Improving the quality and cost of blood glucose monitoring across the Mersey
In 2014-15 the eight Pan-Mersey CCGs spent £4.569million on blood glucose meter (BGM) strips, with mean strip cost being 25.75p. There are many different brands of BGM strips, and many are effective and acceptable to patients and cost less than 20p per strip. The most expensive strips can cost up to 32.6p per strip. Reducing the mean strip cost to 20p or less for Pan Mersey would provide a cost improvement of over £1m per annum.
Pan-Mersey CCGs proposed the creation of a guideline that recommended high quality, lower cost BGM strips that could be adhered to by primary and secondary care prescribers in their area.
MLCSU provides medicines support to the 8 CCGs involved in the Pan-Mersey Area Prescribing Committee. We searched for best NHS practice, and identified a recent evaluation of BGM strips by the Greater Manchester Medicines Management Group (GMMMG), which provided a criteria-based evaluation of a large number of meters.
Using the outputs from GMMMG, MLCSU developed a single guideline for all 8 CCGs to direct first choice meters based on agreed criteria approved by all the CCGs. The approach agreed was to recommend up to 10 meters that met ISO standards, and other criteria ensuring the list included meters that would support patients with different needs e.g. visual impairment. Guidance was provided where use of a higher cost BGM was appropriate for specific patient needs.
Following consultation, the Pan-Mersey APC approved the BGM guidance in October 2015, and the CCGs took forward implementation actions at a local level with diabetes teams across secondary and primary care.
Overall there has been a reduction in expenditure on BGM strips in Pan-Mersey CCGs to £4.521million, with an increase in quantity of BGM strips prescribed in comparison with 2014/15 prior to production of the guideline.
This has resulted in a reduction in mean strip cost to 23.54p per strip, with a theoretical annual cost saving of £423,523. Some of this reduction is likely to have come from manufacturer price reductions.
The proportion of prescribed strips in Pan-Mersey CCGs that are identified as first choice in the guideline has increased from 12% to 36% between 2014-15 and 2018-19.
Whilst these outcomes suggest some improvement, further analysis and discussions with CCGs (2019) highlight considerable problems with the implementation phase resulting in no or low improvement in several CCGs. Plans didn’t always progress due to competing priorities; the method of implementation lost momentum with patient level reviews not being delivered; and there wasn’t always a good agreement or ownership with diabetes specialists or primary care/GPs. So whilst the work has helped contain costs and improve use of quality meters, a lot more could be done. A sample of the feedback is below:
“In order for a programme to be successful every single prescriber needs to be singing from the same hymn sheet and only prescribing a, b or c and there needs to be an active switch programme implemented too.” CCG Medicines Lead 1
“When the review first happened, we met with our community commissioned service and our diabetes clinical reference group. We narrowed the list down further to three meters and one combined blood/ketone meter and produced a policy also. This policy was eventually approved by the CCG and was geared towards commencing new patients on a low cost meter and switching patients from high cost meter to a low cost meter – it didn’t really happen.” CCG Medicines Lead 2
However there is a view now that with the better integration of the NHS underway, there is a real chance to take this work and develop it in a different way; to include more of a focus on the ‘need’ for meters as well as the ‘best choice’ for patients.