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Primary Care Antimicrobial Guidelines

The final version of the updated guidelines is now on the Antimicrobial guidelines and resources page. It is a working document, so will be updated when changes happen. New sections are being worked on.

 

Updates following the August Area Prescribing Committee Meeting

Red, Amber, Green Classifications:

 

RAG Submissions:

•Cyproterone – Agreement to classify as RED for new patients and AMBER for existing patients

Indication: Prostate cancer

 

•Midodrine – Agreement to classify as Green with Specialist Initiation

Indication: In adults for the treatment of severe orthostatic hypotension due to autonomic dysfunction when corrective factors have been ruled out and other forms of treatment are inadequate.

 

Reslizumab – Agreement to classify as RED

Indication: as an add-on therapy, is recommended as an option for the treatment of severe eosinophilic asthma that is inadequately controlled in adults despite maintenance therapy with high-dose inhaled corticosteroids plus another drug, only if the agreed criteria is met.

 

•Phenol 2% in Zinc paste – Agreement to classify as RED

Indication: Intractable pruritus ani

 

•Quinidine – Agreement to classify as RED

Indication: Short QT syndrome, Brugada syndrome, and idiopathic ventricular fibrillation (VF)

 

•Obinutuzumab – Agreement to classify as RED

Indication: Treatment of cancers

 

•Pembrolizumab – Agreement to classify as RED

Indication: Pembrolizumab for locally advanced or metastatic urothelial cancer previously treated with platinum-based chemotherapy only if the agreed criteria is met.

 

•Atezolizumab – Agreement to classify as RED

Indication(s):

For treating previously platinum-treated locally advanced/ metastatic non squamos or squamos non-small cell lung cancer.

For locally advanced or metastatic urothelial cancer previously treated with platinum-based chemotherapy only if the agreed criteria is met.

 

•Nivolumab – Agreement to classify as RED

Indication: Treatment of cancers

 

•Blinatumomab – Agreement to classify as RED

Indication: Recommended as an option for treating Philadelphia-chromosome-negative relapsed or refractory precursor B-cell acute lymphoblastic leukaemia in adults.

 

•Avastin – Agreement to classify as RED

Indication: For Neovascular Glaucoma and Neovascularization of the Retina

 

•Neomycin oral tablet – Agreement to classify as RED

Indication: Surgical prophylaxis alongside oral metronidazole, plus standard intravenous surgical prophylaxis for colorectal –with mechanical bowel preparation

 

•Ketogenic Dietary Products –  Agreement to adopt Leeds Teaching Hospital Trust Traffic Light Classification for ketogenic prescribable products (Green with Specialist Initiation)

*ONLY FOR PATIENTS REFERRED INTO THE REGIONAL SERVICE FOR PAEDIATRIC EPILEPSY*

 

Commissioning Statements:

 

Brimondine – Approved (June) – comments have now closed for public opportunity to comment.

Hyaluronic Acid – Approved (June) – comments have now closed for public opportunity to comment.

 

Paraffin-containing skin preparations (emollients)

West Yorkshire Fire & Rescue Service has produced YouTube Videos for the public and patients and one for Healthcare Professionals warning that even low-level paraffin based products can increase the risk of a fire developing. The YouTube videos have been added to the following sections of the website for information and discussion:  Medicines Alerts and Safety Issues, Patient Information and Care Homes. There is also information on the Fire Service’s website.

 

The ratified minutes from the June meeting have been added to the business section of the website for information.

 



South West Yorkshire Area Prescribing Committee – Interim Commissioning Position – Flash Glucose Monitoring Systems – Updated March 2018

The expected cost of the Flash Glucose Monitoring Systems to the NHS is over £900 per patient per year of continuous use compared with £360 – £650 per patient per year for finger pricking (based on testing 4-8 times per day). Therefore, it is currently unaffordable and unsustainable to make it available for all people with diabetes.

Work is ongoing between the six CCGs within the South West Yorkshire Area Prescribing Committee (Bradford City and Districts CCGs, Calderdale CCG, Greater Huddersfield CCG, North Kirklees CCG, Wakefield CCGs) and diabetes specialists to agree which groups of patients would gain most health benefit from using Flash Glucose Monitoring Systems, whilst keeping it affordable for the NHS.

There is also a need to consider our neighbouring heath economies to ensure consistency of care across a wider footprint, and therefore we have to take account of how neighbouring CCGs and health economies are managing this device.

The current situation re: Flash Glucose Monitoring Systems is that they are not routinely commissioned, and any requests for use need to go through the IFR process where the patient exhibits exceptionality. Patients currently using this system in the meantime should continue to self-fund; GPs should not initiate any prescriptions for Flash Glucose Monitoring Systems.

Any change to this position will be communicated to GPs as soon as an agreement is reached, and the website will be updated to reflect this.

We have put together a list of some frequently asked questions which you can find here.

 


 

Items which should not routinely be prescribed in Primary Care: Guidance for CCGs

 

Following the publication of the above NHSE guidance to CCGs; the SWYAPC CCGs intend to commission in line with the guidance and align the Commissioning Statements.

The SWYAPC have also produced a letter to inform Community Pharmacies in Bradford, Calderdale, Kirklees and Wakefield of the local plans regarding the NHSE guidance.