see message below, sent on behalf of Paul Evans (Regional LMC Chair) and Richard Glennie (Regional LMC Vice-Chair).
Dear all,
You have likely all read the GLP1 LES offered by NENC ICB. We’ve had a lot of questions, and note that on the ICB webinar not all questions were answered by the ICB. Below is a summary of what we know, and the thoughts of the regional LMC:
- Did the RLMC agree this LES?
The LES was improved slightly from the initial offer, after discussion with the ICB. What we have is the ICB’s final offer to practices, on a ‘take it or leave it’ basis, with some minor concessions having been made by the ICB, and the understanding that if practices do not take it up then it may be offered out to other non-medical providers.
- Does the Regional LMC believe the funding is adequate for the work involved?
The Regional LMC believes that the LES can be made financially-viable if practices:
– use the cheapest staff they can find to deliver the LES
– displace non-revenue-generating activity
The LES will not adequately fund additional staff time to deliver it; this is not a gold-standard service that can be funded via it. Review appointments may have to consist of a receptionist with a set of scales taking a weight, asking the patient tick-box questions and sending a task to a prescriber. They may also have to involve group consultations with a non-doctor. Please weigh the cost of provision and the risks before devising a model.
- The £242.85 headline figure is based on a patient completing 12months of treatment but the ES only runs for just over 9months. Is the ICB committing to completing the payment schedule no matter what the date of entry to the ES?
This question has not been answered by the ICB. We will keep asking.
- The headline qualifying BMI is >40 but SS 3.2, Table 4 suggests that BMI ≥37.5 kg/m2 for service users from a South Asian, Chinese, other Asian, Middle Eastern, Black African, or African-Caribbean backgrounds. Can we confirm that this is correct?
Yes, this is the national specification.
- How can we ensure that patients who are not eligible do not flood us with appointments to discuss this?
We suggest that you put out comms to all patients on website/Social Media etc stating you will contact anyone who is eligible, AND empower your receptionists to not permit appointments to be booked to discuss this by anyone not on the list of those eligible.
- What does ‘baseline blood tests’ mean?
There is no requirement for ‘baseline blood tests’. Perform blood tests ONLY if you think clinically necessary and would have done them anyway. NICE makes no reference to these and we presume this is an error by whoever wrote the specification. The entire concept of ‘baseline bloods’ is clinically not valid, but any bloods clinically-relevant to you as a clinician should of course be taken, whenever you think needed.
- Can reviews be on the phone?
No, these must be in person. See question 2).
- Can we confirm that an initial appointment with a patient eligible for Tirzepatide treatment who subsequently decides not to proceed with treatment will still attract the “Patient Initiation Payment”?
No, payment is for initiation only. We do not agree that this is fair, but this is what the ICB have decided.
- Does the wording about ‘variance of contract’ mean we are committed to delivering this even if the ICB pull funding?
No, this wording was lifted from the national DES template. If the funding stops, stop doing the work.
- What happens when capacity is exceeded for the wraparound care specified by NICE as being necessary?
Good question – we don’t actually know as the ICB have not answered this. NICE are clear that wraparound care is essential. If and when capacity in this service is exceeded, we suggest that you cease referring/initiating and advise patients that the service is no longer available. They may wish to contact the ICB at this point, and we would suggest you do so also.
- What happens when the overall capacity for the LES is exceeded?
This is extremely likely to happen – we suspect that NHSE’s estimate of those eligible will be a significant underestimate, based as it is on data ONLY on patients with a recent BMI; it is likely more will fit the criteria as they get weighed +/- develop 4 of the 5 qualifying conditions.
- 12. Are patients who were eligible on the LES criteria but have now lost weight with private GLP1s eligible for this service?
If BMI >40 AND they have 4 or 5 of the qualifying conditions, yes. If BMI now <40 (unless ethnicity caveats above) then no, even if their starting BMI was >40.
- Does this affect how we handle those on GLP1s from private providers?
No, it does not; we suggest that on being notified of such patients you continue to send the BMA template letter by email to said provider. You have no more responsibility for the prescribing of these patients than you do for a rheumatology patient on adelimumab, or an oncology patient on chemotherapy; record as ‘hospital-issue, 0.001 quantity’ in order to be aware of drug interactions, send the letter and move on.
- Can we sub-contract this to a federation or other provider?
If you wish, yes you may. However, given the inadequate resource attached to this LES we are dubious that, after management costs have been taken into account, any federation will be able to deliver this both safely and cost-effectively.
- Why have the LMC agreed a LES that is less well-resourced than in many other areas of the country?
We have agreed to present this to practices, as the ICB’s final offer. We leave it in your hands to take on, or not, noting that pharmacies will likely be delighted to step into the breach, in which case we would anticipate that all funding would go to the pharmacy, and most questions about side-effects/interactions would still end up with the patient’s surgery.
Please do not hesitate to ask any further questions.
Paul Evans & Richard Glennie
Chair and Vice Chair of NENC Regional LMC
