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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…

Greater Huddersfield and North Kirlkees

Final Response

East Kent CCGs - Ashford, Canterbury & Coastal, South Kent Coast and Thanet CCGs

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

Dorset

Reply from Meds Management:

Dear Mr Cahm,
Thank you for your e-mail about FreeStyle.
In response to your two questions I can confirm that:
1) Dorset CCG plans to commission FreeStyle Libre sensors in line with the recently published NHS England criteria for the allocated number of patients with Type 1 diabetes And 2) The commissioning statement will be updated to reflect the agreed Amber status. Patients will be initiated and then monitored by secondary care for 6 months, in line with NHS guidance, and when appropriate will be transferred to primary care for continued prescribing.

Doncaster

Oh dear....

Good morning

Thank you for your e-mail, I have passed this enquiry onto our Head of Medicine Management and he has asked me to contact you back with the following link

http://www.doncasterccg.nhs.uk/10614/flash-glucose-monitoring-support-for-people-with-type-1-diabetes/  and that it is Amber Guidance status

Regards

My response (nothing received since) Dear ,
Unfortunately, that is not the response I am looking for and is out of date.
On 14th February 2019, national guidance was issued by NHSE that specified the the Libre "postcode lottery" would end on 1st April.  They also detailed the cohort of patients to whom Libre would have to be provided, otherwise CCGs would be financially disadvantaged.  Details about the RAG status and how Libre prescribing was to be initiated is the responsibility of the individual CCGs, hence I am contacting many of them to find out what is happening.
The policy is here: https://www.england.nhs.uk/2019/03/nhs-england-publishes-guidanc…

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

Final policy now available via NTAG website.
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.
I'm still waiting for the official response, but this response has been sent to a Libre group member (thanks Rachel!):
I have contacted my colleague in Medicines Management and he has advised me that the CCG…

Shropshire

FOI acknowledgement:

Thank you for your request for information. Your request was received on Thursday 28 March 2019 and I am dealing with it under the terms of the Freedom of Information Act 2000.

Your request was received for the following CCGs:

CAS-04261-T6S1R1-SHShropshire CCG

Bassetaw

FOI Response: Dear Nick

FOI_19_51

Thank you for your recent request for information under the Freedom of Information Act.  Please see our responses highlighted below.

1)     Your plans for meeting the NHS England Libre policy

Our local agreement with our neighbouring CCG and local hospital is similar to the NHS England Policy – we will discuss with these other organisations what changes need to be made to our local pathway

2)     How the Libre prescribing process will be handled? Will it be Red, Amber or Green listed?

Freestyle Libre is currently available to our patients who meet the local criteria and is initiated by diabetes specialists; therefore please see answer to first question, depending on what final pathway is agreed will determine what changes to the pathway are then made.

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.

Swindon

FOI acknowledgement:

Dear Mr Cahm
Thank you for your request for information which we received on 25 March 2019 regarding documents and services relating to Freestyle Libre.
I am pleased to acknowledge your request on behalf of the following Clinical Commissioning Group (CCG):
NHS Swindon CCG
We will be dealing with your request for information in accordance with the Freedom of Information Act 2000.
Under the Act we have 20 working days to respond to your request and we expect to be in a position to reply to you by 24 April 2019.

FOI Reply

Croydon

FOI Response (Original)



Sheffield

And the booby prize goes to Sheffield (I love Sheffield and I'm saddened by this nonsense response).  This is literally the full response:

Discussions are being held at our Area Prescribing committee re plans for meeting the NHS England Libre policy and the associated prescribing processes.

Minutes once agreed can be found here https://www.intranet.sheffieldccg.nhs.uk/area-prescribing-group.htm.

The minutes are published around two months in arrears!

This is my response:

I'm afraid this isn't an acceptable response.  Patients will be asking me and you what the plans are.  If I use the website suggested, it will be at least two months before any information is released.  The new NHS policy came into force yesterday and your CCG is now losing money every day that Libre isn't being prescribed.  Justifying this will not be easy. 
I am not trying to be difficult - it is just that I get many requests from all over the country.  I have contacted 135 CCGs in the past month and t…

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.
Final Response
Here's the reply from then (arrived 06/04)

Hull and East Riding

From the Diabetes Team:Dear Nick,
Thank you for copying me into this letter . I can allay your concerns because the prescribing for FreeStyle Libre from Hull University Hospitals Trust to the Hull and East Riding CCG’s is on a ‘red’ basis. FreeStyle Libre prescription was agreed with the CCG’s together with a structured education programme for new users before the RMOC criteria were created and subsequently the full RMOC criteria where adopted. Hull hosts the ABCD Nationwide Audit of FreeStyle Libre and was one of the largest contributors of data on people with diabetes using FSL to the audit. The very encouraging  preliminary findings were presented at the recent Diabetes UK meeting in Liverpool (see press release on the ABCD website)
https://abcd.care/abcd-nationwide-freestyle-libre-audit-shows-improved-diabetes-control-people-type-1-diabetes-during
The specialist unit is already working with local commissioners towards implementing the newly-revised guidance, at which point prescript…

Barnsley

Final Response (rather comprehensive).
Dear Nick

In response to your request for information I have received the following details:-

The Barnsley CCG has a Freestyle Libre within its Formulary and an initiation plan in place via protocols.

1) Current Barnsley protocols for adults and children – web links are provided below. These are currently being amended in line with national guidance ( Feb 19)  in respect of eligible patients. This amended draft guidance is currently being considered by the Local Medical Committee with the aim of being endorsed by the Barnsley Area Prescribing Committee at the beginning of May 2019.

http://best.barnsleyccg.nhs.uk/clinical-support/medicines/shared-care-guidelines/Freestyle_Libre_Protocol.pdf

http://best.barnsleyccg.nhs.uk/clinical-support/medicines/shared-care-guidelines/Freestyle_Libre_protocol_children.pdf

2) Its proposed that Freestyle Libre supply will remain Amber  - as currently with first six months prescribing through specialist nursing team…

South Worcestershire, Redditch & Bromsgrove, Wyre Forest

After prompting, I received this reply:

Dear Mr Cahm
Sorry for the the delay in responding to the letters that you sent to the three Worcestershire CCGs about Freestyle Libre on 22nd March.
As you are awareNational guidance published by NHS England on 7th March 2019 outlined the requirements and clinical criteria for use of Flash Glucose Monitoring (FlashGM, specifically Freestyle Libre®); this guidance has informed arrangements agreed by Worcestershire Clinical Commissioning Groups (Redditch and Bromsgrove, South Worcestershire and Wyre Forest) for the 2019/20 financial year.
The Worcestershire CCG arrangements make provision for consideration of appropriate patients at annual diabetes review. Patients who meet the referral criteria will be referred to diabetes specialist teams in hospital. This means that patients will not be able to access FlashGM sensors immediately from their general practice on 1st April 2019.
Following referral from general practice, diabetes specialist service…

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.
Here is the information from the Surrey PAD (plenty of additional information on the website linked above):
INTERIM HOLDING STATEMENT:

The APC has recommended prescribing of flash glucose monitoring system (FGS) in line with guidance from NHS England

It was given a BLUE traffic light status.

Commencement must be within a diabetes specialist led clinic.  At least 1 month supply of sensors m…

North Norfolk, South Norfolk, West Norfolk and Great Yarmouth & Waveney

FOI confirmation:

Dear Requester

Thank you for your email.

We can see you have asked for information relating to Norwich CCG.  To assist you further we can advise that we also process requests on behalf of North Norfolk CCG, South Norfolk CCG, West Norfolk CCG and Great Yarmouth & Waveney CCGs.

May we ask if you wish to request the same information for any of the above?  Once clarified we can progress your request.

We have also attached a response on the same subject matter which you may find useful.  Should the attached response answer your request in full or part please advise.

To which I responded:

Hi all,
Thank you for your response.
The attached response does answer most of my questions and I was looking for the same information for all of the CCGs listed.
There is one outstanding answer though for each of the CCGs, which was detailed in the original letter. The NHSE policy does not stipulate how prescribing is to take place.  Could you confirm how prescribing of Freestyle Libr…

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

FOI Response
1) Your plans for meeting the NHS England Libre policy 
Yes MKCCG will be adopting the NHS England criteria from April.
2) How the Libre prescribing process will be handled? Will it be Red, Amber or Green listed? 
It will be listed as Amber 1 - on the recommendation of a Specialist. In practice this means secondary care will supply the reader and first sensor and provide training and then request that subsequent sensors are prescribed by the GP.

Merton

Response to FOI (original text)

Your plans for meeting the NHS England Libre policy

In July 2018, FreeStyle Libre was approved for use in NHS Merton CCG. In developing this policy, the Regional Medicines Optimisation Committee (RMOC) - North statement was considered by NHS England London diabetes clinical networks (Clinical Leadership Group and Type 1 Diabetes Network). Additional advice was sought from members of the South East Coast and London and Young Peoples Diabetes Network for paediatric patients. These groups had representation from a variety of clinicians,commissioners and patient representatives.

On the 7th March 2019, NHS England published revised criteria for ‘Flash Glucose Monitoring: National Arrangement for Funding of Relevant Diabetes Patients’ publication’. NHS Merton CCG recognises that Flash Glucose Monitoring is a novel and innovative device and will now consider the recommendations in this document for the benefit of the patient group as specified.

How the Libre p…