Has NHS funding been blocked for glucose sensors?

“Clearly one rule for one & one rule for the elite. Circled here on @theresa_may  is a freestyle Libre continuous glucose sensor. You know the type she blocked NHS funding for? These are a lifeline to diabetics. Double standards???”

Viral tweet, 13 July 2018

We were asked by a reader to factcheck this tweet claiming the Prime Minister had blocked funding for a type of glucose sensor used by diabetics. At the time of writing it had been retweeted over 3,000 times.

The particular brand of glucose sensor mentioned in the tweet is available on the NHS across the UK to some extent.

In November 2017 it was added to the drug tariff—which sets out how much pharmacists and GP practices will be reimbursed for prescribing various drugs or medical devices to patients.

In England—where the UK government is responsible for healthcare—it is ultimately up to individual groups of GPs, consultants and other NHS staff responsible for spending on healthcare in the local area to decide whether the sensor is funded and available.

NHS England has said that from April 2019 the FreeStyle Libre will be available on prescription for all patients in England who meet the clinical criteria.

These glucose sensors are available to some extent on the NHS across the UK

The FreeStyle Libre is “a small sensor... placed under the skin to check glucose levels in the tissue’s fluid. The sensor stays in situ and transmits information about glucose levels to a monitor.”

The brand of sensor in question is now available on the NHS across Great Britain to some extent and through Health and Social Care Northern Ireland (the NHS equivalent there).

The original tweet appears to come from a Scottish account. In Scotland the FreeStyle Libre was available in seven of the fourteen NHS health boards as of June 2018.

In England the FreeStyle Libre has also been introduced in some areas but not in others. An investigation by the British Medical Journal reportedly  found that as of July 2018 two of 195 clinical commissioning groups (CCGs) in England prescribed it to more than 20% of patients with Type 1 diabetes. Another 15 had prescribed it to more than 10% and 25 had issued no prescriptions.

NHS England says that that if CCGs followed the clinical guidance on who can be prescribed the devices, the number of patients with access to them could be increased to around 20-25% across England. It also says that 144 of 195 CCGs have already signed up to providing the Freestyle Libre.

Approving glucose sensors for use across the UK

There are a number of stages between a drug or health appliance being ready for the market and people being able to purchase it or get it on prescription from the NHS.

The licence and use of drugs and medical devices in the UK is monitored by two agencies, the European Medicines Agency which functions across the EU and European Economic Area (EEA), and the Medicines and Healthcare Products Regulatory Agency, which is a branch of the Department of Health. In order to be made available in the UK a drug or health appliance has to be approved by one of these organisations.

In September 2014 the FreeStyle Libre glucose sensor was approved by the EMA for use on the European market.

The route to the NHS

Guidelines on various treatments in England they’re produced by the National Institute for Health and Care Excellence (NICE)—though NICE guidance can be used in the rest of the UK too.

These guidelines are produced to help medical professionals and patients understand the evidence behind a new treatment or device and to help them make decisions about it.

According to the Scottish Parliament Information Centre “SIGN guidance is not mandatory but it is expected that healthcare professionals should take it into account in their practice. If it is considered that guidance does not reflect the most recent evidence, clinicians would be expected to look to more recent guidelines such as those from NICE.”

The most recent NICE guidelines say that “Continuous monitoring of interstitial fluid glucose using a continuous glucose monitor is not recommended for routine use but can be considered for some people (see table 1). No NICE guidelines currently include recommendations for intermittent interstitial fluid glucose monitoring (such as that provided by FreeStyle Libre)”.

Taking the guidance of these bodies into account it is then up to individual CCGs Groups (across England) or NHS Health boards (in Scotland) to decide whether they will introduce the drug or technology in their area.

In England, Wales, Northern Ireland, and Scotland the FreeStyle Libre device has been available for prescription on the NHS since November 2017, though the NHS says this is dependent on local approval and the person being prescribed it meeting certain criteria.

Where it is available, the NHS says patients typically need to test their blood glucose eight times a day and have “disabling hypos” before they would be prescribed a sensor.

Private purchase is also possible

It is also possible to purchase the FreeStyle Libre separately, rather than getting it on prescription. The NHS’s “rough guide” says that this will cost around £150 for the starter pack and then another £50 each for more sensors and readers to top this up.