Meeting documents

To consider a report by the NHS Dorset Clinical Commissioning Group (attached).

The Committee considered a report by the NHS Dorset Clinical Commissioning Group (CCG) that outlined the processes followed to determine the local NHS prescribing arrangements for the flash glucose monitor, Freestyle Libre®.

The report was introduced by the Head of Medicines Optimisation who outlined the timelines for the decisions that had been made since 2015.

She stated that an application for use in children had been made by Paediatric consultants at Poole General Hospital (PGH) and Dorset County Hospital (DCH) to the Dorset Medicines Advisory Group in September 2018 and a decision would be made that day.

Members highlighted the longwinded nature of the processes involved that would benefit up to 200 patients based on the current criteria. The necessary data collection to provide the evidence would not be onerous and they questioned why a trial was necessary when it was already available on prescription in Wales and Ireland.  It should not be a postcode lottery and access should not be restricted for Dorset residents.

The CCG Head of Medicines Optimisation explained the formulary and approvals processes used in Dorset.  She confirmed that an application for use by children had only recently been received and that this cohort had not been excluded.

Members felt that young people, in particular, would engage and benefit the most from using this device and it would help in setting out a lifestyle in which they could manage their condition at an early stage. 

Whilst appreciating the trials and processes, members wished to know how much longer it would take for residents to get access to the device when neighbouring counties had gone through a similar process and had reached a conclusion.  They noted that the process appeared to be longwinded in light of the trials that had already taken place in other counties and that Diabetes UK had estimated that there were approximately 4,469 people with Type 1 Diabetes living in Dorset.

Members were informed that the decision on adults had been made and that a system of education and specialist initiation was currently being put in place. A decision in relation to use of the device by children was imminent.

It was confirmed that this was not a trial, but a period of 6 months to assess whether the device worked for a limited number of individuals and submitting data to national data collections.  This was being overseen by the National Institute for Health and Care Excellence (NICE) who recognised that there was limited trial evidence, only 1 of which concerned children. The data would be available in February / March 2019 and a reassessment of whether it should be released into primary care would take place at that point. 

Members considered that attention to the timescale available to people would be critical in some instances, however, they were informed that there was no evidence to suggest that using the device would change long term outcomes, particularly if patients were already measuring blood glucose levels.

Despite these reassurances, members could not understand why the lengthy timescales were necessary leading to a considerable delay into 2019, when neighbouring local authorities were already prescribing the device.

The CCG Head of Medicines Optimisation confirmed that the same restricted criteria and limited cohorts were being used in other areas and had been based on cost effectiveness and clinical evidence.  Further national guidance was expected in future.

The CCG Chief Officer explained that Dorset was not an outlier in terms of this product, but acknowledged that the timescales were slightly behind.  In the event that a treatment delivered strong outcomes then the NHS could implement it in 3 months, however, those strong outcomes were not currently evident, although this may change over time.  All of the evidence gathered so far had been submitted to NICE who had concluded that a bigger cohort was required to demonstrate the benefits of the device.  This process was needed in order to prioritise funding.

A representative from Diabetes UK, addressed the Committee at the Chairman's discretion.  He explained that he worked with CCGs in the South West, and although the device was limited in other areas, there were more people using it than the 200 people in Dorset.  He had been informed by a paediatrician that the device was being distributed "like hot cakes" in Gloucestershire and was seen as very beneficial.  He considered that the evidence was mounting that suggested the device could make dramatic improvements and avoid unpleasant outcomes for patients with diabetes.

Resolved

1.    That the Chairman formally writes to the NHS Dorset CCG to highlight the need to fall in line with the rest of the UK and to make the Freestyle Libre® device more widely available to people in Dorset who would clearly benefit;

2.    That a further report on progress and availability for patients with Type 1 diabetes is considered by the Committee in March 2019;

3.    That the decision of the CCG decision in relation to children's provision be formally relayed to the Committee.

Following deliberation of this item it was confirmed that use of the device by children in Dorset had been approved by the CCG Committee that afternoon.