lmsg.nhs.uk/traffic-lights/v…

Harrow

Short!

Dear Nick,

I can confirm that the process for adopting the NHSE guidance will be implemented across NWL by all of the CCGs and will be based on a London wide process, similar to when the product became available.

Regards,

Brent CCG

Initial response 18/3

Dear Nick Cahm,

I am writing to acknowledge receipt of your enquiry dated 16 March 2019 which was sent to the Brent CCG public enquiries generic email address:  BRECCG.Brentenquiries@nhs.net.

Please be advised that we are dealing with your enquiry and our aim is to respond to you as soon as possible, no later than 20 working days from receipt of the enquiry.  If there are exceptional circumstances that mean the CCG is unable to respond within these timescales you will be notified accordingly.

In the meantime if you require any further information please do not hesitate to contact me via the generic email address above.

Blackburn with Darwen CCG

Detailed initial response from this CCG - suspect that they may reply for other CCGs too.


19 March 2019
Dear Mr Cahm,
I am writing in relation to your email dated 15 March 2019, in which you raise concerns regarding NHS Blackburn with Darwen Clinical Commissioning Group (CCG) policy for the prescribing of Freestyle Libre®. I understand that you have self-funded Freestyle Libre® since its launch and you run several support groups for users of the monitor.
You state that through research you have noted that when Regional Medicines Optimisation Committee (RMOC) guidance was released, some CCG policies mirrored the RMOC guidance, some cherry-picked sections and a couple chose a different path entirely.You have also identified that according to the latest data NHS Blackburn with Darwen CCG is only prescribing Freestyle Libre® to 0.9% of the total Type 1 diabetes patient population in the area; through Primary Care prescribing. However, this does not consider the ‘Red’ rating currently adopted …

Berkshire West

First reply from Diabetes Lead on 14/3

Good morning Nick, I do not set the parameters for the CCG, but the SOP for this is that we have been allowed to issue 200 devices for adults, and 100 for children up to April 1st, and existing self funding users are able to have FSL prescribed if they meet the same criteria for new starts, which are testing or used to test >8 time day, hypoglycaemia, but not for those with reduced awareness, or people being considered for CSSI

I think this might require further discussion!

Southend

FOI Acknowledgement:

FOI Request: FreeStyle Libre Glucose Monitoring Sensors
Our Reference Number: 1819425

Dear Mr Cahm,

I am writing to acknowledge receipt of your request under the Freedom of Information Act 2000 to NHS Southend CCG on 18th March 2019. The information is currently being collated and a response will be sent to you no later than 20 working days. The deadline is calculated to be 15th April 2019.

If you have any queries regarding your request, please do not hesitate to contact the FOI team on this email address.

Cambridgeshire & Peterborough CCG

First reply:

Thank you for your email.  We have passed it onto a senior clinical pharmacist who will review the request and will take the required action to address it.   The senior clinical pharmacist will feedback to you the outcome of their investigation.
If your request is clinically urgent advice can be accessed by phoning 01480 387125.  Service Available: Monday to Friday from 0900 to 1600.    Outside of these times you can contact the hospital’s pharmacy service if you have medicines information queries relating to patients cared for in hospital.
Thank you for using this service.
Medicines Optimisation Team Cambridgeshire & Peterborough Clinical Commissioning Group

Camden, Enfield and Haringey CCGs

The three CCGs come under the North East London area, so have had a single reply to my email.  Not sure why St Patrick's Day is counted as some sort of non-working day...that's a new one on me!

Dear Mr Cahm
RE: Freedom of Information Request
I am writing to formally acknowledge your request for information regarding the prescribing of Freestyle Librewhich will be processed under the Freedom of Information Act 2000. I can confirm your request was received on 19 March 2019 (18 March 2019 is not counted as a working day due to St Patrick’s Day) by NEL on behalf of the Clinical Commissioning Groups (CCGs) listed below. The references for your requests are shown alongside.
FOI.18.CAM266 NHS Camden CCG FOI.18.ENF257 NHS Enfield CCG FOI.18.HAR4359 NHS Haringey CCG
An initial investigation is currently taking place into whether the information you have requested is held by the CCGs and if so, whether it can be released in accordance with the legislation.
Any fees applicable to this reques…

Bexley

FOI acknowledgement:

We acknowledge receipt of your FOI request and will revert in due course.
Kind regards
FOI ADMINISTRATOR NHS Bexley CCG – a member of the NHS South East London Commissioning Alliance (NHS Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark CCGs)
Tel: 020 8298 6000 Email: bexccg.foi@nhs.net Web: www.bexleyccg.nhs.uk
2 Watling Street, Second Floor West, Bexleyheath, DA6 7AT

North Tyneside

FOI Confirmation:

Our reference: NT4093 - Acknowledgement 
Thank you for your Freedom of Information (FOI) request dated 19 March 2019 received at North Tyneside CCG.
Your request is being dealt with under the terms of the Freedom of Information Act 2000 and will be answered within twenty working days.
In some circumstances a fee may be payable.  If that is the case, I will let you know.  A fees notice will be issued to you if appropriate. You will be required to pay the relevant fee before we will proceed to deal with your request.
If you have any queries about this request or wish to contact us again, please email ntccg.foi@nhs.net.  Please remember to quote the reference

RESPONSE
Link to FOI Response
Key text:
North Tyneside CCG support provision of Freestyle Libre in line with the RMOC criteria. This is currently through provision via secondary care in line with the NTAG policy.
NTAG is aware of the new NHS England guidance and have committed to review their current policy  before…

Hartlepool & Stockton

FOI Confirmation

Our reference: HS1476  - Acknowledgement

Thank you for your Freedom of Information (FOI) request, received at Hartlepool and Stockton on Tees CCG.

Your request is being dealt with under the terms of the Freedom of Information Act 2000 and will be answered within twenty working days.

In some circumstances a fee may be payable. If that is the case, I will let you know. A fees notice will be issued to you if appropriate. You will be required to pay the relevant fee before we will proceed to deal with your request.

If you have any queries about this request or wish to contact us again, please email the address above and the message will be forwarded appropriately. Please remember to quote the reference number above in any future communications.

North East Essex

Response from diabetes team...PALS?  A useful service, but not sure it's appropriate for this!

Hi Nick,
We have been advised by the CCG to divert any queries into the CCG pals department (01206918730).
I have a meeting arranged for early April about how NHSE criteria will be taken up and rolled out locally and have been telling other patients asking that NEEDS will put an update on our website and social media as soon as we know the plan. Details below on my signature.
Reply from PALS
Good morning Mr Cahm,

Thank you for your Email regarding Freestyle Libre Sensors.

We are aware that the government announced on World Diabetes Day that Flash Libre will be available on prescription across England to those who meet certain criteria from April 2019.  


However, to date we have had no confirmation on how the guidance will work from April. The CCG is currently reviewing the guidance and an update will be published as soon as a decision has been confirmed.

Northumberland

FOI acknowledgement:

Our reference: N1428  - Acknowledgement
Thank you for your Freedom of Information (FOI) request dated 19 March 2019 received at NHS Northumberland CCG.
Your request is being dealt with under the terms of the Freedom of Information Act 2000 and will be answered within twenty working days.
In some circumstances a fee may be payable.  If that is the case, I will let you know.  A fees notice will be issued to you if appropriate. You will be required to pay the relevant fee before we will proceed to deal with your request.
FOI Response
Northumberland CCG support provision of Freestyle Libre in line with the RMOC criteria. This is currently through provision via secondary care in line with the NTAG policy.  NTAG is aware of the new NHS England guidance and have committed to review their current policy before the end of March to ensure patients in the region can access Freestyle Libre as outlined in the national publications. Northumberland CCG will follow that policy.

BNSSG

A response I guess...but rather disappointing...especially from the second largest CCG.

Dear Mr Cahm,
Thank you for your letter dated 18th March 2019.
I have attached the current BNSSG CCG response to the Freestyle Libre Device enquires. This is the most up to date information that we are currently able to offer.
The CCG website will be updated as actions are agreed.
Thank you for contacting us.
This is what is on the attachment:

Basildon & Brentwood

Initial response from Basildon and Brentwood CCG (also Thurrock and Mid Essex)

FOI Request: FreeStyle Libre Glucose Monitoring Sensors
Our Reference Number: 1819416

Dear Mr Cahm,

I am writing to acknowledge receipt of your request under the Freedom of Information Act 2000 to NHS Basildon and Brentwood CCG on 13th March 2019. The information is currently being collated and a response will be sent to you no later than 20 working days. The deadline is calculated to be 12th April 2019.

If you have any queries regarding your request, please do not hesitate to contact the FOI team on this email address.

A reply from the Diabetes Clinic (15/3)

Dear Nick Thank you for the letter. I will direct this to our team lead who will answer this when she is next in the office next week. Hope that is ok.
and a second reply on 18/3:
Hi Nick,

Thank you for your letter. From a DSN point of view we are keen to prescribe. We are bound by our medicines management team and we are awaiting instructions of how and…

South Tyneside

FOI confirmation

Dear Mr Cahm
Thank you for your Freedom of Information (FOI) request dated 19th March 2019, received at South Tyneside CCG.
Your request is being dealt with under the terms of the Freedom of Information Act 2000 and will be answered within twenty working days.
In some circumstances a fee may be payable.  If that is the case, I will let you know.  A fees notice will be issued to you if appropriate. You will be required to pay the relevant fee before we will proceed to deal with your request.
If you have any queries about this request or wish to contact us again, please email stynccg.foi@nhs.net.  Please remember to quote the reference.
Yours sincerely

Surrey Downs

Response from Diabetes Specialist on 15/3

Dear Nick,

Thank you for your email. I have passed the request on to our communications team who can liaise with medicines management to respond to your request.

It is indeed excellent news that funding for Libre will be centrally determined from April and I'm confident we will soon hit the expected 20% threshold.

Greater Preston and Chorley and South Ribble

Single response from both CCGs:

Dear Mr Cahm,
Thank you for your enquiry in relation to the Freestyle Libre policy.  Please be advised that your enquiry has been logged on our system and forwarded to the relevant department within the CCG, and a response will be provided as soon as possible.
We note that you have also emailed NHS Greater Preston CCG with the same enquiry.  We can confirm that the response provided will relate to both NHS Chorley and South Ribble CCG and NHS Greater Preston CCG.

South Warwickshire

Initial response from CCG:

Dear Mr Cahm,
Thank you for your recent email.  I can confirm that following discussion at a meeting of the Governing Body today, it has been agreed that South Warwickshire CCG will be commissioning in line with the national eligibility criteria from 1st April 2019.  Please see Annex A in the attached NHS England document for the appropriate criteria [the national policy, which I am well aware of!].
I have gone back to them and asked how prescribing will be initiated.

BaNES

Confirmation of FOI request:


Swale

FOI confirmation


So, everyone's going to get Libre on prescription on 1st November?!

In short, they're not. Nobody has them on prescription yet (edit 03/11/17 - almost nobody - there is some evidence that a few people might have them, but yet to be totally convinced). There are a small number that have persuaded their doctor/specialist to fund, but it's difficult to know exact circumstances and it hasn't been done in a coherent way.

The situation became different from 1st November, in that it is now possible to prescribe the Libre. However, the budgets are controlled by the local health authority (CCG) and ultimately they decide whether to fund or not and who to fund it for. There could be a chance that a GP/Specialist could go 'maverick' and prescribe without authority...but like current funding, will be rare and not coherently managed.

The problem the CCG have is two-fold. Firstly, budgets run from April to April. Starting funding in November means that they'll have to find extra cash from somewhere to fund the Libre - at least initially, it…