NHS England flash glucose monitoring guidelines for CCGs
If you don’t work in the diabetes field, or know someone with type 1 diabetes, you may not have heard of Flash Glucose Monitoring or Libre. This is something that CCGs now need to know about thanks to new mandatory criteria from NHS England.
People with type 1 diabetes require insulin treatment however over the last few years the rapid rise in medical technology and innovation has given us different methods for delivering insulin and monitoring blood glucose levels. Access to these innovations has caused debate, not least due to their cost.
Flash Glucose Monitoring (currently in the UK; Freestyle Libre) is a new way of monitoring glucose levels. A sensor is placed on the upper arm for 14 days, measuring interstitial glucose. The sensor is scanned with a reader providing current glucose reading, a trace for the previous eight hours, and importantly trend direction arrows depicting whether glucose levels are going up, down or stable.
This empowers the individual person with diabetes, providing a much clearer picture of their glucose levels through the day and overnight compared to traditional ‘snap shot’ finger prick blood glucose testing, informing the person’s decision about any action needed.
Each sensor costs £32.47. As a comparison, test strips for blood glucose monitoring cost between £12.21 and £37.03 if checking levels eight times a day over the same period (depending on device used). That would also be 112 uncomfortable finger pricks.
The Libre system has been available to buy in England since 2014 and on NHS drug tariff since November 2017. However there is huge variation in prescribing – in some areas over 20% of their population of people with T1 diabetes have been prescribed Libre, in other areas it is 0%. Recognising this unacceptable variation, the NHS Long Term Plan announced that, “patients with type 1 diabetes would benefit from life changing flash glucose monitors from April 2019”. The full guidance was published on 7 March 2019.
It sets out the criteria for people suitable for flash monitoring, including the need for education and follow up. NHSE will reimburse CCGs for each set of sensors prescribed for up to 20% of their population with type 1 diabetes – minus a proportion of cost savings from reduced requirement to fund test strips for this group.
When Libre became available on NHS drug tariff, the Northern NHS Treatment Advisory Group (NTAG) produced guidance on its use recognising that improving long term control through enhanced testing reduces the burden of long term costly diabetes complications and enhances a person’s quality of life. Newcastle Gateshead CCG worked with other CCGs in the North East and Cumbria and secondary care colleagues, to support prescribing from Diabetes Centres via our Value Based Commissioning system. Following the recent announcement we will be reviewing our local criteria and prescribing systems to ensure we are following the national guidelines. Locally the NHSE document has been circulated to relevant clinicians and commissioners, the medicines optimization and finance teams, and there will be a Diabetes Clinical Network meeting soon where this will be high on the agenda.
For individual CCGs this is a relatively small piece of work. For people with diabetes this is a hugely important step forward, and there will be people contacting GPs, hospitals and CCGs from the 1st of April asking about Libre. Type 1 diabetes is a relentless and invasive long term condition where multiple daily decisions are needed about food, exercise, and insulin – with both immediate and long term health impacts. This device can make a very real difference to some people. When I asked secondary care colleagues and patients who have used Libre to tell me about it, the phrases used were “game-changer”, “life changing”, “I’m in control”, “better understanding”.
At the Diabetes UK Professional Conference earlier this month, early results from the ABCD audit of Freestyle Libre showed significant improvements in HbA1c, improvement in diabetes related distress and possible reduced admissions (awaiting one year follow up data). Finally, in the 2017/18 National Diabetes Audit only 29.9% of people with type 1 diabetes had an HbA1c <58mmol/mol, and this is static since 2013. The things we are currently commissioning and the blood glucose test strips we are prescribing, are not leading to an improvement in results for most people. This indicates the need to do something different. The NHS England Diabetes team has made it easier for us, with national criteria and reimbursements – CCGs now need to work with local diabetes specialists to deliver, and stop the postcode Libre lottery.
Becky Haines
Dr Becky Haines has been a GP partner at Glenpark Medical Centre in Dunston since 2002. She has been the practice lead for diabetes since then, involved at a PCT then CCG level for most of this time and became the Gateshead Clinical Lead for Diabetes NGCCG in 2014. She is also a Year of Care trainer and has helped to implement YOC care and support planning across the CCG. She is an RCGP Champion for Collaborative Care and Support Planning.
17 comments
Very informative. Never heard of libre flashing until i had my YOC, a few days ago. Sounds good.
This seems okay but having suffered type 1 for over 60 plus years, I have tried to obtain Flash monitoring system for over two years even speaking to my useless MP who says it up to my ccg to organise them. I have final stages of heart failure, after having a by pass in 2000 and the need for further heart treatment including a new 3 core pacemaker inserted and further treatment at Royal Papworth for stents, I have on going Kidney failure and neuropathy in my legs which they say is all diabetes related have small hands and fingers which with all the tablets I take cause my fingers to bruise easily
so still cant get this machine to help me. I suffered a severe hypo which resulted in Hospital treatment to bring back under control but still cannot get this machine. So all the publicity in how great the NHS is in getting for they estimate 300,000 type ones is not beneficial to all of us with this ailment so better all than any
Whilst I am “only” a type two, I started with these about two and a half years ago. Because of the insights they give me as to what foods cause glucose spikes I am now under control and with no meds (HbA1c of 5.1 two weeks ago, down from 8.9 in February).
I do low carb high fat and measure my ketones with a breath meter (because Abbott’s pricing for ketone testing strips are too high for regular use) to try and infer my developing insulin sensitivity.
But they are expensive on an ongoing basis. Does anyone know of any way that I can buy (and pay for them) at the stated NHS price of £32.47 instead of the over £50 they work out at from the manufacturer? I live in Oxfordshire.
Dear Alan. My guess,if you have pancreatic exocrine insufficiency is that you have CF? If you do you are entitled to an NHS prescription.
I have type 2 genetic diabetes I have recently moved onto insulin after suffering years of stomach problems with metformin my fingers are black and blue from testing this looks very interesting but also costly i am very aneamic I don’t know if that makes a difference bruising wise.
I have diminished awareness of Hypo.
I have to prick my fingers more than 9 to 10 times. My sugar level is not under control, but Whenever i have used Flash Libre I have avoided Hypo and have much better sugar control.
I have to buy Flash Libre and it is very expensive for me as I am retired and live on pension. i am still waiting for NHS Flash Libre prescrition. Can someone help me.
Please can you help I have been trying to get Freestyle Libre on prescription I am checking my levels over 9 times a day, but not finger pricking as this is too painful, my levels have improved but experiencing a few hypo which resulted in collapsing and being taking to harefield hospital I am unable to work now and cannot afford this great product. Last year I was admitted to hospital 3 times and I am having to go to the hospital twice a week for my feet, and my eyes where I have had each month injections in my eyes 7 times so far. I have been seeing Dsn and consultant at my local St Albans hospital on a regular basis,also see consultant as I have insufficient exocrine pancreas and taking over 30 tablets a day. My doctor is arranging for me to see someone from mental health team.
Dear Alan,
NHS England is unable to comment on individual cases and you will need to discuss your eligibility for flash glucose monitoring at your next diabetes review. Depending on local arrangements this may be with either your specialist diabetes team or with your GP.
The guidance issued by NHS England in March 2019 sets out the groups of patients with Type 1 diabetes who meet the criteria for national funding of flash glucose monitoring sensors. That guidance is here: https://www.england.nhs.uk/publication/flash-glucose-monitoring-national-arrangements-for-funding-of-relevant-diabetes-patients/.
Kind regards,
NHS England
I am a type 1 diabetic of 32 years standing and have asked my GP for FGM having waited to the 1 April 2019. They have refused to assess me for FGM as they say Hasting & Rother CCG have not received funding so no local Diabetic patients can have this life changing technology.
How come FGM is still banned locally?
Dear Steve,
If you think Flash Glucose Monitoring might be suitable for you and you meet the criteria, you should speak with your specialist diabetes team or with your GP. Guidance issued by NHS England in March 2019 sets out the groups of patients with Type 1 Diabetes who meet the criteria for national funding of Flash Glucose Monitoring sensors. That guidance is here and you may wish to take this with you: https://www.england.nhs.uk/publication/flash-glucose-monitoring-national-arrangements-for-funding-of-relevant-diabetes-patients/.
Clinical Commissioning Groups (CCGs) will be reimbursed for the cost of Flash Glucose Monitoring sensors for those who meet these criteria.
We will also share your experience with the relevant CCG.
Kind regards,
NHS England
I had a check up at my GP and ask for a flash monitor was told NSH don’t supple them,checked on line found them since 1st April 2019.Since 2014 when my Pancreas and spleen removed I have done over 8 blood test a day do you fill I meet criteria to get a flash monitor
Dear Tom,
If you think Flash Glucose Monitoring might be suitable for you and you meet the criteria, you should speak with your specialist diabetes team or with your GP. Guidance issued by NHS England in March 2019 sets out the groups of patients with Type 1 Diabetes who meet the criteria for national funding of Flash Glucose Monitoring sensors. That guidance is here and you may wish to take this with you: https://www.england.nhs.uk/publication/flash-glucose-monitoring-national-arrangements-for-funding-of-relevant-diabetes-patients/.
Clinical Commissioning Groups (CCGs) will be reimbursed for the cost of Flash Glucose Monitoring sensors for those who meet these criteria.
If you let us know where you are based in the country then we can also share your experience with the relevant CCG.
Kind regards,
NHS England
My son meets the needs,his diabetes team ask my surgery to proscribed ,but they said they are not allowed.so how does that work
Dear Lin,
If you think Flash Glucose Monitoring might be suitable for your son and he meets the criteria, you should speak with his specialist diabetes team or with his GP. Guidance issued by NHS England in March 2019 sets out the groups of patients with Type 1 Diabetes who meet the criteria for national funding of Flash Glucose Monitoring sensors. That guidance is here and you may wish to take this with you: https://www.england.nhs.uk/publication/flash-glucose-monitoring-national-arrangements-for-funding-of-relevant-diabetes-patients/.
Clinical Commissioning Groups (CCGs) will be reimbursed for the cost of Flash Glucose Monitoring sensors for those who meet these criteria.
If you let us know where you are based in the country then we can also share your experience with the relevant CCG.
Kind regards,
NHS England
Why can’t I get the criteria for taunton area from anyone??
X
Dear Penny,
There is only one set of criteria for use across the country. The standard minimum criteria for people to access flash glucose monitoring on the NHS in England from 1 April 2019 is available here: https://www.england.nhs.uk/publication/flash-glucose-monitoring-national-arrangements-for-funding-of-relevant-diabetes-patients/
Kind regards,
NHS England
This blog highlights a very important message to commissioners. Change will need to happen for the benefit of all our patients with type one diabetes who struggle to manage their control. We cannot sit back and talk rhetoric and the need to support patients to self manage their condition without giving them the tools to do it well. However we still need to manage the cost implications so difficult decisions are ahead.