Restriction of Testing equipment/strips

[CollieBoy]

My doctor told me (type 2) that I only need to check my blood once a year! get that! Hospital say's I should check 3-5 times a day! Who is right?

The Hospital is right IF you use the data to manage your T2.
Listen to your doctor and look forward to complications,and possible limb/sight loss .He is only parroting what the short termist bean counters tell him to. so he can maximize his income stream and minimize his costs. :thumbdown:

 

[Westie2]

As some one who could be described as a 'short termist bean counter' I would like to counter the statement that the GP is maximising his income.
In the new NHS the money is held by the CCG who allocate the prescribing budget to individual practices, following a complicated formula to account for local needs.
The GP needs to manage his budget to maximise drugs and services for his patients.

BGM strips can vary greatly in price and so some CCGs are looking at using meters with the cheaper and hence more cost effective strips.

The guide lines say BGT should be offered to Type 2 as part of a structured education programme. Carb aware patients would meet that criteria, but it is the GPs clinical decision if to prescribe if diet or Metformin only. Have a reasoned discussion with your GP.
Type 1 and insulin using type 2 together with those on sulphonylureas will need to test following guidelines from NICE and the DVLA.

So please talk and explain your request to your GP.


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[chrism1981]

i don't have any issues getting testing supplies from my GP but trying to get my insulin pens is almost impossible! They require 48 hours for repeat prescriptions but when ever i ask for insulin it takes at least a week!

 

[Westie2]

The standard turn round that GPs tend to aim for is 48 hours for standard repeats, 72hours for it to reach the pharmacy. For non repeat or acute requests the turn around will be longer as the GP will want to consider the request from a clinical perspective.

A large practice could receive over 200 requests a day, so a major task.


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[Paul_c]

As some one who could be described as a 'short termist bean counter' I would like to counter the statement that the GP is maximising his income.
In the new NHS the money is held by the CCG who allocate the prescribing budget to individual practices, following a complicated formula to account for local needs.
The GP needs to manage his budget to maximise drugs and services for his patients.

BGM strips can vary greatly in price and so some CCGs are looking at using meters with the cheaper and hence more cost effective strips.

I'm a bit confused as to how it can be coming from HIS budget when I'm paying for my prescriptions...

 

[Thommothebear]

I'm a bit confused as to how it can be coming from HIS budget when I'm paying for my prescriptions...

You may be paying the prescription charge, but the balance of the costs (most pots of strips are about £25 a pop, far higher than the prescription charge) are paid out of the GP budget

 

[SimonClifford]

We really should be giving our GPs a better time than this. Put yourself in their shoes. You're a very senior chap in your practice, you've spent your whole working life caring for and healing the public of ALL sorts of ills. You're good at it & you know what you're doing. You're aware of the implications of ALL your decisions.
All of a sudden, you now need to be a financial advisor & accountant (which IS in itself, a life-long and very intricate job). You have blessed little training, little interest to deal with money. You NOW have to do all these things AND keep the conscience of a medical practitioner.
I reckon that's pretty a impossible job. And NOW someone says, "but I want testing strips and insulin THIS WEEK". Could you do that? Juggle two completely opposing ideals? Forego MUCH of your medical ideals to implement "new more-efficient policy"?
No, and no wonder it takes days of wrangling with their conscience to make a decision.
Give the poor guy a chance!


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[CollieBoy]

]

You may be paying the prescription charge, but the balance of the costs (most pots of strips are about £25 a pop, far higher than the prescription charge) are paid out of the GP budget

Thommo, you are mistaking what Boots & Co rip you off for (includes VAT & markups :cry: )fpr what the NHS pay for strips (~£15/50)

 

[Thommothebear]

Thommo, you are mistaking what Boots & Co rip you off for (includes VAT & markups :cry: )fpr what the NHS pay for strips (~£15/50)

True enough, but that is still considerably more than the prescription charge

 

[Westie2]

Hi to clarify the budget issues.
The prescription charge goes directly to the government it has nothing to do with your GP.

The GP gets his prescribing budget from the CCG who are given a pot of money to use for prescribing, acute and community trusts and other services. That is the money he has to manage.

The cost of the strips and all medication to the NHS is worked out by the manufacturers and the DH to ensure a fair price for NHS. These prices are mainly listed in The drug Tariff and issued on line and as hard copy monthly.

The prescription charge bears no relationship to the cost of the medication supplied.

I hope this makes it all bit clearer, NHS budgets are a nightmare ....

Westie2


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[SimonClifford]

So the GP doesn't do any medicine these days, just managing budgets, income streams and cash flows for the NHS?
Who does the healing then, these days?


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[Westie2]

Simon be reassured the GPs still do lots of clinical face to face patient work, because that's what they want and enjoy doing. The practice managers are often the business manager who looks after the budgets etc. the GPs together with their Medicines Management Pharmacists look and agree issues around the prescribing budget, their decisions are clinically based but must now be cost effective to ensure a balanced budget.


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[zeie]

As some one who could be described as a 'short termist bean counter' I would like to counter the statement that the GP is maximising his income.
In the new NHS the money is held by the CCG who allocate the prescribing budget to individual practices, following a complicated formula to account for local needs.
The GP needs to manage his budget to maximise drugs and services for his patients.

BGM strips can vary greatly in price and so some CCGs are looking at using meters with the cheaper and hence more cost effective strips.

I'm a bit confused as to how it can be coming from HIS budget when I'm paying for my prescriptions...

If you're diabetic (unless you are controlling it through diet alone) you shouldnt be paying for your prescriptions:

People with certain medical conditions can get free NHS prescriptions if:

they have one of the conditions listed below and
they hold a valid medical exemption certificate.

Medical exemption certificates are issued on application to people who have:
...
Diabetes mellitus, except where treatment is by diet alone
...
from http://www.nhs.uk/NHSEngland/Healthcost ... costs.aspx

I'm T2, diagnosed 8 months ago. I was in hospital for a minor day op and a routine urine test, followed by a BG test, showed I was severely hyperglycemic. I was put on an insulin drip to lower my BG before they'd operate, and the diabetic nurse was called. They gave me a meter with strips on the spot. I went to the doctor once I was released from hospital and got a repeat for the strips (along with everything else I needed).

I've lost 10kgs, reduced my hba1c from 128 to 62.5, brought my average fasting BG down to 6.2 and halved the initial dose of gliclazide I need since then. My doctor calls me "a model patient" and "an inspiration" - apparently I'm doing everything right that I need to do in order to remain as healthy as possible. The simple reason for this is I am totally anal about testing!!!!! I monitor my BG religiously. Waking, before meals, after meals, before bed. Ok, yes, I dont test as much now as I did to start, because I have pretty much worked out what I can and cant eat, but as some of my symptoms can be caused either by my diabetes or my fibromyalgia (restless leg, IBS, extreme fatigue amongst others) I test whenever I dont feel 100%. Also, every time I go to the doctor or DN they ask me for my BG test results since the last time they saw me! Helps them to work out whether my meds need adjusting apparently.

Knowing my BG levels on a meal by meal basis has helped me tremendously, I'm now on a low glycemic load diet (after struggling to understand why a low glycemic index diet didnt work the way I expected, I stumbled across a book by Dr Rob Thomas). My energy levels (although not perfect thanks to the fibro) have improved a lot, I've lost weight steadily, and I personally believe that keeping my diabetes under tight control helps me manage the fibro too! There is definitely an increase in the pain levels from the fibro when my BGs are high.

I dont know what we can do to improve the situation, except keep going with the protests, petitions, and encouraging people to fight for their right to test as they see fit, but I strongly feel that testing can only be beneficial for both us (the sufferers) and the NHS (reduced complications must surely mean reduced long term costs).

Good luck to anyone struggling to get their test meters and strips, I hope my story can help in some small way.

 

[forty six]

I have only just stumbled upon this topic and am a newly diagnosed T2 - 3 weeks ago.

In those 3 weeks I have been told by my Dr that GP's are told not to offer diet and exercise as alternative to medication and that they are not to discuss self monitoring. Luckily I have my own testing kit already which came with 102 strips, but how are you meant to control a disease that can cause you irreparable harm if you cannot test yourself on a regular basis. My Dad was first diagnosed with T2 in 1981 and a testing kit and strips were the first things he was given.

Two things have changed since then. The move away from government advice to reduce your carbs (this was how our parents and grandparents lost weight they just reduced their carbs) in the 1980's and the EPIDEMIC of diabetes we now have in the Western World. Now if there is not a link there then I'm Elvis Presley.

When it comes to messages about this disease I do not trust:
our government
NICE -a contradiction in terms
pharmaceutical companies -the only ones who benefit from us taking drugs like metformin etc

I am lucky in that I have a very good relationship with my GP and when I told her that I was already having very bad side effects from standard metformin has now prescribe the SR version, however she told me that she would get in trouble for doing so and only let me have one months supply.

When you develop this illness, for whatever reason 'you' cease to exist, you become a diagnosis and therefore a drain on the public purse - one I would like to add that I have paid into for 30 years already.

I like Julie will fight my PCT all the way kicking and screaming if needed and I now have enough ammunition about guidelines and policy to fill an armoury.

Let battle commence and good luck Julie because if all the people with diabetes all stood up and shouted this government would be deaf for the right reason.

 

[julie54]

Hello forty six!! Unfortunately so many of us get the same response from the G.P regarding the route to take following a diagnosis of diabetes!! My G.P. - like yours - did not offer any alternative other than writing out a prescription, stating that this was now their policy - and dismissed any discussion on diet and exercise. And as for a meter - that was an absolute No No!! You do have to stand your ground - and follow whichever route you feel is best for you. My G.P. told me I was 'silly' and I haven't been back to see her since. I have, however, seen the Diabetic Nurse, who I almost feel seems somewhat embarrassed to have to follow the 'party line' although her hands are tied!! I am now 6 months down the line. I started off with an HbA1c of 11.4. At two months, my HbA1c was down to 7.8. At the beginning of November ( 3 months further on) my HbA1c was down to 6.1 - and for the first time the DN made no mention of metformin!! She seemed almost peeved by my good results - rather than being praiseworthy!! She told me 'of course, you know you are not cured'!! Of course, I replied, I know that I am not cured - but I do know that I am in control of the condition (I refuse to call it an illness!) - there doesn't seem to be any credit given for being a fairly intelligent, rational and logical person!! I have followed a low carbohydrate diet since diagnosis - which was again ridiculed by the G.P. - and have lost two and a half stones and brought my blood glucose levels within normal range. I am by no means arrogant and do not profess to know more about diabetes than the Health Care Professionals - but I approached my journey using my ability to research - and through lots of excellent advice on these forums. The issue of test strips was a major thorny one - but I took them to task about that too - wrote to the CCG and also to Sir David Nicholson (the Chief Executive of NHS England, who as a newly diagnosed type 2 was immediately handed a meter and strips!!) and my DN did give me a meter and strips - although very reluctantly because this is what I mean by her hands being tied as she has clearly been told not to give them!! I do not get given them willingly - I have to ask and justify each time - but as I use them less now than I did initially, this is not now such an issue - although it still galls me!! I felt that I had to prove myself - which I did - and this could not be ignored as the results proved my efforts. However, I am constantly - even now - made to feel that I am 'bucking the system' - which makes no sense to me whatsoever. I am yet to revisit the G.P. and rub her nose in my results - but I am going to wait until another few more months have gone by as my journey is still ongoing and I have not yet reached my final goal of weight loss and maintained low bg levels - but that day will come!! How sad it is that the battle with the Health Practitioners is in some ways even worse than the battle of getting in control of this condition!! Instead of being encouraged and supported, I have felt all along as though I am some kind of awkward rebel!! But my shoulders are broad (well probably not as broad as they used to be!!) and I shall continue to follow my instinct and you have my support whilst you also continue to follow yours! Good luck - and keep me posted on your progress. I do not profess to know any or all of the answers - and my journey has been solely as a result of forming my own opinion through lots of good advice from some great people on these forums. I think that you will find the same. And anyway - its kinda nice being a rebel!! Julie

 

[Paul_c]

I was put on diet and exercise back in May 2012, given no meter, just the NHS dietary guidelines and put on a DESMOND course.

I followed the dietary sheet to the letter, all low-fat, heart-healthy, wholegrains... I put on weight still and still felt bad.

I found this forum and also both Jenny Ruhl's website and Dr. Briffa's "Escape The Diet Trap" book... I bought my own meter and strips and was horrified at the levels my BS was remaining at and going to on that **** NHS diet...

Switched to following a low-carb high-fat diet and everything got sorted out, lost loads of weight, down from 17 1/2 stone to 13 1/2 stone by the time of my first annual checkup, got my HbA1c into the 5% club lost 6 inches off my waist... and yet my doctor still refuses to prescribe a meter and strips and considers my diet to be an unsafe faddy diet with no long term success, he also doesn't like my cholesterol figures either...

Well stuff them, stuff the lot of them. I'm determined to stay LCHF and in control of my diabetes no matter how much they disapprove of it...

I don't test anywhere as often now as I did when I first started doing it as I know what I can tolerate...

 

[elaine77]

There have been many many suggestions that the switch from low carb high fat to low fat low fat low fat at all costs in the 1980s is the main cause of this diabetes epidemic we are now seeing....I honestly think there is some truth in it too....

 

[SimonClifford]

That's interesting Elaine, thanks. I suspect most of us got bored with "low fat" a while ago & started eating up eggs, butter & well-roasted meat!

 

[CollieBoy]

That shows what state our once amazing NHS is in now - the bean counters are in control - it's all about being able to demonstrate that you can save money. It should be about value for money - i.e. providing a quality service at the best price point.

Shame it's not seen that those who wish to Self Monitor their Blood Glucose levels are actually saving the NHS thousands of pounds by avoiding complications.

I do recognise, however, that not all the populus that have Diabetes want to manage their condition - i was the only person on the DESMOND course that asked to be there!

There shouldn't be a blanket approach to restricting monitors from those who wish to manage their conditon.

the problem IMHO is one of selling the solution to the patient (and to the HCP as well). Too often the patient is told that they are being sent on a course rather than being sold the solution and a desire created to work toward a solution.

 

[anteater2012]

Well I had a surprise when I went to surgery for first time the other day!

I was diagnosed 9 months ago outside the uk and received pretty good help and assistance including a free meter and 100 strips per month. After reading some of the stories on here with regards to the support being offered by your surgeries I was dreading visiting mine I.e loosing drugs and being taken off meter.

Well it was not the case. Not only did he listen, he put me back on diamicron which I think I needed to be back on and he issued strips for my meter (only 50 per month), but I am confident I will manage on those. I did offer to change to a cheaper meter but he said they had issues with some of the cheaper meters.

It sounds like I might have lucked into one of those doctors who recognises a patient who is prepared to work at keeping things under control. Hurrah.

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