# Where is Flash available on the NHS?



## Diabetes UK (Jan 8, 2018)

Many people have asked where Flash is available on the NHS. We have been gathering information around the UK to create a new helpful resource - The Flash Map.

It’s a map of where we know Flash is available at the minute, where we know it isn’t and where there’s been no decision we know of so far.

https://www.diabetes.org.uk/get_involved/campaigning/flash-glucose-monitoring

There’s also an option to write to the local healthcare authority and ask about or challenge their decision if they either haven’t provided flash or haven’t decided yet.

The map was launched today, but is a work in progress. If you would like help fill it in, you can ask your local healthcare authority what the situation is your area by using our quick online tool. And our team would love to hear any responses you get back from them – please send any replies you get to diabetesvoices@diabetes.org.uk

Or if you have further information you want to share about local policies – please contact policy@diabetes.org.uk


----------



## Northerner (Jan 8, 2018)

Good idea!  Has this been shared with the various Abbott groups on Facebook?


----------



## everydayupsanddowns (Jan 8, 2018)

I'll make sure it has been picked up in the group I help with.

EDIT: as expected they are already aware of it and very pleased to see it in the UK group.


----------



## Diabetes UK (Jan 9, 2018)

Northerner said:


> Good idea!  Has this been shared with the various Abbott groups on Facebook?



Not yet, but it would be great to share it with any relevant Facebook groups


----------



## khskel (Jan 9, 2018)

Having looked at several areas where the Libre will be available it looks like their criteria will exclude most people with reasonably controlled diabetes. Most are saying it will only be prescribed in cases where there is recent loss of hypo awareness, admission to hospital on two or more occasions +/ consistently high BG levels.


----------



## trophywench (Jan 9, 2018)

Well my area doesn't seem to prescribe em yet, but before everyone who has never tried on gets too worked up can I just remind everyone that they are not of any help whatsoever to some people who you'd assume on the face of it they would be - eg  myself as a case in point !

Why?  because my BG does whatever my BG does and there's an end to it - years ago I was lent a fullblown CGMS by my clinic that I wore for a week - I couldn't see any results, had to download it.  All I had to do with it, was do 4 meter blood tests a day and enter them into the CGM machine.  The machine was then downloaded onto software at the clinic a week later, and graphs printed off.  I didn't have any trends or patterns then I could iron out - and I still don't now!


----------



## AJLang (Jan 9, 2018)

Jenny I also don't have trends or patterns but the Flash Libre helps to highlight sudden unexpected changes that I then double-check with a finger prick. As a result I've avoided numerous hypos by realising that I'm going down and having glucose whilst in the 4's. Similarly when it is going up I can do small (or if necessary large) boluses. Plus if usually when I'm half asleep during the night I will reach over and do a quick scan - it is the only way that I realised that I was having bad hypos recently that needed 30g of fast acting carbs.


----------



## Steevo (Jan 9, 2018)

worth reading the Policy statements as well to see what guidelines might apply for a free one.


----------



## Greyhound Gal (Jan 9, 2018)

khskel said:


> Having looked at several areas where the Libre will be available it looks like their criteria will exclude most people with reasonably controlled diabetes.


The daft thing is that many people, myself included, have got good control BECAUSE of using the libre...


----------



## khskel (Jan 9, 2018)

Likewise and the consultant at the clinic was of the same opinion.


----------



## trophywench (Jan 9, 2018)

Aaaah - but, having achieved better control because of the Libre - what would happen if you ceased using it - I mean if you DO have repeating patterns fir enough but now you know you have them you've presumably altered your doseage so as to avoid em now.

Fair enough you'd want to check every so often same as the sporadic 24hr basal testing - it's physically impossible to do that every day hence we don't - but unless you are mega random and DO keep having hypos (which I don't otherwise I expect I'd want a Libre) I can't say I agree everyone needs it full time - I do absolutely rely 90% on my meter of course but in truth I could use a far cheaper one if I had to - same as yes I could probably stay alive with mixed insulin delivered in glass syringes attached to blunt needles - or something in between that and a pump at least!

However I just don't WANT to cos I do get better control this way.

And want is not the same as need.

If they are going to restrict who gets them - who cross examines the needy person and does the random checks on them in their real lives, to ensure they are already doing everything they might, to control their BG anyway?  I have in mind a certain person here who was issued with a pump years ago as she had such lousy control and had already killed one kidney, had masses of laser in both eyes, injections in her eyes with all the new drugs PDQ after they were released, her transplanted kidney was on its way out and so was her remaining 'own' one ....... her heart started playing up and Oh wow, she was on the transplant list ......  meanwhile I had my pump and said to daughter one day soon after that I'd just scared myself - had taken it off to have a shower, then totally forgot to reattach it (but had now)

She said 'How long was it off for?'  A couple of hours I suppose.  'Yeah - that's about what I thought - hardly likely to kill you, M used to leave hers on the bathroom windowsill for 2 or 3 days at a time - and it hasn't killed her yet!!'  Andf M subsequently got the transplant and so started to moan all the while with how many tablets she had to take and how very very difficult it was to drink the amount of water you have to after such a transplant .......

Oh yeah, let's waste all our best resources on people who refuse to help themselves shall we?  Yep that's sour grapes indeed and I freely admit that - but I do actually resent helping people who won't.  If they CAN'T then that's a different matter !


----------



## mikeyB (Jan 10, 2018)

As ever, Jenny, you’ve hit on a point that doesn’t often get mentioned. You can throw any expensive kit at folk with bad control, and some will still have bad control. You can’t change a mindset with flashy kit. The authorities are making their criteria aim at just such people. 

That said, there are folk on the forum with conditions like gastroparisis or the creonistas who have difficulties with precise control who would benefit. Indeed, most on this forum are looking for help. Maybe that should be the criterion?


----------



## SB2015 (Jan 10, 2018)

In my area there’s is a clear criteria that the person must have demonstrated that they are able and willingness to make use of the additional information that the Libre will give, as well as showing that they are willing to address all aspects of their Diabetes, not just HbA1c

For me, in addition to pattern finding and doing fasting tests, my biggest use is heading off highs and lows, especially when there is no logical reason for them.  I would not be aware of these without the Libre, unless I start de to do BG test more often.  Swiping is easy and no problem to do.  

The other big advantage is during exercise.  Being able to swipe during a game enables me to react as necessary. As matches vary a great deal there is no obvious pattern,  ut I pick up any problems easily without interrupting a game.  It has prompted me to do more exercise.  

Overall outcomes: Lower HbA1c, more active, higher percentage on target, fewer/smaller  hypos and hypers and a much happier person.


----------



## Matt Cycle (Jan 11, 2018)

Interesting as there are patterns as to where it has and has not been prescribed.  So it's a yes in the North East, Greater Manchester, Northern Ireland and Wales and a no in the Birmingham area and surroundings and around the Fylde coast with odd yes's and no's in other areas but the majority still yet to declare including the biggest - London.  Postcode lottery indeed.


----------



## stephknits (Jan 11, 2018)

In my area it is a blanket no.
http://www.westsuffolkccg.nhs.uk/wp...-Monitoring-Systems-Prescribing-Policy-V5.pdf


----------



## Barbie1 (Mar 7, 2018)

I can see I shall have to "lose" hypo awareness pretty quickly now.

The response from North Hants is

*Diabetes*
*Current Statement in regards to Flash Glucose Monitoring (FreeStyle Libre)*
 
The CCG agreed on Friday 23 February 2018 to adopt recommendations made by the local Southampton, Hampshire, Isle of Wight, Portsmouth (SHIP8) Priorities Committee about the commissioning of ‘flash’ glucose monitoring systems, such as FreeStyle Libre.
Whilst the CCG has agreed the SHIP8 Priorities Committee recommendations, there are now some important details to work through and agree with our service providers about how these will be adopted in practice. The Priorities Committee has scheduled for further review in early 2019.
The SHIP8 Priorities Committee guidance has been considered alongside other national guidance as well as the NHS England Regional Medicines Optimisation Committee advisory statement on Flash Glucose Monitoring systems.
You can view the policy recommendation document Below

_*(Draft Policy Recommendation: ‘Flash’ Glucose Monitoring in Diabetes
Date of Issue: *Jan 2018
*The prescribing of ‘flash’ glucose monitors in diabetes in patients 4 years and above*
‘Flash’ glucose monitoring systems such as the Freestyle Libre may be *recommended *in patients
with Type 1 diabetes or those with Type 1 or 2 diabetes who are pregnant and who fulfil *one or more*
of the criteria below:
· Patients who are required to undertake intensive monitoring with 8 or more finger prick blood
tests daily. This does not apply to those who chose to frequently finger prick test.
· Those who meet the current NICE criteria for insulin pump therapy (HbA1c >69.4mmol/mol)
or disabling hypoglycaemia as described in NICE TA151 where a successful trial of flash
glucose monitoring may avoid the need for pump therapy
· Those who have recently developed impaired awareness of hypoglycaemia, when it may be
used as an initial tool in its management with a review at 6 months.
· Frequent (>2 per year) hospital admissions with diabetic ketoacidosis or hypoglycaemia
where other management plans have failed.
· Those requiring third parties to carry out monitoring or where conventional blood testing is not
possible.
This method of monitoring must not be initiated in a primary care setting and should only be initiated,
or recommended, by the *consultant-led *service and who fulfil the criteria below:
· The patient should have previously been through an advanced insulin self-management
education course such as “DAFNE” (Dose adjustment for normal eating: DH, 2002)1 or local
accredited education programmes. The patient should be actively engaged in enrolling
themselves into the management system and would be expected to go through a further
course of education on the use and interpretation of the readings the management system
delivers.
o Primary care may be subsequently asked to prescribe the monitoring sensor packs in
the community for people who fulfil the above criteria. This should lead to a reduction
in use of prescribed Blood Glucose Testing Strips (see below)
· If no improvement is demonstrated in one or more of the impact areas below over a 6 month
trial period, then the use of Flash glucose monitoring should be reviewed with alternative
method of monitoring considered.
· Reductions in severe/non-severe hypoglycaemia
· Reversal of impaired awareness of hypoglycaemia
· Episodes of diabetic ketoacidosis
· Admissions to hospital
· Reduction in HbA1c by more than 0.5% where appropriate
· Blood Glucose Testing strip usage reduced
· Quality of Life changes using validated rating scales
· Commitment to regular scans and their use in self-management.
The use of Flash Glucose Monitoring systems for any other indication is outside of the pathway are
considered *low priority *and will be subject to an IFR process.)_

*Additional useful information*

Please be aware that FreeStyle Libre is not currently endorsed by the DVLA as a sole method of monitoring and in order to meet the national regulations patients who drive must still test using a standard blood glucose meter. 
Patients fulfilling the criteria for prescribing are likely to be seen by a specialist at their routine appointment.
Patients who have obtained FGS through clinical trials or private treatment, or who have been self-funding, must demonstrate that they satisfied the prescribing criteria when they commenced the use of FGS as well as meeting the continuation criteria, to receive FGS on NHS prescription.

So there we go.


----------



## Northerner (Mar 7, 2018)

Barbie1 said:


> I can see I shall have to "lose" hypo awareness pretty quickly now.
> 
> The response from North Hants is
> 
> ...


That would be a 'no' for me too  Shame - when using sensors I hardly tested at all, so there was a minimal increase in cost to the NHS, but the enhancement to my quality of life when using sensors is considerable. They really don't get it, do they?


----------



## mikeyB (Mar 7, 2018)

Only three health boards in Scotland have a pathway to prescribing, usually through a consultant, Lothian, Forth Valley and Borders. That leaves eleven (including mine, Highland) without. 

It is likely that national guidance will be produced which should equalise all health boards.


----------



## Matt Cycle (Mar 8, 2018)

Barbie1 said:


> I can see I shall have to "lose" hypo awareness pretty quickly now.
> 
> The response from North Hants is
> 
> ...



This seems to be the standard criteria for those CCG's now prescribing.  We all know though that if they want to they'll find ways around it.  Maverick consultants will do what they want.  There have already been cases mentioned of GP's prescribing in areas.  Pumps are supposed to be T1 only (I had to have a C-peptide test after more than 30 years of T1 to get CCG approval for mine) but I know supposed 'T1's ' who with inconclusive C-peptide test results have pumps.  How did their consultant manage that?  As a T1 I don't care what we get as long the same tests and criteria are applied equally to all across the country without bending the rules.


----------



## zx10pilot (Mar 9, 2018)

Barbie1 said:


> Patients who are required to undertake intensive monitoring with 8 or more finger prick blood
> tests daily. _This does not apply to those who chose to frequently finger prick test_.


What an absurd statement. Surely those who "chose to frequently finger prick test" are the ones who most want to have good control and are actively involved in their own care.
My local ccg (Brighton & Hove High Weald Lewes Havens) have this same initial criteria but without the secondary (conflicting) statement.
I have just returned from my consultant review.
I have been granted a Libre on prescription.
I'm over the moon as I will now be able to view trends instead of spot readings, with the benefits this will bring to my own control.
Yes, I have to sign up to a contract that states I will make use of the readings... and reduce my test strip useage. Not exactly a difficult thing to agree to!
Apparently there is approx 6 week waiting list before my first "training session" and I am given my first sensor.
Interestingly the consultant refers to the first six months use of the Libre as a Trial Period and if the contract is broken the recipient will be removed - this I assume is to prevent the type of person who can't (or won't) help themselves.   
I can't wait to get it, but realise I am also very lucky as it is definitely a postcode lottery.


----------



## Northerner (Mar 9, 2018)

zx10pilot said:


> What an absurd statement. Surely those who "chose to frequently finger prick test" are the ones who most want to have good control and are actively involved in their own care.
> My local ccg (Brighton & Hove High Weald Lewes Havens) have this same initial criteria but without the secondary (conflicting) statement.
> I have just returned from my consultant review.
> I have been granted a Libre on prescription.
> ...


Terrific news @zx10pilot !


----------



## trophywench (Mar 9, 2018)

Brill news !  However - be aware it didn't actually provide either reliable or useful info for me - I used one sensor officially provided plus two that a kind soul on here donated, so I think that's enough to really 'see'.  Terribly disappointed.  I couldn't really use any less test strips - unless you test you blood with the pump meter, the algorithm to calculate the appropriate correction or bolus dose of insulin cannot work.

You can indeed work it all out manually but I'd rather not go back there again after 9 years not needing to do it!


----------



## everydayupsanddowns (Mar 9, 2018)

trophywench said:


> I couldn't really use any less test strips - unless you test you blood with the pump meter, the algorithm to calculate the appropriate correction or bolus dose of insulin cannot work.
> 
> You can indeed work it all out manually but I'd rather not go back there again after 9 years not needing to do it!



I’ve always found that frustrating about Roche pumps. Im not sure if other ‘remotes’ like Omnipod allow you to input from another BG meter like Medtronic does. I’m rather relieved I can use any meter (eg if I lost my linked one and needed to fall back to a spare from the cupboard)


----------



## immyboy7 (Mar 9, 2018)

was at my clinic appointment on wed 7 march consultant mentioned flash  but also said it was not approved yet in north lanarkshire but they would find out in approx 6 months and she asked if i was interested to which i replied i,d be first at the door


----------



## Robert Craig (Jun 18, 2018)

zx10pilot said:


> What an absurd statement. Surely those who "chose to frequently finger prick test" are the ones who most want to have good control and are actively involved in their own care.
> My local ccg (Brighton & Hove High Weald Lewes Havens) have this same initial criteria but without the secondary (conflicting) statement.
> I have just returned from my consultant review.
> I have been granted a Libre on prescription.
> ...


Hi zx10pilot as a matter of interest who prescribed your "Libre" was it your GP'S practice or was it your consultant at " Diabetis care for you


----------

