Welcome to the SWYAPC website

March 2018 APC update:

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.

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 written a letter to inform Community Pharmacies in Bradford, Calderdale, Kirklees and Wakefield of the local plans regarding the NHSE guidance.


Updates following the February Area Prescribing Committee Meeting

Red, Amber, Green Classifications:

Octreotide in syringe drivers – Agreement to classify as GSI for palliative care indications

Pentosan Polysulphate (Elmiron®) – Agreement to classify as RED for the indication Interstitial Cystitis (Unlicensed)


Updates following the December Area Prescribing Committee Meeting

Red, Amber, Green Classifications:

Venlafaxine doses above 300mg per day – re-classified from AMBER to GREEN for the treatment of major depressive episodes.For prevention of recurrence of major depressive episodes. Treatment of generalised anxiety disorder. Treatment of social anxiety disorder. Treatment of panic disorder, with or without agoraphobia.

(SPC no longer states doses above 300mg require specialist initiation and specific requirements for regular monitoring of blood pressure at doses above 300mg. Statement now reads. Blood pressure should be reviewed periodically, after initiation of treatment and after dose increases. I.e. no specific frequency and not specialist monitoring)


Dimethyl Fumarate (Skilarence) – for new indication of Psoriasis – classified as RED

•Azithromycin – for long term treatment of bronchiectasis & COPD – Classified as GREEN SPECIALIST INITIATION

•Metyrapone – for the management of patients with Cushings Syndrome – classified as RED for new patients and GREEN SPECIALIST INITIATION for existing patients.

Shared Care Guidelines

Alcohol drugs (acamprosate, disulfiram and naltrexone) – Approved


Updates following the October Area Prescribing Committee Meeting

The following changes and additions have been made to the website following the Area Prescribing Committee Meeting in October:

Red, Amber, Green Classifications:

•Fiasp® (insulin aspart) – classified as Green Specialist Initiation for the treatment of diabetes in adult patients with Type 1 diabetes who are likely to benefit directly from a more rapid onset of action, including:
2.Use of insulin pump
3.Young adults unable to manage with Novorapid because of poor post-prandial glucose control, despite adequate therapeutic trial


•Roflumilast (Daxas®) – classified as Green Specialist Initiation – As per TA461: Roflumilast, as an add-on to bronchodilator therapy, is recommended as an option for treating severe chronic obstructive pulmonary disease in adults with chronic bronchitis, only if:
•the disease is severe, defined as a forced expiratory volume in 1 second (FEV1) after a bronchodilator of less than 50% of predicted normal, and
•the person has had 2 or more exacerbations in the previous 12 months despite triple inhaled therapy with a long-acting muscarinic antagonist, a long-acting beta-2 agonist and an inhaled corticosteroid.


Commissioning Statements

The following DRAFT commissioning statements have been added to the website for public comments until 23rd November 2017 – Comments have now closed:

•Liraglutide for obesity

•Homeopathic Medicines

Shared Care Guidelines

•GnRH analogues for prostate cancer – Approved and added to the website

•Denosumab for the prevention of osteoporosis – Approved and added to the website

September updates:

Antibiotic campaign

This year’s antibiotic campaign will start on Monday 2nd October. The campaign pack and other resources are available from here. Resources for the public and patients are available from the patients and public sections on the left hand side of the home page.

Wound Management

Minor changes have been made to the handheld version of the Wound Management Formulary and also to section 12 – dressing selection. Allevyn Cavity has been removed as being discontinued by the manufacturer.

PHE notes in it’s guidance on primary care infections that widespread use of topical antibiotics, especially those agents also available systemically, is to be avoided. If use is indicated, topical use should be limited in most cases. Metronidazole gel has been removed from the handheld version of the Wound Management Formulary.

Mental Health

Valproate in mental health – a document has been produced by the Drug & Therapeutics Committee (SWYPFT) – this has been added to the ‘ for clinicians’ section of the website

Antimicrobial guidelines and resources

A link to this section has been added; the link is to a guide for staff in schools and other childcare settings on managing cases of infectious diseases.

August updates

The following changes and additions have been made to the website following the Area Prescribing Committee Meeting in August:

Red, Amber, Green Classifications:

•Netupitant and palonosetron – classified as RED for the indication of anti-emetic for use with cancer chemotherapy  

•Rifaximin, new indication added  – for the treatment of small intestinal bacterial overgrowth – classified  as RED

Caphosol®, reclassified from GREEN to RED for the indication – prevention and treatment of mucositis caused by high dose chemotherapy

Liothyronine, classified as BLACK except in the following circumstances (as per commissioning statement):

•Patients who are allergic to levothyroxine and thus liothyronine is the only treatment option to manage their condition.

•Post thyroidectomy thyroid cancer and non-cancer patients. Patients that need to receive radioactive iodine treatment after their surgery will initially be started on liothyronine due to its shorter half-life and therefore faster onset of action. These patients will be switched to levothyroxine when the course of radioactive iodine treatment is completed.

•In-patient treatment of profound hypothyroidism, under the care and/or direction of an endocrinology expert.


Commissioning Statements  – comments have now closed 

The following DRAFT commissioning statements have been added to the website for public comments:

Licensed E-cigarettes

Trans-anal Irrigation Systems

Antioxidant Vitamins in Age Related Macular Degeneration

Shared Care Guidelines

Modafanil, approved and the shared care guideline added to the website

Colomycin®, a link has been added to the Leeds Teaching Hospital Shared Care Guideline for the indication –  pseudomonas infection in the lungs