The United Kingdom (UK) has a publicly funded healthcare system founded in 1948, which is collectively known as the National Health Service (NHS). It is made up of 4 systems: NHS England, NHS Scotland, NHS Wales and Health and Social Care in Northern Ireland. The NHS is broken down into smaller, more regional areas (known as Clinical Commissioning Groups) that manage the funding for that area. In the UK, people with chronic conditions, including type 1 diabetes, are eligible for a medical exemption for all of their prescriptions, so they do not have to pay for any prescriptions, including those that do not relate to diabetes.

What happens if you need to see a doctor?
Most people in England are registered with a local General Practitioner (GP) who deals with day-to-day health complaints. They can prescribe medication and make referrals for patients to see a specialist. When a GP prescribes medication, there is a fee that you must pay when you go and get the medication, but there is no cost to see the GP. You can find more info here on costs of prescriptions. Diabetes treatment is separated into age categories with the paediatric team being separate from the adult team. The paediatric team is specialised with different treatment areas and funding. Similarly, the young adult team has a specialised nurse and sees specific patients. There is also an annually compulsory retinal screening that patients must undergo.

Who decides what medicines a doctor can prescribe?
The National Institute of Clinical Excellence (NICE) is the body that decides which medicines and medical technology – such as insulin pumps – are okay for doctors to give to patients. They produce ‘guidelines’ that healthcare professionals should follow. New diabetes technology is being added to the prescribed medications all the time. For example, a type of continuous glucose monitor (CGM) or insulin pump may not yet be provided by the NHS and any individual who wants these devices would need to buy them privately, if possible.

Practically, what is it like to live with type 1 diabetes in the UK?
Insulin, test strips, ketone meters, insulin pumps (and supplies) and everything else type 1 related are free to patients and are usually prescribed by a GP. Patients with type 1 diabetes should be referred to a local hospital to see a diabetes specialist (endocrinologist). All appointments are free of charge. How often someone sees the specialist is decided between the patient and them; for children, it tends to be every 3 months and for adults it can be every 6 months to a year. Patients should, in theory, have access to a dietician and a diabetes specialist nurse through their diabetes clinic. They should also have access to psychological support. Specialists can change a patient’s medication (for example, change the type of insulin or brand of test strips) and inform their GP of this change – although often it is quicker for a patient to inform their GP themself.

What about getting admitted to hospital?
Again, all treatment and medication provided by a hospital is free of charge for all patients. Any medication prescribed during a hospital stay is exempt from prescription charges.

How does diabetes care vary throughout the country?
Variability of care is great across the UK, with everyone able to receive insulin for free, but not everyone able to get an insulin pump, let alone a CGM. Test strips are sometimes limited by doctors who will only prescribe a certain amount of strips per month. Many people do not receive all of the essentials that a person with diabetes should receive under the UK health care system. Instead, they receive varying levels of care and support depending on their location or the clinic they attend.

Thank you, Siobhan Murphy and Eleanor Callaghan, for your help and support with this project.