'Concerns' Over Diabetes Prescription Changes

Peter Russell

February 04, 2019

A diabetes charity said it had concerns about proposals by NHS England to restrict the prescription of glucose testing strips for people with type 2 diabetes, and insulin pen needles for all people with diabetes.

The plan to restrict the routine prescription of some items over a certain price would save the NHS millions of pounds, NHS England said.

'Tools, Not Luxuries'

Diabetes UK said it would be contributing to a consultation process and urged people with diabetes to make their views known as well.

It said the items under review were not luxuries but essential tools that enabled people with diabetes to manage their condition.

Nikki Joule, policy manager at Diabetes UK, said: "We believe it's vital that people with diabetes who are largely self-managing their condition have all the support they need to do so.

"We worry that these proposals will undermine people's ability and confidence to do this, and are also concerned that the cheaper needles proposed by NHS England might not be as effective as the more expensive options."

She said that limiting the availability of glucose testing strips would be disruptive.

Value for Money Issue: NHS England

NHS England said it was important that the health service achieved the greatest value from the money that it spends. However, Clinical Commissioning Groups (CCGs) would need to take individual decisions on implementation locally.

For glucose testing strips, the recommendation was to:

  • Advise CCGs that prescribers in primary care should not initiate blood glucose testing strips that cost more than £10 for 50 strips for any new patient

  • Advise CCGs to support prescribers in stopping the prescription of blood glucose testing strips that cost more than £10 for 50 strips for existing patients, and where appropriate, ensure the availability of relevant services to facilitate this change

It said the intention of the changes would not be that patients were denied being prescribed blood glucose testing strips but that more cost-effective alternatives were encouraged.

It said there were currently more than 40 different types of blood glucose test strips available in the UK, with prices ranging from £5.45 to £16.53.

Each year the NHS spent £173,110,700 on these items.

Switching patients from more expensive to cheaper meters would allow healthcare professionals to better assist patients with their testing, NHS England said.

For needles for pre-filled and reusable insulin pens, the proposal was to:

  • Advise CCGs that prescribers in primary care should not initiate insulin pen needles that cost more than £5 per 100 needles for any new diabetes patient

  • Advise CCGs to support prescribers in stopping prescribing insulin pen needles that cost more than £5 per 100 needles for existing patients, and, where appropriate, ensure the availability of relevant services to facilitate this change

The consultation document said there were many different types of insulin pen needles available at a varying cost from £3.95 to £30.08 per 100.

It said encouraging the use of the shorter 4mm needle would save money, and was in line with safety advice from the Forum for Injection Technique.

Annual spend on pen needles was currently £33,229,300, it said.

'Disruptive' Changes

However, Diabetes UK said the change to cheaper needles would be unpopular with many patients. "We've heard from people with diabetes who have used the needles and say that they aren't as easy to use, they're painful – and we've heard that from healthcare professionals as well," Nikki Joule told Medscape News UK.

On the proposed changes to test strips, she said: "We don't have an issue that the cheaper test strips aren't as good and don't meet a certain standard but it's about people preferring not to have things changed if they're used to them. So, it's about disruption but also the potential limiting of choice."

The consultation document is the latest in a review of the effectiveness of items dispensed as part of the £9.17 billion prescription budget in England.

According to NHS England: "The current financial situation means that CCGs need to make increasingly difficult decisions about how to spend the NHS budget and this means prioritising those things that will give patients the best clinical outcomes.

"Any savings from implementing the proposals will be reinvested in improving patient care."

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