- Messages
- 8,934
- Type of diabetes
- Type 1
- Treatment type
- Other
Following yesterday’s NNF conference on Continuous Glucose Monitoring (CGM) and the ensuing Twitter debate that frequently happens with these types of event, I gave some thought to an alternative approach to funding CGM.
What it boils down to is that, instead of being tied to Self Monitoring of Blood Glucose (SMBG) using finger prick strips, the budget that NICE allocates for ten times daily finger prick testing could be applied to both CGM and SMBG, and the patient would be responsible for managing that budget and making up the difference in any costs that arose. A perfect example of patient centric care.
Instead of mandating that the only way that prescription monitoring can be provided under the NICE guidance for those who fall outside the prescriptive requirements for CGM, it should be possible to apply, through either your Diabetes Care team or your GP for a “Self Monitoring Fund”. It is a similar model to the Personal Health Budget.
Let’s be clear on this one though. This is not for everyone. The standard model of care is the NICE guideline. Each patient gets the standard SMBG provisions and supplies as normal. They can apply for CGM if they qualify under the criteria listed previously. The Self Monitoring Fund is undertaken on application only. It is not the new “Normal”. In patient centric care, the patient gets to decide, in association with their healthcare team, what monitoring would be most appropriate for them. If they feel that a combination of SMBG and CGM is appropriate, then they can apply for and move on to this model. In doing so, they rescind their right to SMBG as standard on the NHS.
It’s very simple. When a patient decides and their HCPs agree that instead of being provided SMBG test strips, they will take management of this into their own hands, they apply, either through their Diabetes Clinic or their GP, to the CCG for the Self Monitoring Fund. The fund provides for £1,059 to be spent by the patient on monitoring supplies and technology. In any way that they elect to do so.
All supplies will need to be available through the NHS Prescription service so that the normal prescription model is followed. This would also allow the GP, for example, to track the cost – most GP prescribing systems contain the cost of prescription items, so it’s a short jump to be able to allocate a cost per patient. When, via the prescription system, the annual fund is exhausted, the patient must purchase additional monitoring supplies out of their own pocket. Whatever those monitoring supplies are. This should come as no surprise to the patient, who should be managing this anyway, and is part of the contract that is signed on application for the fund. Both parties have to go in with their eyes wide open on this one.
Given that the companies that provide these items are already working with the NHS, this shouldn’t be a huge jump.
The benefits to this approach are in better patient care and in evidence gathering for future guidelines and use of NHS funds.
1. This isn’t a one size fits all approach. It’s an “on application” model that means you only do it if you feel you can and your healthcare team agrees.
2. It allows those who want to define their own care model to elect how they monitor themselves and what technologies to use to do this.
3. By including the details of how many patients have applied for and are using the “Self Monitoring Fund” approach in the National Diabetes Audit, it allows a clear picture to be obtained as to the demand on the NHS for CGM. The prescription data also adds to this picture. There is currently doubt that this demand is as high as the Diabetes Online Community (which is very noisy) makes it seem.
That’s the proposal. I’m sure that I’m likely to have missed something, and as with all these things, there will be challenges along the way. The question for the GB Diabetes Online Community is “Would you be willing to work within this type of framework?”. It’s not the panacea in terms of the NHS paying for everything, but I don’t think it should be. The NHS can’t afford to cover everything for everybody. This allows a way for those of us who want it to get better coverage to do so, without causing extra cost and headaches.
Who knows, it might even encourage a better deal on the price of the CGM supplies in the UK if the NHS had signed up!
What do you think of this as a budget-flat approach that could be considered via the NHS? Full details are available on my blog, including a lot of the evidence that has gone into this.
What it boils down to is that, instead of being tied to Self Monitoring of Blood Glucose (SMBG) using finger prick strips, the budget that NICE allocates for ten times daily finger prick testing could be applied to both CGM and SMBG, and the patient would be responsible for managing that budget and making up the difference in any costs that arose. A perfect example of patient centric care.
Instead of mandating that the only way that prescription monitoring can be provided under the NICE guidance for those who fall outside the prescriptive requirements for CGM, it should be possible to apply, through either your Diabetes Care team or your GP for a “Self Monitoring Fund”. It is a similar model to the Personal Health Budget.
Let’s be clear on this one though. This is not for everyone. The standard model of care is the NICE guideline. Each patient gets the standard SMBG provisions and supplies as normal. They can apply for CGM if they qualify under the criteria listed previously. The Self Monitoring Fund is undertaken on application only. It is not the new “Normal”. In patient centric care, the patient gets to decide, in association with their healthcare team, what monitoring would be most appropriate for them. If they feel that a combination of SMBG and CGM is appropriate, then they can apply for and move on to this model. In doing so, they rescind their right to SMBG as standard on the NHS.
It’s very simple. When a patient decides and their HCPs agree that instead of being provided SMBG test strips, they will take management of this into their own hands, they apply, either through their Diabetes Clinic or their GP, to the CCG for the Self Monitoring Fund. The fund provides for £1,059 to be spent by the patient on monitoring supplies and technology. In any way that they elect to do so.
All supplies will need to be available through the NHS Prescription service so that the normal prescription model is followed. This would also allow the GP, for example, to track the cost – most GP prescribing systems contain the cost of prescription items, so it’s a short jump to be able to allocate a cost per patient. When, via the prescription system, the annual fund is exhausted, the patient must purchase additional monitoring supplies out of their own pocket. Whatever those monitoring supplies are. This should come as no surprise to the patient, who should be managing this anyway, and is part of the contract that is signed on application for the fund. Both parties have to go in with their eyes wide open on this one.
Given that the companies that provide these items are already working with the NHS, this shouldn’t be a huge jump.
The benefits to this approach are in better patient care and in evidence gathering for future guidelines and use of NHS funds.
1. This isn’t a one size fits all approach. It’s an “on application” model that means you only do it if you feel you can and your healthcare team agrees.
2. It allows those who want to define their own care model to elect how they monitor themselves and what technologies to use to do this.
3. By including the details of how many patients have applied for and are using the “Self Monitoring Fund” approach in the National Diabetes Audit, it allows a clear picture to be obtained as to the demand on the NHS for CGM. The prescription data also adds to this picture. There is currently doubt that this demand is as high as the Diabetes Online Community (which is very noisy) makes it seem.
That’s the proposal. I’m sure that I’m likely to have missed something, and as with all these things, there will be challenges along the way. The question for the GB Diabetes Online Community is “Would you be willing to work within this type of framework?”. It’s not the panacea in terms of the NHS paying for everything, but I don’t think it should be. The NHS can’t afford to cover everything for everybody. This allows a way for those of us who want it to get better coverage to do so, without causing extra cost and headaches.
Who knows, it might even encourage a better deal on the price of the CGM supplies in the UK if the NHS had signed up!
What do you think of this as a budget-flat approach that could be considered via the NHS? Full details are available on my blog, including a lot of the evidence that has gone into this.
