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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 how education 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® is recommended for restricted use as an option in specific groups of patients with supplies coming from hospitals only. The local recommendation documents are available at: https://hertsvalleysccg.nhs.uk/clinicians/medicines-guidance/topic/1049/Endocrine_system/541

Updates on this guidance are expected in April/May 2019 and will be circulated to GPs and via our website, which you can access at the following link: http://hertsvalleysccg.nhs.uk/.

I hope that this helps.

UPDATE

Further to this, I asked when the meeting was and the outcome:

Thank you for your further email dated 12 April 2019.

Following the HMMC meeting held on 4 April 2019, we await final approval of the funding decision for FreeStyle Libre®. In line with accepted governance processes for local prescribing decisions, revised guidance will require ratification by two local committees. We also need to agree how to prioritise patients for starting treatment and how education and training for patients is offered. Herts Valleys CCG intend to finalise this process as a priority, and although we cannot give you a specific date, we aim to complete this within the first quarter of 2019-20.

As you are aware, in the interim we are following our existing guidance and funding arrangements, available on the Herts Valleys CCG website at https://hertsvalleysccg.nhs.uk/clinicians/medicines-guidance/topic/1049/Endocrine_system/541. As such, primary care prescribing is not recommended; FreeStyle Libre® is to be initiated, managed and supplied by a hospital Trust consultant led specialist diabetes team only.


I hope this helps, but should you require further information please do get in touch.

Update 2 - 24/05 (end of June? Why?)

I appreciate your concerns regarding the availability of FreeStyle Libre® and a decision from Herts Valleys CCG on the implementation of NHS England’s funding recommendations. Following publication of NHS England’s guidance (issued 7 March 2019) https://www.england.nhs.uk/publication/flash-glucose-monitoring-national-arrangements-for-funding-of-relevant-diabetes-patients/, Herts Valleys CCG are urgently reviewing and updating their current guidance in light of the national arrangements. Herts Valleys CCG intends to complete this process as a priority, by the end of June 2019.

Our current guidance and funding arrangements in line with the East of England Priorities Advisory Committee (PAC) remain in place and are available on the Herts Valleys CCG website.
I can confirm that once a ratified decision has been reached in relation to the new guidance, this will be published on our website and will inform GPs and patients alike on the process to follow in assessing new patients’ eligibility for prescribing.

Comments

Alan said…
Copy of email I sent the Chief Exec:

I am a Type 1 diabetic living in Radlett, Hertfordshire under the care of West Herts Hospital, who greatly benefits from my use of Freestyle Libre.

To recap:

> In September 2017 NICE published a medtech innovation briefing (MIB) on FreeStyle Libre for glucose monitoring which is available at https://www.nice.org.uk/advice/mib110

> In October 2017 NHS England’s Regional Medicines Optimisation Committee (RMOC) (North) reviewed the use of Freestyle Libre and issued the following advice to Area Prescribing Committees:
https://www.sps.nhs.uk/articles/regional-medicines-optimisation-committee-freestyle-libre-position-statement

> In November 2017 the Department of Health and Social Care authorised the flash glucose monitoring system Freestyle Libre to be made available on Part IX of the Drug Tariff.

> In early 2019 the NHS Long Term Plan was published and announced that "the NHS will ensure that, in line with clinical guidelines, patients with type 1 diabetes benefit from life changing flash glucose monitors from April 2019, ending the variation patients in some parts of the country are facing"

> On 7th March 2019 a guidance document was published which set out the criteria for flash glucose monitoring and the maximum amounts CCGs will be reimbursed for the ongoing costs of flash glucose sensors.

> The DVLA has also recently announced that they accept readings from devices such as the Freestyle Libre to support driving for Type 1 diabetics.

That’s all good news for me as a Type 1 diabetic who is self-funding the Freestyle Libre. I find it an essential tool to help my diabetes management: this is the only tool that I have access to which shows the trend of my blood glucose levels across the day helping me decide how much insulin to inject before food as well as any adjustments needed at other times of the day. It is having a positive impact on my health. The alternative is to test over ten times per day - before food and then at hourly intervals afterwards to measure my post-prandial levels (a particular problem for me). In the short term it gives me early warning of potential adverse events (hyper or hypo glycemic episodes). In the long term it helps me keep my levels low and hopefully reach my target Hba1C and avoid long term and expensive complications of this disease.

The problem is, that despite government statements I still cannot get Freestyle Libre on prescription. My consultant at West Herts agrees that I would benefit from it and meet the criteria and yet says that the CCG is still not approving its prescription across the area because the necessary information has not been uploaded to Blueteq, Your delay is costing me £100 per month and saving you expenditure on the lancets and testing strips that I use much less than before.

Could you please provide immediate approval for funding of Freestyle Libre for me.

Best regards

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