Type 1 - threatened test strip withdrawal

[Paul520785]

Just check my e-mails and this just annoys me
E-mail from surgery >>
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From: E###, Y####(NHS NORTH NORFOLK CCG) [mailto:#################]
Sent: 07 December 2016 15:20
To: Paul##############

Subject: test strips

Following our conversation on Friday 2nd December, after your consultation with our New Doctor, Dr #######.


I informed you that the extra 5 boxes issued by Dr ######### may not be issued as he was unaware of your limit with test strips.
As has been said before, we issue enough strips for you to use each month, not for you to have a separate box in each of the residences you attend.
You are expected to take a box with you for the day.
I discussed your case with Dr ########, we agreed to issue the 5 extra boxes this time, therefore we ordered them in and they have since been collected from dispensary.
I also explained that your monthly quantity of strips is 4/5 alternately and this will remain.
Hence the online quantity is 4 as 5 were issued in December.

yours sincerely
Y##### E### (dispensary manager)
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from the e-mail above - errors continue.

extra 5 boxes issued Still cannot count the doctor said was prescribing 6 not 5

he was unaware of your limit with test strips. Wrong because I gave him a copy of the letter at the start of this thread then I explained there was a limit imposed some years ago relating to before I retired but under current NHS guides this now appears to be out of step so an expected daily test schedule was provided and discussed and agreed at the appointment.

You are expected Says who ????

I also explained that your monthly Not to me - I just said "talk to the doctor" and walked out so assume means explained to the doctor but I did not realise dispensary staff issued that type of instruction.

Now I am just going to wait until after I can arrange another appointment with my Doctor to clarify the situation.

 

[slip]

OMG!

 

[novorapidboi26]

I get 2 boxes of 50 each time........when they run out I order more....

Is this not normal...?

 

[donnellysdogs]

I get 2 boxes of 50 each time........when they run out I order more....

Is this not normal...?

No.

 

[novorapidboi26]

No.

Why?

 

[slip]

I get 2 boxes of 50 each time........when they run out I order more....

Is this not normal...?

Same here, I in fact have 2 boxes on 4 week repeat along with tablets that Boots deal with, never have a problem with that....(if only! but problems are rare and aren't connected with the OP issue) and then I order 2 more boxes online via patient access as and when, probably averages every 3rd week - depends how much testing I'm doing.

In the email above they have admitted they are limiting test strips when they shouldn't!

 

[tim2000s]

So let's go back to basics with this one shall we @Paul520785 ? Under NG17, you are expected to be supported in having enough test strips to encourage testing up to ten times per day if the following applies:

1.6.11 Support adults with type 1 diabetes to test at least 4 times a day, and up to 10 times a day if any of the following apply:

• the desired target for blood glucose control, measured by HbA1c level (see recommendation 1.6.6), is not achieved
  
  
• the frequency of hypoglycaemic episodes increases
  
  
• there is a legal requirement to do so (such as before driving, in line with the Driver and Vehicle Licensing Agency [DVLA] At a glance guide to the current medical standards of fitness to drive)
  
  
• during periods of illness
  
  
• before, during and after sport
  
  
• when planning pregnancy, during pregnancy and while breastfeeding (see the NICE guideline on diabetes in pregnancy)
  
  
• if there is a need to know blood glucose levels more than 4 times a day for other reasons (for example, impaired awareness of hypoglycaemia, high‑risk activities). [new 2015]

1.6.12 Enable additional blood glucose testing (more than 10 times a day) for adults with type 1 diabetes if this is necessary because of the person's lifestyle (for example, driving for a long period of time, undertaking high‑risk activity or occupation, travel) or if the person has impaired awareness of hypoglycaemia. [new 2015]

Let's assume that you fit these criteria somehow, so they should be supporting you in providing 10 strips per day. That's basically your six boxes a month.

Now your email suggests a discussion of some sort with your dispensary manager that you have multiple residences and that you want to leave test strips there. They are within their rights to say "No" to that, as it's not a point in the NICE guidance that they have to provide you with strips in multiple locations, when you, like every one of us, can carry them around with you. It's a bit of a nitpicking point, but it's valid none the less.

Personally, from here, I would contact your practice manager and you need to have a face to face meeting on this one. You need to have both them and your dispensary manager in the same room.

You then need to quote NG17 at them, specifically the sections above, detailing what the factors are requiring you to do 10 tests a day. If they can be anal, so can you.

You then need to produce the letter that @noblehead can provide that states what practices are supposed to do in support of T1s and SMBG.

Stick to the guidance, and stick to the provided reasons for enough test strips. They can't argue against those. And do it face to face. Let them feel the heat of your wrath.

 

[noblehead]

I get 2 boxes of 50 each time........when they run out I order more....

Is this not normal...?

I just don't see the logic, if say a box of 50 strips lasts a week then your putting in a repeat prescription every 2 weeks, IMHO at the very least they should be prescribing 200 strips to insulin users.

You then need to produce the letter that @noblehead can provide that states what practices are supposed to do in support of T1s and SMBG

The letter that Tim is referring to:

https://www.gov.uk/government/uploa.../Safe-care-of-people-with-type-1-diabetes.pdf

 

[novorapidboi26]

I just don't see the logic, if say a box of 50 strips lasts a week then your putting in a repeat prescription every 2 weeks, IMHO at the very least they should be prescribing 200 strips to insulin users

It must be to do with their accounting or something, you know, to make it easier for them to keep track or whats being spent on what...complete guess though...

 

[noblehead]

It must be to do with their accounting or something, you know, to make it easier for them to keep track or whats being spent on what...complete guess though...

Not sure what the reason is tbh, but it's frustrating when they hold back on the test strips

 

[novorapidboi26]

Not sure what the reason is tbh, but it's frustrating when they hold back on the test strips

Fortunately for me its not an issue, I don't mind going back every 2 weeks as the process is really simple....send an email, collect 2 days later...

 

[noblehead]

Fortunately for me its not an issue, I don't mind going back every 2 weeks as the process is really simple....send an email, collect 2 days later...

If your happy with the procedure then that's great @novorapidboi26 , I found it all too inconvenient and annoying so have had to involve my diabetes team to make the surgery see sense and up the prescription.

 

[bravedart]

They are giving you enough to test yourself 7 times a day comfortably. What exactly do you do, or what other reason do you have, to justify having to test 10 times a day? And why is it acceptable to put the name and contact information for the dispensary manager online?

 

[novorapidboi26]

If your happy with the procedure then that's great @novorapidboi26 , I found it all too inconvenient and annoying so have had to involve my diabetes team to make the surgery see sense and up the prescription.

How many pots are you getting each time, 4?

 

[noblehead]

How many pots are you getting each time, 4?

6, it was increased from 4 after I started on a pump.

 

[novorapidboi26]

6, it was increased from 4 after I started on a pump.

And how long does 6 last you....?

 

[donnellysdogs]

I was on 300 and then 200 when I got my libre. I wait to see what happens when I get my funded cgm..

 

[noblehead]

And how long does 6 last you....?

Around 5 weeks.

 

[London36_]

I posted earlier in the year with the same problem. Fortunately I have a leading consultant from a good hospital and after calling their PA, and speaking with my consultant, she called and wrote to my GP and the issue was resolved. I think Practice Managers I charge of the budget and the admin are the main culprits.

One of the best tips given to me here on the T1 community was that it is illegal for your to drive without testing first. You may wish to drive several times a day and in addition to the NICE recommendations, you require more strips than they are prescribing and they are therefore forcing you into an unhealthy, dangerous and illegal position.

I've previously got into heated debates/arguments with a previous GP who said I was testing so much I was 'bringing the NHS down!!!!' He was silent to my assertion that not prescribing me strips I require would mean my future complications would bring down the NHS and b) he wouldn't get his bonus for my HbA1c being in target (despite it being nothing to do with him!)

Good luck

 

[Paul520785]

Firstly - Thank you all for the comments and thoughts - I hope it provides everyone a view of what others do and think.

@tim2000s Excellent Info-
Having discussed my daily activity level with the doctor - and Driving (DVLA Rules) he thinks 6 boxes should do.
I meet the rules, for 10 daily, described in at least 4 areas and I wish I did not!
Again >> Thank you.

After over 55 years experience of injecting insulin I feel that everyone is different but the most important thing is to be "comfortable" that you have both knowledge and what you need to survive as a diabetic.