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CCGs failing to offer access to ‘flash’ glucose monitoring devices

Only about 3-5% of patients with type 1 diabetes in England have access to FreeStyle Libre on the NHS

Louise Prime

Thursday, 08 November 2018

Only about 3-5% of patients with type 1 diabetes in England are prescribed the FreeStyle Libre glucose sensor on the NHS as many clinical commissioning groups (CCGs) are ‘paying lip service’ to offering access to the device, a BMJ investigation* has found. Experts told the report’s authors that this postcode lottery means that tens of thousands of patients are being denied the potential lifestyle and health benefits of flash glucose monitoring.

Flash glucose monitoring, in which a portable reader or smartphone is used to take readings from a sensor attached to the skin, has been available on NHS prescription since 1 November 2017. NHS England has advised CCGs on which patients should be given prescriptions for the devices (FreeStyle Libre is the only one available in the UK); and, although it admits to ‘gaps in the evidence base’, it has said such devices have the potential to improve patients’ quality of life, support self-management, and could save money in the long term by reducing the rates of complications and hospital admissions.

Prime minister Theresa May recently told parliament that the FreeStyle Libre, which she uses herself, is available on the NHS; but during its investigation, published this morning, the BMJ found that a year after the device became available, about a quarter of CCGs in England are not recommending it for patients even if they meet NHS England criteria.

According to report author Gareth Iacobucci, “Partha Kar, NHS England’s associate national clinical director for diabetes, estimates that only around 3% to 5% of patients with type 1 diabetes in England have access to the sensor on the NHS. If CCGs were following guidance correctly, he believes this figure should be closer to 20% or 25%, if not higher.”

And, he added, he was told by Emma Wilmot, a consultant diabetologist at University Hospitals of Derby and Burton NHS Foundation Trust, that some of her patients have considered changing GP practice to one that would prescribe them the device, while others have funded it themselves by making “huge sacrifices”. She said: “My worry is the people who aren’t in a position to self-fund it. The most deprived people in the population often have the least access.”

From CCGs’ responses to freedom of information requests, the BMJ discovered that some of them have spent thousands of pounds on prescribing the devices for hundreds of patients; others said they were only prescribed through secondary care; and others “are imposing stricter access criteria than those recommended by NHS England, leading GPs to ignore this advice because they think the device will help their patients”.

The BMJ was given official prescribing data by diabetes campaigner Nick Cahm, revealing that only 2% of patients in England with type 1 diabetes are getting FreeStyle Libre on GP prescription, compared with 11% in Scotland, 16% in Wales, and 35% in Northern Ireland. And as at July 2018, GP prescribing data showed that only two out of 195 CCGs in England had prescribed Freestyle Libre to more than 20% of patients with type 1 diabetes, only 15 CCGs had prescribed it to more than 10% of type 1 patients, and 25 CCGs had issued no prescriptions at all. Cahm said he thought CCGs were considering only their short-term finances rather than the longer-term gains to be had from better control of type 1 diabetes in their patients.

NHS Clinical Commissioner’s chief executive Julie Wood, told the BMJ: “Unfortunately the NHS does not have unlimited resources, and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities, and increasing financial pressures is one of the biggest issues CCGs face.”

But Emma Wilmot told the BMJ she believes the FreeStyle Libre is one of the most important, life-changing advances in type 1 diabetes for many years. She said: “I’ve lost count of the number of times I’ve said to people in clinic, this is the best HbA1c you’ve had in a decade. That’s the level of impact it’s having on some people. … But also, the reason that we strive to reduce complications is to maintain quality of life. And actually, by preventing people having access to the Libre you are compromising their quality of life compared with what it could be.”

* Iacobucci G. Patients with type 1 diabetes are missing out on flash glucose devices, finds BMJ investigation. BMJ 2018; 363: k4675 doi: 10.1136/bmj.k4675.

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