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Re: [IPk] Pump consumables on Perscription

Hi All,

Sorry for the long delay in replying, I have had problems with my Fax &
Computer line, so no e-mails. It's taken BT 3 days to fix it.

Having just finished an 86 page submission to NICE on the appraisal on
insulin pump therapy, I can confirm that NICE guidance on pumps is scheduled
for April 2003.

Submissions have been entered on:

Health Technology Appraisal:
Insulin pump therapy for diabetes.


Diabetes UK
Pump Management for Professionals (PUMP)
Royal College of Nursing
British Dietetic Association
Association of British Clinical Diabetologists
National Collaborating Centre for Chronic Conditions
Royal College of Physicians
Insulin Diabetes Trust

There are two more appraisals committee meetings on;

26 September 2002
23 January 2003
Guidance to NHS. April 2003

In the meantime still keep pushing for your funding, it is still very much a
question of where you live. (Postcode prescribing? Naaaaa don't you believe

If you need help with your funding, don't forget we have a funding
information pack. It's free! so just ask.

Bear in mind it can take a long time to obtain funding, although we have had
one case recently of the application going in on the Monday, and approval
received on the Thursday the following week. The norm seems to be about 6-8

For the information of newbies to the list I enclose the following:


The official policy from the Department of Health states:

 "Although pumps are not in wide use across the country, if resources allow,
 hospital consultants may prescribe insulin pumps as part of NHS treatment."

The funding of an insulin pump and its associated supplies should,
therefore, be obtained from the relevant Primary Care Trust or Primary Care
Group. Certain criteria have to be met and the full support of the Diabetes
Team is essential.

Local Health Authorities have told us that:

"Treatment funding is normally left to the individual consultant to decide.
If pump therapy is decided as the best course of action, this should be paid
for from within the Health Authority's Service Level Agreement that has been
agreed with the provider (the hospital at which the patient requiring the
treatment attends). The SLA is adjusted each year to account for new
treatment options and areas that may be over or under-funded.

A consultant may request funding for several patients, if so, this area may
be seen to be over performing (i.e., this treatment option is required by
many patients), then money would be removed from under-performing areas who
have more than they require to provide their service. If an area is
over-performing, GPs and consultants may be asked to cease referrals for
patients requiring expensive treatments. In theory, if more money needs to
be spent it should be made available through the SLA rather than patients no
longer being referred.

It is the responsibility of the Diabetologist to bid for the cost pressure
of insulin pump therapy as a necessary clinical need for individual
patients. Finance will be decided as a cost pressure by the Health Authority
if Diabetologists push for this treatment."

Unfortunately, in practice this does not happen. Most consultants do not
seem to be aware that this is the procedure, they will tell you that insulin
pumps are not funded by the NHS and that you will have to pay for it
yourself! THIS IS NOT TRUE, funding can, and has been, obtained from Health
Authorities and Primary Care Groups across the country. What you have to do
as the patient, is to persuade your consultant together with the diabetes
team to prepare their "cost pressure" (or business plan) and ask for the
funding. This may be a long and forlorn exercise.

In the meantime however, we have to do it ourselves.

Firstly, you must obtain the backing of your diabetes team and/or your GP.
Ask them to support your request in writing, stating the reasons why the
pump will be beneficial to you. Our experience has shown that funding is
assessed "on the grounds of clinical need."  Health Authorities do not
accept "wanting a better quality of life" as a valid reason for changing to
pump therapy, however, with the advent of Primary Care Trusts and the NICE
appraisal of insulin pumps, this is beginning to change.

Be prepared to show that you have been doing your best to control your own
diabetes.  Patients using pumps are expected to do at least four blood sugar
tests a day and keep these recorded. This is necessary to show that the pump
is providing the amount of insulin you need at various times in the day (and
occasionally during the night).

A detailed log of your control prior to starting pump therapy is good
evidence of your requirement for this treatment. This should include insulin
dosages; levels of HbA1c; number of hypo's; any ketones in the urine; days
off sick; hospital visits; hospitalisation; and so on.  Any complications,
medical or social problems should also be stated.

If you already use a pump, do the same for the period you have been using it
and then chart the results as a comparison between the two. If you can
download the information from your Blood Glucose meter and provide graphs,
so much the better. Be prepared to answer questions about abnormal readings.

You may need copies of relevant clinical studies that have been undertaken
these can be obtained from us, free of charge.

Obtaining Funding

As from April 2002 Health Authorities will cease to exist, they will be
replaced by Primary Care Trusts, in many areas these PCT's are already
operating. Our advice is to approach your Primary Care Trust via a letter to
the Chief Executive or Commissioning Officer, your GP should have the
details and in many cases will make the application for you. We can supply a
draft for your guidance. We have written to every Health Authority in
England, Wales & Scotland and will be writing to all PCT's, some will not be
aware of the benefits of pump therapy when you make your application, should
you have any difficulties please contact us, we can provide substantial
evidence to support your case.

If you do not get a positive response from your Health Authority, PCT or PCG
it may help to write to your MP stating the problems you are having. They
will take the matter up with the Chief Executive or Consultant in Public
Health on your behalf. Lobbying of your MP will prioritise the case of
insulin pump therapy with the Health Authority. When raised by the MP, your
individual case will become more urgent as a result.

We wrote to Jacqui Smith MP, Minister of State for diabetes, pointing out:

"There is a clear case of "Post Code" prescribing currently being adopted by
the National Health Service. In addition, for those with diabetes who are
unfortunate enough to live in an area where funding is not available, there
is another discrepancy. The same infusion sets used for insulin pump therapy
are also used in other treatments and are being funded by the NHS. These

Continuous Diamorphine for pain control.
Infusion of Desferol for the treatment of chronic asthma.
The treatment of Thallasemia.
Heparin Infusion.
Hormone Infusion.
Anti-Emetic Infusion.
Subcutaneous Re-Hydration.

It is estimated that about 60-70% of infusion set usage is into non-diabetes
markets and are being funded by the NHS. It would seem that not only do we
have "Post Code" prescribing, but we have discrimination against diabetics
as well."

Make sure you use this in your application.

The task is not easy, your first application may not succeed but you have to
keep trying, perseverance in our experience does pay off.

The list of Health Authorities, Primary Care Trusts and Primary Care Groups
that will assist in funding pumps increases daily, so keep in touch and
please let us know how you get on.

Best of luck and don't forget we are here to help.


John Davis,
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
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