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Northumberland Update October 2014


North of Tyne APC update


Guidelines approved:  Guidelines and Statements | North Of Tyne Area Prescribing Committee

  • Guideline for management of erectile dysfunction in adults ≥ 18 years
  • Guidelines for the use of feminising hormone therapy in gender dysphoria
  • Newcastle, North Tyneside and Northumberland Guidelines for the Management of Adults with Asyptomatic Liver Function Abnormalities
  • Seven Day prescriptions
  • Guidelines for the management of Patients with Swallowing Difficulties

Information leaflets for primary care  approved : Information Leaflets | North Of Tyne Area Prescribing Committee

  • Buccal Midazolam (Midazolam Hydrochloride 5mg/ml) – Buccolam®
  • Buccal Midazolam (Midazolam maleate 10mg/ml) – Epistatus®

Shared Care Guidelines  approved: Clinically Agreed and Commissioned Guidelines | North Of Tyne Area Prescribing Committee


Formulary Decisions

Movicol liquid: Approved

The request for Movicol liquid was approved as a second line macrogol laxative for care home residents only where the sachet formulation is not tolerated.

Melatonin review

The review recommended the use of three products

–           Melatonin 2mg MR tablets – first line

–           Melatonin 2mg MR tablets (crushed) – second line

–           Melatonin 5mg/5ml oral solution – third line.

The formulary will be amended to include the above three formulations of melatonin as the only formulations approved North of Tyne. The Blue leaflet will be revised.

Ropinirole for the treatment of restless legs syndrome: Approved as first line agent

Rotigotine is on the formulary as a second line agent for restless legs syndrome, however there is no specified first line agent. Ropinirole is recommended for the treatment of restless legs syndrome by CKS, therefore the committee agreed to add ropinirole to the formulary as the first line agent for this indication, and update the blue information leaflet accordingly.

Green Cost Saving initiatives

Summary of Green Cost Saving initiatives:

Medication Approximated Potential Annual savings Comments/ Ease of implementation
Tolterodine M/R to immediate release £140,000 Agreement from Urinary Consultants in July 2014 that this should be removed from the North of Tyne formulary. Expected to be removed from formulary by September 2014.
Macrogol/Movicol to Laxido ( or CosmoCol) £46,000 Equivalent product – Laxido endorsed by the North of Tyne formulary as the preferred choice based on cost.
Compound/Strong compound vitamin B £52,000 Not sufficient therapeutic evidence to justify spend. Savings may be offset by increased use of thiamine where clinically appropriate.
Oxybutinin – use of 2.5mg and 5mg immediate release preps only £45,000 Formulary guidance.

Potential savings based on switch to immediate release preps from m/r preps and away from 3mg strength (non-formulary)

ZeroDouble Gel £28,000 ZeroDouble Gel is the ‘zero’ range equivalent to Doublebase Gel. Switch from like to like product. Should require minimal prescriber input.

Further products in range also available and endorsed in formulary – Zero AQS and Zero Cream

Olanzapine oral lyophilisate to olanzapine orodispersible £27,000 Therapeutic equivalent.


Total potential savings £338,000  

An email has been sent to PMM administrators, prescribing leads and practice managers detailing:

–       A summary of the new raft of green cost saving initiatives  (as above)

–       A supporting document which gives some additional information on the initiatives along with some resources to help implement these changes.

–       Baseline Prescribing Data for the initiatives (taken as December 2013) shown as per initiative and per practice. As with the cost savings launched in 2013/14 this will updated on a periodic basis throughout the year.

The green cost saving initiatives form the third part of the SLA – extract from SLA below:

“Cost saving initiatives: 20% of payment is based on delivery of identified cost saving initiatives – “green” savings and “do not prescribe” list.  These initiatives have been given to practices in the 13/14 work plan.  They will be measured on these in quarter 1 2014/15; they need to achieve 90% of savings identified in November 2013 to qualify for the 20% payment in 2014/15.  New initiatives identified in 2014/15 will be expected to be delivered to target by the end of quarter 1 2015/16 to qualify for the 20% payment in 2015/16.”

Please discuss this with the wider practice team, in order to agree your own plan as to how the practice is going to implement these initiatives.

Practice Prescribing Waste Reduction Scheme

The practice prescribing waste reduction scheme has been launched by the CCG to try and help address the continued budget pressure they are facing. A number of steps are being taken by the CCG to help address this pressure and the prescribing waste reduction scheme is one of these.
The resources, sent as a zip folder in a an email to PMM administrators, prescribing leads and practice managers, have been designed to help practices adopt a flexible and tailored approach to the scheme. There is no expectation that practices will complete or take part in all of the initiatives included in the resources, rather that they are used as most appropriate in each situation.

Further details will follow regarding the MUR and NMS referrals pathway to community pharmacy although if any practices wish to  revisit the paper based system developed last year  resources are available to do so and can be obtained by contacting the MO team if they are not still available in practice.
Please discuss this scheme with the wider practice team, in order to agree your own plan as to how the practice is going to implement these initiatives.

Shortage of Betnovate

There is currently a supply issue with Betnovate cream and ointment (including the RD preparations).

Unfortunately there is currently no further information on when this is likely to be resolved, but it is suggested that these products should be prescribed generically to enable patients to have their prescriptions filled with a suitable product.

You will be aware prescribing of topical betamethasone as betnovate this was included in the amber list of cost savings, launched in October 2013. The CCG MO group are aware that such changes are subject to market forces but felt they could not ignore the immediate savings available to them in the current economic climate. Until there is further information available practices who wish patients to continue on topical betamethasone products will need to prescribe generically.

Those practices using SystmOne will be aware there is a protocol to prompt prescribers to choose betnovate rather than the generic preparations, this protocol has been disabled by the ‘owner’ due to the current supply issues.

The CCG MO team appreciate this is frustrating for practices but would like to thank you for your continued work on the cost saving initiatives which have delivered significant financial savings for the CCG for re-investment in patient care.

Advanced inhaler training workshops

NECS have commissioned the Centre for Pharmacy Postgraduate Education (CPPE) to deliver a number of workshops to healthcare professionals in North Tyneside area on advanced inhaler technique. A number of pharmacists have already completed the training and feedback has been excellent.

Why are we providing this training?

  • Inhalation is the preferred route of administering drugs to patients with COPD and asthma
  • Many people find it difficult to use their inhaler correctly
  • Incorrect usage reduces the effectiveness of therapy

Who should attend?

All healthcare professionals with a target audience of

  • GP’s
  • Primary care pharmacists
  • Secondary care pharmacists
  • Community pharmacists
  • Practice nurses

What are the outcomes?

Providing healthcare professionals with a range of opportunities to undertake high quality training on the selection of and use of inhalers

  • Ensuring that patients receive consistent training from all health care professionals

All sessions start at 6.30pm (for 1 hour 30 minutes)

  • 5th November 2014 – Education Centre Lecture Theatre at North Tyneside General Hospital
  • 19th November 2014 – Education Centre (upstairs) at Hexham General Hospital
  • 8th December 2014 – Education Centre Lecture Theatre at Wansbeck General Hospital

Places are limited and will be allocated on a ‘first come first served basis’. To book please contact MO admin team on 0191 217 2756 or 0191 2172681. Deadline for booking a place is one week prior to workshop