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Freestyle Libra – criteria for availability from April 2019
Updated March 18th 2019
After the announcement from NHS England last November that the FreeStyle Libre would be free on the NHS to people with Type 1 diabetes who fitted into the criteria (not listed at the time), we promised that we would keep our members and others informed of any developments. On March 7th, NHS England published a document containing the criteria for people with Type 1 diabetes to obtain the Libre free on an NHS prescription.
There are parts of this that IDDT finds difficulty understanding the logic, the thinking or the fairness. For instance, it does not mention children or adolescents with Type 1 diabetes, a group who really need this device both for comfort and to encourage them to test more. Equally, it does not mention other conditions along with Type 1 diabetes which we know makes diabetes control more difficult. However, we will take these points up with NHS England at a later date when we know the effects of this on people with Type 1 diabetes but we wanted you to have the necessary information as soon as possible.
- One of the criteria is that you “require intensive monitoring more than 8 times daily, as demonstrated on a meter download/review over the past 3 months”. This means that you have to show that you have done at least 8 tests a day for the last 3 months. This may prove difficult for people who have not been able to obtain this many test strips from their GP!
- The document also states the funding arrangements for Clinical Commissioning Groups (CCGs) giving the maximum amounts that CCGs will be reimbursed for the ongoing costs of the sensors. In 2019/20 CCGs will be reimbursed for each set of sensors prescribed for up to 20% of their Type 1 diabetes population. It contains a list of all CCGs in England, the total number of patients with Type 1 diabetes in each CCG and 20% of this number, so it appears that while there will no longer be a postcode lottery of availability but a financial one on the part of NHS England. Only up to 20% of people with Type 1 in each CCG will have access to the Libre so for instance, in Darlington CCG the 20% figure is 112 patients with Type 1 diabetes, so what happens if you are patient number 113 but still fit into the criteria for the Libre on the NHS?
- For people who are already using the Libre and obtaining sensors on the NHS but do not fit into the new criteria, then CCGs should consider providing it if people fall into existing local CCG criteria and there have been observable improvements in their glucose management or psycho-social wellbeing (such as depression, stress or anxiety levels).
- The Libre on the NHS can be obtained from either the hospital clinic (secondary care) or from your GP practice (primary care) depending on where you receive your treatment.
If you do obtain a Libre, it is only available initially for 6 months and future supply is dependent on demonstration of improvements in diabetes self-management, such as an improved HbA1c, time in target glucose range, improvements in DKA or hypoglycaemia or psycho-social wellbeing.
We would recommend that you keep records, certainly your glucose test results and your HbA1cs, details of hypos and/or DKA and anything else you feel is important to you. If you do obtain a Libre, it is only available initially for 6 months and future supply is dependent on demonstration of improvements in diabetes self-management, such as an improved HbA1c, time in target glucose range, improvements in DKA or hypoglycaemia or psycho-social wellbeing.
If you are already using the FreeStyle Libre and paying privately, then it is important that you keep records of any improvements you have experienced while using it if you want to try to obtain it free on the NHS.
If you apply to obtain the FreeStyle Libre on the NHS, please do let us know what happens to you by writing to me at the above address, email me on email@example.com or give us a call on 01604 622837.
Flash Glucose Monitoring: National Arrangements for Funding of Relevant Diabetes Patients (PDF) – from NHS England
FreeStyle Libre available on the NHS from April 2019, but…
To coincide with World Diabetes Day, Simon Stevens, Chief Executive of NHS England, announced action to end the postcode lottery for access to the FreeStyle Libre flash glucose monitoring system. A press release was issued:
“From April 2019, the device will be available on prescription for all patients who qualify for it in line with NHS clinical guidelines. These patients will be able to receive it on prescription from their local GP or diabetes team helping them to better manage their blood sugar levels.
The device should ultimately help people with Type 1 diabetes to achieve better health outcomes and benefits including:
- Easily noticing when their sugar levels are starting to rise or drop, so action can be taken earlier,
- Giving patients more confidence in managing their own condition, Not having to do as many finger-prick checks.
The funding for this will come from next year’s funding growth for local health groups which will allow flash monitoring throughout the country.”
The Press release also says:
“It is estimated that around 3-5% of patients with Type 1 diabetes in England have access to Freestyle Libre but if clinical commissioning groups (CCGs) were following the guidance correctly, this figure could eventually rise to at least 20-25%. Currently, 144 of 195 clinical commissioning groups have signed up, and today’s announcement mean thousands of patients still missing out will now get access.”
The news was very much welcomed by people with Type 1 diabetes across the country and it was good to know that apparently people with diabetes have been heard. It appears to end the unfairness that has existed whereby there has been a postcode lottery of availability of the Libre but there were various points that are still unclear and left unanswered questions.
On November 21st 2018, IDDT wrote to Simon Stevens with copies to Dr Partha Kar, Associate National Clinical Director for Diabetes, Mr Matt Hancock, Secretary of State for Health and Social Security and Mr Keith Vaz MP. The points we have made are:
- The announcement only mentions people with Type 1 diabetes and not people with Type 2 diabetes who are injecting insulin but the NICE guidance for the approval of the FreeStyle Libre states that “it is an alternative to routine blood glucose monitoring in people with Type 1 and Type 2 diabetes who use insulin injections”. Why has this group been excluded from the benefits of the FreeStyle Libre? This seems grossly unfair and is a divisive decision.
- People who have been refused access to the FreeStyle Libre by the CCG in their local area, have been told that CCGs make decisions according to local need. While appreciating that this device will be funded from next year’s funding growth for local groups, how can CCGs be effectively forced to fund the FreeStyle Libre when the NHS system specifically gives them control over local spending according to local need? Are people with diabetes going to have to go through the process of refusal again?
- The press release states that the FreeStyle Libre will be available “for all patients who qualify for it in line with NHS Clinical guidelines”. We are aware that the Guidelines that have been used have varied geographically, could we be told what these guidelines are, especially now that there is a second version of the FreeStyle Libre with an alarm system?
IDDT has still not received any response to our letter of November 21st 2018.
NHS Long Term Plan
In January 2019 the NHS 10-year Plan was announced and one of the paragraphs under the title of ‘Diabetes’ promised:
“People with Type 1 diabetes will benefit from flash glucose monitors from April 2019 in line with clinical guidelines to end the variation of availability across the country.”
We will have to see how this works in practice…