Birmingham, Solihull, Sandwell and Environs (BSSE) Area Prescribing Committee’s (APC) formulary for blood glucose meters was published in 2015. By 2017, advances in the meters and a fall in the price of test strips had left it out of date. Birmingham and Solihull CCG’s spend on glucose/ketone strips increased £3.08 million in the previous five years. With over 80 glucose meters on the market, the challenge was to create a quantitative evaluation process to select products that met the needs of all diabetic patients. Mindful that the previous review took two years, the new process had to be efficient. The APC’s Diabetes Medicines Management Advisory Group (DMMAG) formed a subgroup to undertake the work. Led by CCG pharmacists, it had clinical representation from all local NHS sectors and collaborated with patient groups and industry. The scope was to review all glucose/ketone monitors, needles and lancets, as well as make self-monitoring recommendations. Within six months 170 products had been considered and new guidelines for APC had been prepared. Subsequent implementation enabled a quick change in practice.
Get the latest updates
The creation of a formulary for blood glucose meters and ancillary products is not new. However, the growth in the number of products, plus advances in their technical specifications, meant that the previous method was not feasible. A new, efficient evaluation process was required, including clinician and patient input, as any decisions could be challenged and jeopardise uptake and implementation. Market research at the start (September 2017) identified more than 80 glucose meters, 60 lancets and 30 needles. Collating clinical and technical information would have required significant manpower, so the manufacturers were invited to make submissions. The subgroup developed weighted evaluation criteria and sent them to all companies with four weeks to respond. Manufacturers could opt out or submit products for evaluation. Giving them the evaluation form meant they could choose which information was pertinent and ensure it was accurate. It also meant that older models or products about to be discontinued were excluded. They were also invited to state any intentions to alter prices or supply of the products. At the four-week deadline 20 companies had returned submissions covering 53 products. The subgroup scored the responses individually. This approach allowed a wide range of products to be assessed with a depth of analysis and within a time frame not usually possible for one formulary team. Because clinician and patient involvement was included, the final formulary choices had been through a rigorous screening process and could stand up to scrutiny.
All manufacturers were invited to participate in the review and received the evaluation criteria.The resulting completed forms were scored, and the shortlisted products put forward for a Diabetes UK-organised patient event. Evaluation sheets were co-designed and approved by CCG Equality and Diversity leads. Attendees reviewed the shortlisted products, with diabetes nurses and pharmacists available to help. Diabetes UK compiled the patient feedback into a report, which informed the final recommendations. The review process and final guidance were published with open access on the BSSE APC website. After publication, the DMMAG subgroup finalised the implementation plan. In primary care (across the BSSE area) launch events were held for GPs and practice nurses, with industry representatives available to demonstrate. All the area’s community and acute Trust diabetes teams have trained their staff and are issuing the new meters. The new formulary was produced within the six-month timescale. It includes high-quality and cost-effective meters and forecasts a combined potential saving of approximately £660,000 in 2018/19.
The project has led to the production of one formulary within a six-month timescale, appropriate for diabetes patients across the health economy with advice on ‘expert meters’. The combined potential saving on blood ketone and glucose strips for Birmingham and Solihull CCG for 2018/19 is £661,478 meaning that the NHS budget can be used wisely and reinvested. All manufacturers were invited to participate in the review and received the evaluation criteria. This significantly reduced the number of products for consideration, improving efficiency. Establishing the review process denotes time efficiencies for future reviews. Feedback from the patient event highlighted service users (and clinicians) wanted more advanced features to be available in the formulary choices, such as smartphone applications and links into clinical systems, as well as simple meters. This means more patient choice and a goal of improved diabetic control. The new formulary enabled a Birmingham hospital to pilot a system of reviewing blood glucose results remotely via smartphone applications to reduce gestational diabetes attendances and improve patient experience. This project has enhanced cross-sector multidisciplinary working to promote future project collaboration.
Sustainability and Spread
The goal of creating a single formulary for meters, needles and lancets that encompasses the preponderance of diabetic patients was met. The review timescale was also met, included patient and clinician input, and is reproducible. There is a two-year review date, or sooner, as required.
The review process and final guidance were published with open access on the BSSE APC website.
The quantitative evaluation criteria can be updated and used to re-evaluate products for time-efficient future formulary reviews. Sharing the process and scoring system with industry ensured transparency. Clinical inertia regarding formulary change was alleviated by including healthcare professionals in the entire review process. Successful collaboration between CCG, patients and clinicians created reassurance that formulary choices were not solely cost-driven and facilitated future team working. This also eased implementation. Predicted savings from the new formulary demonstrate sustainability, enthusiasm for implementation and compatibility with health economy objectives. The new formulary enabled the Birmingham hospital pilot mentioned above. A neighbouring CCG requested use of the review process and it has been shared with the West Midlands Cardiovascular Network and NHS England (West Midlands), which have asked CCGs to prioritise blood glucose monitoring.
Back to the top