Sunday, September 17, 2017

Libre…What next?

Are we all a bit more calm now? Post the news breaking of Libre being available on NHS Tariff, the reactions have been pretty much on expected lines. Feverish excitement, wild speculations , a tiny minority expressing their concerns, views, forums abuzz with questions…its all happened. My inbox exploded- as did my Twitter feed- with views ranging from a former MP suggesting I be knighted to some suggesting I had little idea of what I was doing. To me, however, a measure of whether policy decision X or Y is good or bad is measured by the side on which the majority of reaction falls. This isn't a job to make everyone happy- its to do what would benefit the majority- beyond the white hot realms of social media. You listen to the views on social media- but you never accept that as gospel- after all, Twitter is where, depending on the social bubble extent, Brexit never happened, Hillary Clinton is POTUS and Corbyn is the PM of this country. However, its a good barometer too about public mood- and thankfully, doing a full time job, interacting with patients, seeing the pros and cons does come in handy. So- its no small sense of achievement to see the news- broadly greeted with optimism- though quite rightly, from sensible heads- with a degree of cautious optimism.

So whats next? I would encourage you to read below- as the majority- if not all- of the folks speculating etc haven't been involved with discussions or negotiations- so for want of a better word, here you go- from the horses mouth
The next stage of this process is to convince all local economies to put this in formulary. The justifiable concern is that it opens post code lottery-just as has happened with Pumps and CGM etc. To help avoid that, the Type 1 diabetes network are working to create a business case template that areas-if they are struggling- can use. The network is spearheaded by the Consultant Diabetes organisation, ABCD- with contributions from doyens of BOTH paediatrics and adult world- ergo Fiona Campbell and Stephanie Amiel; diabetes charities, leads of the Insulin Pump network, representation from all 4 countries, as well as respected experts, former NHS England National clinical directors- so a pretty good bunch of folks who can help steer this. I would also encourage anyone successful to get this on local formulary- to share with others. Its called cascading good practice- the N in the NHS is supposed to stand for National. Who knows- this could actually be a template of working we all learn from and tackle post code lottery in other areas of diabetes care!

The next phase of concern is that it will "eat into the CGM budget". So let me explain something to all and sundry. There is NOTHING called a CGM budget- there is in fact nothing called a Type 1 diabetes budget. There is a "Diabetes" budget.Which, on this instance, is a good thing. Here is something as regards how much we spend on diabetes drugs in the overall budget. Of every £9 we spend in the whole NHS, about £1 is spent solely for diabetes care. Thats a huge budget spend- is there opportunity to ensure that this is used appropriately? Yes- absolutely. Simply take your time and see the amount of expensive drugs we use in elderly people or folks who don't need them as per indications or indeed look at how over-treatment in elderly frail Type 2 diabetes causes more admissions. Stop those-save the money on the drugs and indeed the admission costs- use the money elsewhere- such as on this occasion, appropriate use of blood glucose monitoring. It is not rocket science, it is about being savvy, being focussed on what the whole diabetes population needs and use of appropriate medication. Needless to say? The majority of spend is NOT on strips- BUT on medications in Type 2 diabetes. They all have their place- just not for everyone- we need to be better at understanding population based care- and use of technology where appropriate.

Abbott also have a responsibility and we are working with them to ensure data collection is done on a national basis so we can see the impact of its use- which must be published too. We are also working with them to ensure the onus for educating patients and professionals simply doesn't fall back on the NHS. For the areas who may not necessarily have those programmes to hand, Abbott must have a commitment to help that process. I am aware they are working on it- and we are working closely on this too. Watch this space!
We are also working with patient charities- together- Diabetes UK, JDRF and INPUT- to ensure we manage expectations properly- and all appreciate that "going on tariff" is only step 1- albeit a big step. Be patient, avoid speculations- and if you want an official update, listen to what the charities put out- not forums or individuals who have little involvement in overall process.

Would you like to know the aim of our ambition? It involves CGM availability- uniformly across the NHS- and I can assure you conversations are ongoing with relevant companies such as Dexcom, Roche, Medtronic et al to tackle this chestnut too. Feel free to contact them and ask too.
It involves ensuring we have enough HCPs too- who know what they are doing-it involves financial assessments etc.
I am also keen to have a unified IT system which cuts across all systems- and ensures a diabetes patient has access to all thats needed as regards notes, data, results etc. I will make no bones about it- I admire the SCI-DC system the Scots have- the query there is whether a disease specific platform is the right way ahead-or not. I would like to have a out of hours hotline/Whatsapp system that is available to any ED in the country to ensure pump patients etc are safe….so many things, huh?

In short? My ambition to improve Type 1 care has no limits- but I am also fully aware that not all can or will be achieved. However, that shouldn't limit the efforts either. To all those who are worried re Libre, my appeal is this. You are one community. Be happy for those who may have access to Libre beyond the ability to pay. and work with us to ensure we also can ensure the other bits-as outlined above- can happen.
Finally, a big thank you to so many who have left messages of thanks- and more pertinently, have asked me not to be discouraged by the negativity of a few.That is unlikely to happen- I know my goals, I bank on the support of the majority and the day the overwhelming feedback is that I am getting it wrong, I will step down

I repeat-again. Together? Stronger.
Divided? We Fall.


4 comments:

  1. Dr. Partha, very informative post., thanks for sharing your views with us. May I ask you, what could be done to get Ambrosia's NightRider approved by NHS so the patient can get CGM like functionality at very low cost/free, it costs £80 and converts recently approved Abbott's FreeStyle Libre sensor into a CGM. So many people are using it and they are satisfied with its performance. If NHS can reimburse it they will be able to get a lot better pricing from Dexcom and Medtronic. Also, will be able to save several hundred million pounds which could be used in covering more patients or services.

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  2. Hi, am considering a day of OpenAPS, Nightrider etc to see what its like etc before making any further moves! I suspect the issue around them will be evidence as well as "governance" concerns. However its certainly something worth exploring

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  3. Great explanation and discussion. Thank you JJ

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  4. Dr Kar, is there anything we can do if our local NHS decide not to provide the Libre? IE anyone we can lobby/plea.

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