Greater Manchester Medicines Management Group

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News Summary

From this page you will be able to access a summary of additions or changes to the GMMMG website on a monthly basis.

April 2020 to March 2021

 

COVID-19

See our COVID-19 page for all documents.

26.3.21

Vitamin D in care home guidance - Please note an error occurred in the original publication of this guidance.  Please use the corrected guidance (available on this website) and discard the previous version. Details are included in the document control on the front of the document.

18.3.21

To all Care Homes

You will receive or will have received Vitamin D drops for each resident from the Department of Health and Social Care (DHSC). CQC expects these to be treated as medicines. The Medicines and Pharmacy Covid19 Cell has designed this guidance to support your home to
      -    store, administer, record and ensure clinical appropriateness.

If you have questions feel free to contact your Home’s medicines management pharmacy professional or the GP/clinical lead.

29.1.21

As the system continues to respond to the COVID-19 pandemic, the decision has been taken to pause all non-essential GMMMG activity until at least April 2021. Essential GMMMG activity will continue, with temporary decisions including medicines prescribing status being assigned and approved through GMMMG Chairs action. Any temporary decisions made will be revisited once GMMMG recommences, and will undergo the usual Greater Manchester wide consultation process at that stage. All such decisions are clearly marked on the formulary and RAG list as “temporary status”.

The formulary and RAG list have been updated to reflect the first decisions made via this process; for more details please see the formulary change log.

If you have any queries or questions regarding this interim process, please email nuth.enquires.gmmmg@nhs.net

20.11.20

The RDTC has updated the COVID-19 QAA No.2 (Asthma and COPD- oral steroid or antibiotic 'rescue packs' and extra steroid inhalers) in response to NICE recommendations for corticosteroids in severe or critical COVID infection. Please see the GMMMG COVID-19 Information and resources page. http://gmmmg.nhs.uk/html/covid-19_information_resources.

10.11.20

The RDTC has updated the COVID-19 QAA No.6 (Alternatives to hydroxycobalamin injection) to include information on newly UK licensed product (Orobalin). Please see the GMMMG COVID-19 Information and resources page. http://gmmmg.nhs.uk/html/covid-19_information_resources.html

7.10.20

The RDTC has updated the COVID-19 QAAs No.7 (Electronic Repeat Dispensing advice ), and No. 10 (Practical warfarin monitoring) with minor changes to the weblinks.. Please see the RDTC COVID-19 Information and resources page. Please see the GMMMG COVID-19 Information and resources page. http://gmmmg.nhs.uk/html/covid-19_information_resources.html

1.10.20

The RDTC has updated COVID-19 QAA No. 13 (Anticoagulation in cancer) with minor changes to the weblinks. Please see the GMMMG COVID-19 Information and resources page. http://gmmmg.nhs.uk/html/covid-19_information_resources.html

29.9.20

The RDTC has updated the COVID-19 QAAs No.5 (Prescribing in diabetes guidance), and No. 12 (Prescribing for Asthma and COPD guidance) with minor changes to the weblinks. Please see the GMMMG COVID-19 Information and resources page. http://gmmmg.nhs.uk/html/covid-19_information_resources.html

11.8.20

The RDTC has updated COVID-19 QAA No. 8 - Vitamin D and infection risk to remove discussion of outdated primary evidence and signpost to NICE Evidence Summary. Additional study of vitamin D and ethnicity added. Please see the GMMMG COVID-19 Information and resources page. http://gmmmg.nhs.uk/html/covid-19_information_resources.html

14.7.20

The latest RDTC Prescribing Support Publications and Prescribing Reports workplan for July 2020 is now available on the website

2.6.20

The RDTC has updated COVID-19 QAA No. 8 - Vitamin D and infection risk to add data from studies on association between vitamin D status and risk of COVID infection and influence of vitamin D status on differences observed between ethnic groups. Please see the GMMMG COVID-19 Information and resources page. http://gmmmg.nhs.uk/html/covid-19_information_resources.html

1.6.20

The RDTC has updated COVID-19 QAA No. 10 - Practical warfarin monitoring to add information on the outcome of a national DOAC procurement.. Please see the GMMMG COVID-19 Information and resources page. http://gmmmg.nhs.uk/html/covid-19_information_resources.html

5.5.20

The RDTC has updated COVID-19 QAA No. 8 - Vitamin D and infection risk. Changes to this version include the addition of data from observational studies on the relationship between 25(OH)D status & COVID severity, and disproportionate effect on BAME population in the UK. Please see the GMMMG COVID-19 Information and resources page. http://gmmmg.nhs.uk/html/covid-19_information_resources.html

4.5.20

The RDTC has updated COVID-19 QAA No. 6 - Alternatives to hydroxycobalamin injection. This update reflects the revised BSH guidance published on the 24th April 2020. Please see the RDTC COVID-19 Information and resources page. http://gmmmg.nhs.uk/html/covid-19_information_resources.html

30.4.20

The RDTC has updated COVID-19 QAA No. 11 - Extension of monitoring intervals for medicines in primary care. In light of the Second phase of NHS response to COVID-19: Letter from Sir Simon Stevens and Amanda Pritchard” letter, this QAA had been revised; recommendations for DMARDs, lithium and antipsychotics are now more closely aligned with standard practice (as per GMMMG SCPs), with some flexibility maintained to allow for decisions to be made on a case-by-case basis.

27.4.20

The RDTC has updated COVID-19 QAA No. 11 - Extension of monitoring intervals for medicines in primary care. Changes to this version include clarification of routine 6-monthly lithium level monitoring in stable (>12 months) low risk patients is in line with NICE CG 185- Bipolar disorder: assessment and management.

23.4.20

The RDTC has updated COVID-19 QAA No. 11 - Extension of monitoring intervals for medicines in primary care (adults). Changes to this version include the addition of guidance for antipsychotics, hydroxycarbamide. Alcohol excess added as a contra-indication to extending monitoring of DMARDs.

21.4.20

A new QAA has been added to the RDTC/GMMMG websites “Can patients with active cancer currently prescribed low molecular weight heparin (LMWH) for the treatment of a deep vein thrombosis (DVT) or pulmonary embolism (PE) be switched to a direct-acting oral anticoagulant (DOAC)”. This enquiry and subsequent answer has been developed by RDTC with input from oncology colleagues across the region, and discusses which DOACs (although not specifically licensed in patients with active cancer) can be considered for patients with active cancer and a confirmed proximal DVT or PE.

20.4.20

The NW Hub of the NHSE Specialised Commissioning team have produced clinical Guidance on the use of daily and pegylated Granulocyte Colony Stimulating Factor (G-CSF) in cancer patients during the COVID 19 pandemic. Please communicate this through your networks as relevant.

17.4.20

GMMMG has updated their vitamin B12 guidance to more closely reflect BSH guidance, this statement can be found on the COVID-19 resources page http://gmmmg.nhs.uk/html/covid-19_information_resources.html. The RDTC guidance remains as originally published, with the GMMMG statement reflecting the GM position.

16.4.20

An RDTC COVID-19 Q, A +A document on Prescribing for Asthma and COPD is now online. Please see the COVID-19 Information and resources page.

16.4.20

The RDTC has published the following COVID-19 Q, A +A document: Can monitoring intervals be extended for adults prescribed shared care drugs and other drugs that require monitoring during the COVID-19 pandemic?” Please see the COVID-19 Information and resources page.

Following publication of the Specialist Pharmacy Service (SPS) guidance on the management of drugs that require monitoring during the COVID-19 pandemic, RDTC has developed practical guidance to aid prescribers. Currently included are:

  • DMARDs: Azathioprine, leflunomide, mercaptopurine, methotrexate, sulfasalazine, ciclosporin and penicillamine when used for rheumatological conditions
  • Warfarin
  • Lithium
  • Clozapine

This guidance has been produced in collaboration with the Greater Manchester Medicines Management Group and specialist clinical teams in Greater Manchester, RDTC has extrapolated the SPS recommendations on DMARDs to apply to other indications for which GMMMG shared care protocols apply We are aware of other resources becoming available that contain advice regarding drug monitoring during the COVID-19 pandemic. As this is a rapidly changing area, resources will be evaluated and revised regularly. This document is being updated and expanded to include other medicines which require routine monitoring within primary care.

14.4.20

An RDTC Q,A +A document on practical warfarin monitoring during the COVID-19 pandemic response is now online.

Please see our COVID-19 Information and resources page.

14.4.20

A document on GM CCG commissioned high cost drugs management in the context of the COVID-19 pandemic  is now online.

Please see our COVID-19 Information and resources page.

9.4.20

Two more RDTC QAAs have been published to the COVID-19 page of the GMMMG website:

Resources available to support practices in maximising Electronic repeat dispensing (eRD) during the COVID-19 pandemic response.

  1. This resource has been developed based on comments from stakeholders across the region
  2. What is the evidence that vitamin D status affects the risk of infection with COVID-19 – this resource  has been developed in response to media reports and is based on the published information currently available.

Please continue to submit queries to the RDTC prescribing support unit, a list of enquiries we are currently responding to is available on the GMMMG website COVID-19 page.

8.4.20

RDTC have published a COVID-19 Q&A&A  statement responding to the query "What are the alternative treatment options for patients who normally receive hydroxocobalamin B12 injection during the COVID-19 pandemic?”. This statement has been prepared  by the RDTC and approved by GMMMG following an evaluation of the available evidence base, comments from clinicians and MO colleagues and discussion with procurement across the wider region. This statement will be revised if new information becomes available and the GMMMG website should be consulted for the latest version. Please continue to submit queries to the RDTC prescribing support unit, a list of enquiries we are currently responding to is available on the RDTC website COVID-19 page.

8.4.20

An RDTC COVID-19 Q,A +A document on Prescribing in diabetes guidance is now online. Please see our COVID-19 Information and resources page.

7.4.20

The statement on early use of antibiotics in high-risk patients has been updated to reflect the NICE rapid COVID-19 guideline on managing suspected or confirmed pneumonia in adults in the community. The update is now live on our COVID-19 information page.

6.4.20

An update of the COVID-19 Q,A +A document on asthma and COPD- oral steroid or antibiotic 'rescue packs' and extra steroid inhalers is now online.

An RDTC®/GMMMG Questions, Answers and Actions Statement addressing the question “Which patients with asthma and COPD should be supplied with oral steroid and/or antibiotic 'rescue packs', higher potency steroid inhalers, and new or additional requests for steroid inhalers during the COVID-19 pandemic response?" is now available on the GMMMG website.” Please note that this statement has been produced with the best available information and on the opinion of clinicians, and may be updated or replaced as new or national information becomes available.

There is now a page dedicated to COVID-19 resources on the GMMMG website. The following items have been added to this page this week:

A communication from the Association of Greater Manchester Local Medical Committees and the Greater Manchester and Bolton Local Pharmaceutical Committees to ensure robust business continuity plans are in place during COVID-19

A GMMMG Questions, Answers and Actions Statement addressing the question “What is the evidence for early use of antibiotics in high risk patients diagnosed with COVID-19 in the community setting?" which concludes that “Prescribers should continue to follow current NICE guidance (CG191 and NG139)
until NICE publish the COVID-19 rapid review guidance in early April 2020”

Due to the COVID-19 outbreak all active GMMMG consultations will be suspended as of Wednesday 1st April 2020. This will continue until the end of June 2020 initially, when this position will be reviewed. We will continue to accept comments on these documents during this time, but no new consultations will be opened

High Cost Drugs Subgroups

3.7.20

The following three documents are now open for consultation

  • AS Pathways
  • PsA Pathways
  • PsA and AS Pathway Outcome Monitor

Please see our consultations page for full details and instructions on how to submit your comments

Clinical Reference Group (CRG)

21.4.21

On behalf of the GMMMG Clinical Reference Group, a shared care protocol for hydroxychloroquine in adults in the updated shared care template is in development. We now seek comments on this draft. This consultation period is open until 5pm Wednesday 2nd June 2021.

21.4.21

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed in the April 21 CRG meeting. This consultation period is open until 5pm Wednesday 2nd June 2021.

1.4.21

With the re-start of GMMMG activity in April 2021, the consultation process which was temporarily suspended between January and March 2021 is now re-opened. On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed in the Dec 20 and Jan 21 CRG meetings and temporary decisions made by GM Chairs during the pause of non-essential GM activity. This consultation period is open until 5pm Thursday 13th May 2021.

Formulary and Managed Entry Subgroup (FMESG)

2.7.20

The following FMESG actions for June 2020 have been proposed. We now seek comments on these proposals.  This consultation is open until 5pm on Friday 14th August.

28.5.20

On behalf of the GMMMG Formulary and Managed Entry Subgroup, an updated Greater Manchester Joint Wound Care Formulary is in development. Adoption of the updated formulary is underway within GM Trusts.  We now seek the comments on this draft from primary care and community services.  This consultation period is open until 5pm Friday 10th July 2020.

Key points:

  • The update is in response to a procurement exercise to rationalise purchase of wound care products through NHS Supply Chain
  • There is no anticipated cost impact to CCGs as a result of this guidance. There is potential for some savings on FP10 (in the region of 500K per annum across GM).

Pathways and Guidelines Development Subgroup (PaGDSG)

26.5.20

Following GM-wide consultation and approval by PaGDSG, an updated Guideline has been published:  CMPA Allergy.

15.5.20

On behalf of the GMMMG Pathways and Guidelines Development Subgroup, an updated Greater Manchester wide shared care protocol for Azathioprine for IBD in paediatrics is in development. We now seek comments on this draft. This consultation period is open until 5pm on Monday 29th June 2020.

15.5.20

On behalf of the GMMMG Pathways and Guidelines Development Subgroup, an updated  Greater Manchester wide shared care protocol for Ethinylestradiol and estradiol for the induction of delayed puberty is in development. We now seek comments on this draft. This consultation period is open until 5pm on Monday 29th June 2020.

  • This SCP has been updated to include estradiol patches (off-label)
  • Patient numbers are small; estimated that 20 patients receive treatment per annum across GM.

15.5.20

Following GM-wide consultation and approval by PaGDSG, an updated shared care protocol has been published:  Growth Hormone in Paediatrics.

Key changes in this update include:

  • addition of Omnitrope® 5mg cartridges to reflect product preference of the endocrine team
  • deletion of Humatrope® device due to unreliable supply chain on this product. This is the only device licensed for use in SHOX so the updated draft includes advice on off-label use of alternative products
  • clarification of endocrine team, patient, and GP responsibilities

 

GMMMG

31.3.21

GMMMG approved Shared Care Protocols are now available here to support prescribing of medicines through the Indigo Gender Service, an NHSE primary care based pilot for adult trans healthcare which has been launched and is set to run across Greater Manchester for the next two years

4.1.21

On behalf of the GMMMG Clinical Reference Group, we now seek comments on a series of draft shared care protocols to support the safe transfer of prescribing between Indigo Gender Services and GM primary care prescribers. This consultation contains three SCPs, one for each of; oestrogens, testosterone, and gonadotrophin-releasing hormones (GnRH) analogues, and uses the new GMMMG SCP template.
Please submit comments before 5pm Tuesday 16th February 2021

4.1.21

On behalf of the GMMMG Clinical Reference Group, we now seek comments on actions proposed at the December meeting. This consultation period is open until 5pm Monday 15th February 2021

27.11.20

The Greater Manchester-Wide COPD Pathway Development Group is pleased to present an updated version of the GMMMG COPD Management Plan. This revised version is still based on GOLD guidance and has a greater emphasis on low carbon options, as well as further detail for certain topics. Please submit comments by Friday 15th January 2021. The RDTC® is developing a tool which will be made available to CCG Medicines Optimisation teams in the coming weeks to consider the carbon dioxide equivalent values (a standard unit for measuring carbon footprint) alongside the financial impact posed by the different inhaler options. This will enable local teams to identify affordable improvements in their carbon footprint through appropriate inhaler choice based on their current usage and with consideration to the principle of this management plan.

19.11.20

On behalf of the GMMMG Clinical Reference Group, we now seek comments on actions proposed at the November meeting. This consultation period is open until 5pm Thursday 31st December 2020.

28.10.20

On behalf of the GMMMG Implementation Group,  we now seek comments on a new GMMMG Resource Pack for Gabapentinoid Prescribing for Pain. This resource pack aims to support safe and evidence-based prescribing, review and deprescribing of gabapentin and pregabalin in the treatment of pain. This consultation period is open until 5pm Wednesday 9th December 2020.

27.10.20

On behalf of the GMMMG Clinical Reference Group,  we now seek comments on actions proposed at the September meeting. This consultation period is open until 5pm Tuesday 8th December 2020

16.10.20

The GMMMG Clinical Reference and Implementation Groups are undertaking a review of GMMMG shared care protocols, processes around transfer of prescribing responsibilities to primary care, and RAG criteria. This is in line with GMMMG priorities for 2020/21.

We now seek comments on three key aspects that underpin this work:

  • Updated Guidelines on Defining Red, Amber and Green Medicine Status
  • New Guidance on the Transfer of Prescribing Responsibilities to Primary Care
  • Updated Shared Care Protocol (SCP) Template- Azathioprine in Adults has been provided as an example

Comments from all sectors are welcomed, particularly from colleagues who are familiar with current shared care arrangements and/ or prescribing across the interface.

This consultation is open until 5pm Friday 27th November.

2.9.20

On behalf of the GMMMG Medicines and Guidelines Subgroup a Polypharmacy Resource Pack is in development. We now seek comments on this draft. Comments are particularly welcomed in relation to the appendices and suggested SMR templates.  This consultation period is open until 5pm Wednesday 14th October 2020.

 

26.8.20

On behalf of the GMMMG Clinical Reference Group, a review of specialist initiation drugs is underway. We now seek comments on updated recommendations for some GREEN specialist initiation drugs.  Comments are particularly welcomed from primary care- especially in regards to any anticipated impact.   This consultation period is open until 5pm Wednesday 7th October 2020.

24.8.20

Oral semaglutide is still to be considered by GMMMG and a decision will be published in due course. This item is currently non-formulary until a recommendation is made. For current formulary choice GLP-1 receptor mimetics, please see chapter 6.

25.6.20

Updated GMMMG Antimicrobial Guidelines have now been published.  A summary of changes included in this update can be found at the end of the document.

30.4.20

 Following discussion and scoping, it has been decided to re-open the consultations currently active on the GMMMG website at http://gmmmg.nhs.uk/html/consultations.html, which were temporarily suspended during April. New closing dates are listed on the consultation page. GMMMG recognises that there is still considerable pressure on services due to the COVID-19 pandemic, but also that progressing documents through the consultation process is necessary to ensure high quality patient care in Greater Manchester.

Every effort has been made to allow sufficient time for appropriate clinical input to these documents, but if you foresee any problems or have any questions please email nuth.enquires.gmmmg@nhs.net          

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