‘Nonsensical’ to stop GPs approving access to glucose monitors

Matt Woodley

27/07/2022 4:48:13 PM

The decision to block GPs from certifying patient access to the devices ‘needs to be reviewed and rectified,’ the RACGP president says.

GP consultation with diabetes patient
College says there is 'no logical explanation' for excluding GPs from approving the device.

On 1 July this year, the Federal Government announced expanded access to subsidised continuous glucose monitoring and Flash GM products for all patients with type 1 diabetes mellitus, via the National Diabetes Services Scheme (NDSS).
Since being developed, continuous glucose monitoring devices have been variously described as ‘empowering’ and a ‘real expansion in clinical utility’, allowing for better self-management of the disease.
However, uptake has been somewhat limited due to cost, with patients required to spend around $5000 per year on the devices unless they qualify for subsidised access – which prior to 1 July was only available for people with type 1 diabetes aged under 21. 
As a result, the RACGP initially welcomed the expansion of the subsidised scheme, but another handbrake impacting the use of the devices has now emerged: the NDSS outlines that only health professionals for whom diabetes is their ‘usual scope of their practice’ are able to certify the access forms.
These include credentialled diabetes educators (CDEs), endocrinologist/diabetologists, nurse practitioners, physicians, and paediatricians, but specifically exclude GPs.
RACGP President Adjunct Professor Karen Price has written to the Department of Health (DoH) to voice the college’s frustration at the restriction, which she believes is ‘nonsensical’.
‘Clearly this policy decision needs to be reviewed and rectified right away,’ she said.
‘There is no logical explanation for why other members of a healthcare team are able to sign a form approving this device, but hardworking GPs are excluded.
‘Not only is it insulting to GPs, it creates an unnecessary barrier to patient access for something that could make a real difference in managing their health.’
An estimated 130,000 people have type 1 diabetes in Australia, and Professor Price says those living in rural and remote areas will be especially disadvantaged by the restriction, as they rely more on GPs for their overall healthcare needs.
‘Telehealth and electronic form transmission may be helpful for some but Medicare rebates for longer phone consultations were removed at the start of this month – something else we are trying to fix,’ she said.
‘There is no point crying over spilt milk. The RACGP calls on the Government to reconsider and recognise that managing patients with diabetes within a specialist team falls squarely within the job description of GPs.
‘GPs are there for our patients managing their diabetes, and the Government needs to be there for us. Let’s chart a new course on approving glucose monitors and ensure that the role of general practice is always kept front of mind.’
The DoH has said the decision to exclude GPs from the authorised certifier group is based on advice from the Australian Diabetes Society (ADS) and the Australian Diabetes Educators Association.
ADS CEO Associate Professor Sof Andrikopoulos has defended the advice, telling The Guardian that type 1 diabetes is a complex condition that requires the use of insulin, a potentially dangerous medication, as well as education and upskilling or specialist care.
‘Diabetes technology, which supports the delivery of insulin, is rapidly evolving, complex and requires considerable training and experience to stay up to date,’ he said.
‘This can be very challenging, even for specialised diabetes health professionals, which is why we advised that the training and support to commence using diabetes technology should be provided by specialised diabetes health professionals – endocrinologists and credentialled diabetes educators.
‘A GP chronic disease management plan provides five Medicare-subsidised visits to allied health professionals, including CDEs.’
Meanwhile, Diabetes Australia’s group CEO Justine Cain told the same publication that anyone having trouble getting an appointment with a specialised diabetes health professional should contact the NDSS Helpline on 1800 637 700.
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Dr Andrew James Rees   28/07/2022 5:36:43 AM

I think it is a good decision. My observation is that we GPs can be poor gatekeepers. Patients present to me outraged that I will not renew the authorisations for benefits to which they are clearly not entitled; initiated by other GPs.

A.Prof Ralph Gustav Audehm   28/07/2022 7:18:48 AM

yes, Sof you forget who looks after the people between your visits. It is sooo easy for them to access to you to certify they have diabetes, especially in the public system - lets say months to have a review. This denies people access to a technology that makes it a little easier for them. Many have used it before but stopped due to stupid rules in the past denying them ongoing access and you state it is soooo complex we can't even state they have type 1. Sorry it is a mess and is manifestly unfair for our patients

Dr Nermana Gradisic   28/07/2022 7:23:55 AM

Yet onother administrative organisation formed for one purpose seeking ever more and new powers ....
More turf, more nonsense and health dollar wasted
Who did this job day in and out before NDDS , diabetic educator , np , specialists existed or patients had accsess too ? Mr Convoluted Condescending or anyone to answer this one ?
Have patients been asked on this one ?
I know whom they would put on the list first !
Yet onother administrative obstacle course for patients and their gps.
When nothing better to do , breake what has been working well before your ingenious idea and get yourself a payrise . 🤔🤦‍♀️🤷‍♀️

Dr Scott David Arnold   28/07/2022 8:20:54 AM

Wow! No wonder there is difficulty recruiting GP trainees. What young doctor in their right mind would want to go through 10 years of training to become a GP and the be told “Insulin is a potentially dangerous medication”

A.Prof Christopher David Hogan   28/07/2022 8:21:34 AM

I am pleased that this matter has been raised & I expect it to be rapidly dealt with.
I expect that it will be rapidly dealt with as the government does not wish to give the strong impression that excluding GPs from such a vital task for those with diabetes is a "Yes Minister" technique for blocking access to a costly but essential program.
Of course, if they cannot afford it, I would prefer that, in the interests of open government, they simply say so.

Dr Everest Osondu Nkire   28/07/2022 8:53:13 AM

This is ridiculous. Excluding the health professionals who make the initial diagnosis and the most frequent follow- ups required for patients with type 1 diabetes from certifying is in-practicable. Besides access to the other approved health workers and professionals is erratic. RACGP and other GP bodies should come out strongly and declare as unacceptable this insane stand and attempt to disrespect our specialty.

Dr Colin Nigel Watson   28/07/2022 9:30:50 AM

I agree wholeheartedly with Dr Price. This restriction is ludicrous and an insult to GP's. The comments from Prof Andrikopoulos are also nonsensical since a nurse practitioner who may not even be working in the diabetes field can enrol a patient.
Yes, patients do have 5 allied health visits funded by Medicare, but once they have seen a podiatrist regularly, a dietitian, an exercise physiologist, it makes no sense to have one of these visits purely to obtain subsidy for something that should be readily available via their GP.
I will be reviewing my ADS membership!

Dr Pradeep Harshan Jayasuriya   28/07/2022 11:32:37 AM

OK, then my understanding is the ADS wants us (GPs) after all the training and education we've had on managing type 1 diabetes to refer ALL our patients with type I diabetes to specialist services for initiation and ONGOING care . This is a fundamental misunderstanding of the nature of primary care, it can't be good for patients and the ADS is clearly disconnected from the real world

Prof Max Kamien, AM. CitWA   28/07/2022 2:21:00 PM

Prof Andrikopoulos of the ADS appears to have a myopic and astigmatic view of the task and practice of medicine. One week in rural and remote General Practice with a review of all Type 1 diabetic patients in the area may help him to see their wants and needs more clearly.