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Re: [IPk] Pump consumables on Perscription



Dear john  can you ask Dr Dayan  weston general Hospital   what happened to
the Somerset   funding that we wear so could to get a share of    he as not
mentioned it at his pumpers meting all he has said is get in contact with
your MP
                                       have you received my letters to your
self   vic at         email @ redacted
                                        38 Tormynton road
                                           worle
                                           Aston super mare
                                              SOMERSET bs229ht
----- Original Message -----
From: "John Davis" <email @ redacted>
To: "Insulin Pumpers" <email @ redacted>
Sent: Thursday, May 30, 2002 5:49 PM
Subject: 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.
>
> by:
>
> INPUT
> 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
> Medtronic/MiniMed
> Disetronic
> 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
> it!)
>
> 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
> weeks.
>
> For the information of newbies to the list I enclose the following:
>
> NHS FUNDING
>
> 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
> include:
>
> 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.
>
> Regards,
>
> John Davis,
> INPUT
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