There’s a lot of discussion around the new rtCGMs being available on prescription, but local GPs saying that they aren’t or telling you there’s nothing they can do.
Most people with diabetes have a reasonably good relationship with their GP, and therefore should be able to have a conversation on a reasonable level regarding the content of this post. I’d highly recommend a friendly, good natured conversation rather than an atahonistic, combative one, as the former is much more likely to get the result you want.
If you are of the opinion that they should be helping you, and you’re happy to push a little, here’s a brief guide to some tactics you might use.
1. The rtCGM I want isn’t “on prescription”
That’s simply not true. There are now three systems available on FP10, or the NHS BSA Prescription Tariff. They can all be found at this weblink, under Part IX-A Appliances and this is a screenshot of the page.
This makes it extremely hard for a GP to say “it’s not available on prescription.”, as you have evidence that it is.
You also have evidence, via the same set of data above, that the Dexcom ONE (if that’s what you are after) is cost neutral with Libre2, so cost is not an excuse
2. It’s not available on my system
That’s not a very good excuse, as any GP can write a prescription by hand. So even if it’s not on the electronic prescription application, such as EMIS, they still can write a handwritten prescription for you.
3. I need to refer you to secondary care for this.
No, they don’t. As NICE have already stated, all those with T1 should be offered appropriate glucose monitoring technology, based on, ultimately, need. As a person with type 1, you have gone to them to ask for this. If they need help, then you can refer them to the ABCD Academy for Healthcare Professionals that includes content on CGM.
You can also share with them the DTN UK content for CGM users, as well as the content provided by the various manufacturers to show you’ve looked at it and understand where help is.
Glucomen Day: https://glucomenday.com/newplatform/glucomen-day-cgm/glucomen-day-cgm-training-and-guides/
GlucoRX Aidex: https://www.glucorx.co.uk/glucorx-aidex-hub/
4. I still can’t prescribe it for you.
If you get to this stage, ask why? And if they say that it’s because the local ICS/Medicines Management Committee/etc hasn’t given them the go ahead, remind them that the thing you’re asking for is cost neutral with the Libre2, that they already prescribe.
If they will not accept that they can and should prescribe at this stage, get in touch with Partha Kar on Twitter, Facebook or via Email. A quick Google search will provide you his contact details.
5. If you have succeeded in getting a Prescription out of your GP, speak to your pharmacist and make sure they understand the procedure for obtaining the transmitters for the required system.
Transmitters are not a prescription item. They are ordered separately by the pharmacy.
If you receive a prescription for a Dexcom ONE starter pack, which includes a transmitter then you’re good to go. If you receive a prescription for Dexcom ONE sensors, then you may need to remind the pharmacy that they will need to order a transmitter.
There is no longer a requirement for the pharmacy to register with Alliance healthcare, as this process was causing issues.
I am not sure what the process is for Glucomen or GlucoRX, so I’d recommend getting in touch with their customer services regarding their approach, however, I expect it to be similar to the above Dexcom ONE process.
Assuming you’ve succeeded in getting your prescription and having it fulfilled, congratulations and long may it continue.
If not, please feed back where you’re having issues to Partha Kar. The numbers of preacrtions are being monitored and pressure will continue to be applied centrally, but without us asking, we won’t be able to help nudge these things along.
Great article that will hopefully help people to argue and get their needed prescription for the systems! #payitforward
Great advice if you have a good relationship with your GP and require a standalone rtCGM.
I am not convinced my GP knows how to spell “Type 1”. I am already under secondary care and my diabetes clinic are saying the rtCGM that works with my pump is not approved by my CCG. It is not on the FP10 list.
The ones that are on prescription are listed in the article. The ones that work with pumps aren’t.
That’s the way of it right now unfortunately.
From what’s previously been said, those that are required for Automated Insulin Delivery will come as part of a package with those, when AID systems are in scope under NICE guidelines or a Technology Appraisal, but that’s not going to be here for a while.
Good stuff Tim let’s all keep pushing.
Great blog, as always. Couple of questions:
1. Do you know of any reason why GPs shouldn’t prescribe three months supply rather than, say, one? (NB I haven’t tried yet)
2. Is there any reason to obtain rtCGM from GPs rather than from secondary care? My consultant is offering to sort it out from the hospital for me. For as long as that’s the case, I don’t see a need to go to my GP, but maybe I’m missing something.
Hi Matt, I agree that it is a pain that the GPs prefer to give prescriptions for short periods. This is because cgm is very expensive and they do not want people buiilding up stockpiles that could get wasted. You can imagine that some scroats might even sell their cgm on eBay! If you ask you gp nicely they might give you extra supplies.
Regarding getting your cgm from the hospital, thie hospital is only able to prescribe very specialised medcines/devices usually for short periods. If you want Cgm on prescription it has to be prescribed from your gp as it comes out of a different budget. Whatever your consultant says, I think it unliky that your hospital pharmacy will prescribe cgm indefinitely. Good luck.