More pump choices

[steveo4]

I think type one diabetics should have more choice over what pump to have. When I was offered a pump I had one choice there was no alternative. If there was then maybe I would still be using the pump instead of going back on injections. Patients should have more choice in all and not just certain areas. Who is the best department to contact to make this happen ?

 

[catapillar]

The reason the choice varies between clinics is because each clinic will have to negotiate a deal with each pump provider - it might be that your clinic had a contract to get a discount on the pump they offered by agreeing to only offer that pump.

If your clinic doesn't offer the choice you want, you do have choice over where you are treated, so you could ask for a referral to a clinic that does offer a choice of pumps.

How to manage the relationship with pump providers is really a matter for each individual clinic - see INPUT for more information - http://www.inputdiabetes.org.uk/alt-insulin-pumps/pumpchoice/

 

[CarbsRok]

I think type one diabetics should have more choice over what pump to have. When I was offered a pump I had one choice there was no alternative. If there was then maybe I would still be using the pump instead of going back on injections. Patients should have more choice in all and not just certain areas. Who is the best department to contact to make this happen ?

Steve as I understood it from your previous posts you were given a pump and had in fact been pumping for 5 years before you decided you didn't like or want the replacement given to you.
Bottom line is that your CCG wont be funding another pump until the 4 year warranty has expired on your present pump.

 

[tim2000s]

It does raise an interesting question though. Why doesn't the NHS negotiate the agreements with the pump companies rather than individual CCGs? The scale would, in theory, hugely reduce the costs of the devices and the consumables.

 

[paulliljeros]

It does raise an interesting question though. Why doesn't the NHS negotiate the agreements with the pump companies rather than individual CCGs? The scale would, in theory, hugely reduce the costs of the devices and the consumables.

Correct, but sadly also potentially hugely restrict the choice also.

 

[tim2000s]

Correct, but sadly also potentially hugely restrict the choice also.

In what way? It's not like there's an open choice in England and Wales anyway. Many clinics only offer one or two pumps. NHS Business Services should be negotiating at least an England purchase agreement on all of the main brands to make them an option.

 

[paulliljeros]

In what way? It's not like there's an open choice in England and Wales anyway. Many clinics only offer one or two pumps. NHS Business Services should be negotiating at least an England purchase agreement on all of the main brands to make them an option.

My concern would be that in order to get a big discount the larger/largest fish will say you can only stock ours, and thereby I could imagine it would end up with the NHS committing to a X-year contract, supplying only one brand of pump. You are right, many only offer a couple of pumps, but across all clinics, all pumps are available and at the moment, you can potentially move across clinics if you have your heart set on one particular pump.

 

[catapillar]

I don't think nhs procurement is very well centralised for this kind of thing & setting the system up, buying out of currently existing contracts from the individual clinics etc would have a significant initial cost that probably no one has an appetite, or a budget, for.

I don't think that the NHS centrally, or individual clinics, can agree proper exclusivity contracts. I hope not anyway as there might be clinical need for an alternative pump. I think the way the agreements work at the moment is that discounted pump A is the default pump for the clinic and patients wanting an alternative will have to fight to show a clinical need for an alternative - because of the differences between the pumps it's going to be difficult to prove a real clinical need for pump b or c over pump a, so in practice it works out as an exclusivity agreement.

 

[Engineer88]

I also think if there is a case put forward by a patient a clinic can make exceptions. I did my research and went to my clinic knowing which pump i wanted an d why. I was the first at the clinic to get that pump and paved the way for others

 

[CarbsRok]

Logically though if you think about it people move house so end up in different areas so does the new hospital attended remove the pump you are using and give you a brand new pump that fits in with their clinic?
I remember Treliske took that stance with me I told em to get stuffed as I had a top of the range pump (Cozmo) and they insisted if they allowed me to pump then I would have to have in my eyes an inferior pump (Roche spirit) which didn't even have a bolus wizard.
I went directly to my PCT as did my GP and my care was under him and still is with a 10 min hello apt once a year with a different consultant from a different trust. This came in end of last year on instructions from the CCG to appease their silly rules and regs.

 

[tim2000s]

@CarbsRok, therein lies the problem. If it was one cost across the board with properly negotiated agreements, you wouldn't have these issues. Instead we have what I can only describe as a mess. I think it would be fair to suggest that no-one anywhere in the NHS could provide decent numbers for the count of each type of pump in use across NHS England.

NHS BSA should be providing benchmark pricing on the pumps themselves, according to the way they are set up, but I've never managed to find that on their webiste.

 

[Gazmaskell1509]

I cannot get a pump unless I move clinic to England. I am in powys and was told if I wanted a pump I need to move clinic to Shropshire

 

[AndyS]

I would just be thrilled to be offered a pump in the first place.
Seems I don't qualify on all counts since I am not a child, pregnant woman, I have fairly good control, no real issues with hypos and am not hugely worried about hypos.

About the only thing I possibly argue on is quality of life but that seems to be something that they use as the deal closer not the only argument.

Oh well only another 1312 (or so) shots left for this year.

/A

 

[paulliljeros]

I would just be thrilled to be offered a pump in the first place.
Seems I don't qualify on all counts since I am not a child, pregnant woman, I have fairly good control, no real issues with hypos and am not hugely worried about hypos.

About the only thing I possibly argue on is quality of life but that seems to be something that they use as the deal closer not the only argument.

Oh well only another 1312 (or so) shots left for this year.

/A

Hi @AndyS, if your signature is still valid, in as far as your HbA1c is so good that your specialist thinks you are hypo all the time, then you have got one of the best arguments for moving onto a pump. Additionally, if you were to hypothetically argue that your BG is so good because you are micro-dosing, and taking, lets say, 8 or 9 injections a day then it can easily by argued that this is simply not sustainable.

 

[AndyS]

Hi @AndyS, if your signature is still valid, in as far as your HbA1c is so good that your specialist thinks you are hypo all the time, then you have got one of the best arguments for moving onto a pump. Additionally, if you were to hypothetically argue that your BG is so good because you are micro-dosing, and taking, lets say, 8 or 9 injections a day then it can easily by argued that this is simply not sustainable.

Yup that A1c is still valid though they did hook me up with CGM for a few weeks to gather data and went away understanding that I am not hypoing all the time.

As for micro dosing I only tend to do that very occasionally when the situation demands it, the rest of the time I tend to lead my food intake just enough to get the peaks to meet (for the most part) so the only other genuine argument I have is that I tend to find these days that when I do go hypo it tends to come on slowly and I really have no desire to eat so it becomes a case of forcing myself to eat, which is I guess more of an annoyance than any kind of medical justification.

/A

 

[CarbsRok]

As for micro dosing I only tend to do that very occasionally when the situation demands it

Ah but does your care team know this?

 

[tim2000s]

Ah but does your care team know this?

It's quite amazing what you can get a downloadable, bolus advising, blood glucose monitor to record...

 

[Snapsy]

Fear of hypos = a detrimental effect on quality of life.

What you say in your signature @AndyS might well support the above as a good reason to have a pump. As your HbA1c is 5.7 then fear of hypos is certainly something your team should consider as being a jolly good reason for pump therapy, in my opinion.

Mine was 44 (in new money) before I got my pump. Absolutely spot-on - but my issue was that 'normal' life had gone for a burton in favour of achieving that level of control. My team were brilliant in their interpretation of the guidelines once they realised how much my diabetes management was taking over my life.

It's not a magic bullet but oh boy I'm so grateful for my pump!

 

[AndyS]

Oh yeah I know all the arguments. The thing is I was taught to be honest and I really don't have any fear of hypos.
For the most part I usually feel them coming and have never once in almost 7 years now required any kind of assistance in treating.

I am completely aware that a pump is only as good as the person that it is attached to / is running it but it really would be nice to be able to do much finer control of basal rates since I know that mine does change when the days turn either stressful or particularly physically busy. So in those cases my care team is well aware that I have to either do micro doses or eat food when I don't want to but like I said all these things come more down to an annoyance than something that I see as detrimental to my quality of life.

/A

 

[iHs]

@AndyS there is no need to achieve a really low a1c in order to be well with diabetes. An a1c between 6.5 to 7.1% has enabled me to live a good life for the past 50yrs and I have no intention of competing with the younger generation trying to achieve an a1c that a person without diabetes would have. It would be stupid of me to do so as my awareness of the hypo feeling would definately diminish and also my ability to be able to drive my car ok would be questioned as well. Although cgm technology gives me a break from pricking my finger a tiny bit, I don't need to rely on it as such and at times I make myself go low so that I can test my awareness out.
Why are you micro dosing or Sugar Surfing?