NHS England to End FreeStyle Libre 'Postcode Prescribing'

Tim Locke

November 14, 2018

LONDON - NHS England is to mandate all remaining health areas in England to fund FreeStyle Libre continuous glucose monitoring systems for eligible type 1 diabetes patients.

The move from next April will end the much criticised 'postcode prescribing' of the devices where people in different areas would have the patch monitoring by smartphone system funded or not.

The announcement coincided with World Diabetes Day and the Diabetes Professional Care (DPC) conference opening in London.

The person credited with the work to make the device available is Dr Partha Kar, associate national clinical director for diabetes at NHS England.


Dr Partha Kar

He told the conference "I tried everything in my power" to get the remaining clinical commissioning groups (CCGs) to fund the device.

Medscape UK spoke to him at DPC at Olympia in London.


Medscape UK: Why didn't 'cajoling' work with CCGs?

Dr Kar: I think some of it is the law, the Health and Social Care Act, because at the end of the day… CCGs have been given responsibility for the local budgets. So if everybody started saying we want this from centre that puts them in a very difficult position. My counter argument to that was that's exactly why we agree to the guidelines, which is more cost neutral. It's not evidence based, it's a cost neutral guideline and trying to help.

And my further argument with that was if 75% of people in the present environment, the same restrictions, are finding the space [in their budgets] the rest, 25% should. And that was my argument rather than head to head against anybody.

In all fairness I think we forget that the majority of CCGs, let's not ignore that, actually did do that and did the right thing as well.

So a bit of swings and roundabouts, but at the end of the day that's where it came to.

Medscape UK: Is the mandate to fund the device unprecedented?

Dr Kar: To a certain extent, because we are saying that actually, we are mandating, so to speak, that we want to make it now available to everybody. And the basic aim is obviously, collaboration when you're trying to improve care. But I think we shouldn't lose sight of the fact that improving care is priority one, collaboration is number two. So you should not compromise the number one while you're trying to do number two, that's my view.

So I think it would have been good if we got everybody on board. And of 25% left, about 10% of them were nearly there. It's the last, I would have said probably about 10%, 15%, who steadfastly had said 'no' to all requests. And that didn't leave us with any other option in that locality for patients to get this.

Medscape UK: Have you set a precedent for whatever the next big thing is?

Dr Kar: I recently wrote a blog where I said that there is, however, a fine balance because they are playing with the finite budget, this one is cost neutral, at least that's the position. But if you look further, if you look at bigger technology that's coming through, the hybrid loops and all that sort of stuff, I think there needs to be a kick-start to the system, some sort of funds to start the ball rolling, and ease a bit of pressure on the CCGs as well. Because otherwise, I think they're forced to do X and stop Y. So I think that's the balance we need to strike.

Medscape UK: Does something need to be done about CCGs not sticking to NICE guidance though? Is there any talk of that in the NHS 10-year plan?

Dr Kar: It's too soon probably, but I wouldn't be surprised if there is. That's obviously in the hands of the overarching body of NHS England and NHS Improvement. But I wouldn't be surprised because I think variation is a key piece of work, which is what gave rise to the whole GIRFT Programme [Getting It Right First Time], which is all about variation.

Medscape UK: One of your other achievements this year has been the Type 1 Diabetes Platform for patients. How's that going?

Dr Kar: So far, so good, I think. I just did a presentation on it. And I think it's very much within the phase whereby we are learning and we put it out there, we have been dependent on patients to help us, which has been great, because they've told us, we actually don't need that, we need this, which has been brilliant.

But now I think it's about getting feedback from the users, which we are collecting. And that will be stage one. And stage two will be, 'can it be developed further, can it become an online resource where you have your own health records?'

If you can evolve it to that, then you have a real type 1 hub, so to speak. Work in progress. But I would say at the moment, we're happy with how it's landed, seems to have a lot of visits, and we collected some feedback as to what needs to change.

Medscape UK: One of the other announcements in the NHS 10-year plan was total meal replacement diets. How big a theme is type 2 diabetes reversal going to be over the coming years?

Dr Kar: I think it's going to be a very big thing, because I think what we are looking at is a big change of paradigm as to how we look at type 2 diabetes care. I mean, a few years back, the whole concept was you got type 2 diabetes, it’s progressive. But now we're looking at very low calorie diets and low carb diets, all of them are in the mix. And I think they will become more and more mainstream because it is something that attracts policymakers, it is something that attracts the whole ethos of can we change the paradigm of something. And I think having big celebrities or public figures coming out and saying, 'Look, I've changed my life,' will also have an impact.

So I think there's much to play in this space. And I think as the evidence will evolve, policy will evolve with it.

Medscape UK: How helpful or unhelpful were last week's headlines about the £1 billion NHS spending on diabetes?

Dr Kar: I think it’s a mixed bag on that one because I think part of it is helpful because it tells you what we are doing. It focuses the mind that actually we're spending so much money on amputations, why do we do it mainstream? Why do we do more self-managed? Why do we do more prevention? And why do we do more appropriate technology to help people, and then you're spending money on this.

That's a good marker that actually makes policymakers be like 'well maybe we need to do more downstream more and more'.

I think we need to be just mindful of what message we put out because there are so many people living with diabetes and I don't think we should make them feel guilty about the money that's being spent. It's not their fault. It's the system that needs to change. So I think there's a bit of a balance, but again it's about raising awareness. It's money at the end of the day that makes health systems go around. So just a bit of careful language used, when you're just saying it's not the fault of the person, and I think that will probably make it more appropriate.


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