Flash Glucose Monitoring – Frequently Asked Questions for Commissioners

There is no further guidance on this element as the potential scenarios are too varied in nature to be able to be meaningfully reflected in guidance, and therefore patients selected using this criterion should reflect individual clinical judgement.

The criteria are considered to be sufficient in range to be appropriate for all age groups (taking into account that flash glucose monitoring is not licenced for children aged under 4) and so separate criteria for children were not considered to be necessary.

As flash glucose monitoring is an innovative technology, part of the learning will arise from the ongoing evaluation to identify and act upon any impact on health inequalities. There are plans to collect data on flash glucose monitoring as part of the National Diabetes Audit (NDA) and linking flash glucose monitoring with other NDA data will support identification of any inequalities issues. As part of the clearance processes for publication the draft guidance was reviewed by NHS England’s Experience, Participation and Equalities team and it was supported, on condition that a Health and Inequalities Impact Assessment is also developed.

CCGs are advised to conduct an equality and health inequalities assessment when planning the local implementation of the provision of the flash glucose monitoring devices in their locality.

There are plans to collect data on flash glucose monitoring as part of the National Diabetes Audit (NDA) and linking flash glucose monitoring with other NDA data will be used to help evaluate the impact of the national guidance on patient outcomes and NHS expenditure. In addition, NHS England will review the uptake and spread of flash glucose monitoring prescribing for each financial quarter.

The need for appropriate means for the safe disposal of sensors existed prior to the national funding arrangements and so local arrangements for these should be in place. For disposal guidance in relation to specific flash glucose monitoring devices, please refer to the manufacturer’s website.

Although we can identify prescriptions issued by Trusts, we cannot accurately identify the appropriate CCG for reflection in their allocation. After considering this, and that the data suggests that longer term prescribing in Trusts is the exception rather than the rule, on balance the view was taken that it would be appropriate for reimbursement to be based only on primary care prescribing.

The approach taken reflects that the majority of CCGs have arrangements for ongoing prescribing of flash glucose monitoring sensors to take place in primary care. As the guidance highlights, this does not preclude overall clinical responsibility for the management of a person’s diabetes remaining within secondary care where appropriate. We recognise that some localities may wish to revisit their prescribing arrangements for flash glucose monitoring sensors in the light of this.

Although NHS England can identify prescriptions issued by Trusts, we cannot accurately identify the appropriate CCG for reflection in their allocation. Taking this, and that the data suggests that longer term prescribing in Trusts is the exception rather than the rule, on balance the view was taken that it would be appropriate for reimbursement to be based only on primary care prescribing.

The approach taken reflects that the majority of CCGs have arrangements for ongoing prescribing of flash glucose monitoring sensors to take place in primary care. As the guidance highlights, this does not preclude overall clinical responsibility for the management of a person’s diabetes remaining within secondary care where appropriate. We recognise that some localities may wish to revisit their prescribing arrangements for flash glucose monitoring sensors in the light of this.

In order to support a consistent approach to reimbursement, it is desirable for this to be based on a single, consistent data source. Therefore, the ePACT data has been identified for this purpose.

The approach taken reflects that the majority of CCGs have arrangements for ongoing prescribing of flash glucose monitoring sensors to take place in primary care (although with initiation being in secondary care in many cases) and so, on balance, it was considered that this was the appropriate approach to take. As the guidance highlights, this does not preclude overall clinical responsibility for the management of a person’s diabetes remaining within secondary care where appropriate. We recognise that some localities may wish to revisit their prescribing arrangements for flash glucose monitoring sensors in the light of this.

The only flash glucose monitoring sensor currently available on the market is the Freestyle Libre by Abbott Laboratories, which is listed as £35 on the NHS Tariff. The actual cost of each sensor for CCGs is £32.47.

The reimbursement amount has been offset by modelling that, prior to using flash glucose monitoring, patients would have been using a greater number blood glucose testing strips, representing a cost to the CCG that will no longer be incurred. The savings from two testing strips per day have therefore been built into the reimbursement level. The reimbursement level is £26.03 after reflecting this saving.