Greater Manchester Medicines Management Group

Greater Manchester Clinical Standards Board



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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 during December 2017

December 2017



"GP guide – lnfluenza outbreak in an adult care home” guidance is now available under the guidance section on the GMMMG website.[Links removed - obsolete documents]


At the December GMMMG meeting the group were presented with an overview of the Second Generation Antipsychotic Injections Rebate Outcome Payment Scheme which is being supported by Health Innovation Manchester on behalf of the GM Mental Health NHS FT, Pennine Care NHS FT and North West Boroughs Healthcare NHS FT.

The Boots Sore Throat Test and Treat Service, and the Point of Care CRP testing piloted by HMR CCG to reduce antimicrobial use were presented to GMMMG, it was agreed that further information would be provided and considered by the relevant GM Subgroups.

It was agreed that FMESG would be tasked with reviewing the NHSE guidance on “items which should not be routinely be prescribed in primary care”, and to return with a GM implementation plan.

The GMMMG Policy on Engagement with the Pharmaceutical industry has been updated and added to the GMMMG website, as has the GMMMG Appeals policy.

The group discussed the outcomes of the GMMMG Chairs meeting, the new GMMMG membership will commence in February 2018 and is being communicated in the coming weeks.

Formulary and Managed Entry Subgroup (FMESG)

The GMMMG Formulary and Managed Entry Subgroup (FMESG) met on the Tuesday 28th November 2017. GMMMG pre-approved those items from the November meeting which will now be subject to GM wide consultation, and approved all other items.

  • The minutes of the Sept meeting and the updated work plan were provided for information.

 At the Nov meeting the group:

  • Noted that the Freestyle Libre Recommendation had been approved by the GMMMG Chairs and was now on the website.
  • Re-reviewed the current recommendation regarding Liraglutide for obesity which will remain “not recommended”
  • Approved the addition of Trimbow into the GMMMG formulary in line with the GMMMG COPD pathway, and agreed that Trelegy would  also be added upon launch.
  • Agreed that Femoston and Femoston Conti be re-inserted into the GMMMG formulary
  • Considered the evidence for pitolisant for narcolepsy and agreed to draft a recommendation to return to the January FMESG meeting for approval.
  • Considered the use of positive expiratory pressure devices and agreed that a recommendation would be drafted, but additional feedback would be sought from physiotherapy departments as to their intended use of these devices.
  • greed to update the formulary in line with NICE and MHRA guidance issued in September and October 2017

Following GM wide consultation of chapter 6 of the formulary the group agreed that:

  • There would be no change to the placing of SGLT2 inhibitors on the formulary
  • Biphasic insulins would remain as a formulary option
  • There would be no change to the placing of GLP-1s on the formulary
  • The group would consider a re-review of the current degludec “not recommended” status, alongside other long acting insulin products
  • There would be an assessment of pen needles for the DNP list
  • General updates would be made to chapter 6 i.e. removal of black triangles status where appropriate

The group considered a request to review the RAG status of various eye preparations in chapter 11 of the formulary. The group have were concerned that this was a supply issue rather than a RAG issue and asked that the specialist representative be contacted for further discussion around alternative supply arrangements. Query had also been raised as to the OTC status within this chapter, it was agreed post-meeting that further communication would be undertaken with the specialist and that comments would return to the January FMESG meeting.

It was agreed that the review of the GMMMG blood glucose test strips recommendation would not take place until further notice.

The group considered responses to the RAG consultation held following the September meeting.

  • The group re-visited the proposal that stiripentol for Dravet’s Syndrome would have an amber status in adults. The group noted concerns from the consultation but pointed out that without an approved SCG this item would remain red anyhow. It was agreed that LH would consult further with SRFT specialists regarding this issue, but that a red status would be assigned at this time.
  • A request for the RAG list to include a “red pending SCP being approved” status had been forwarded to the RDTC

The following RAG assessments were considered and agreed as follows:

  • Sildenafil for digital ulcers - red
  • Azathioprine for neurological conditions – red pending SCP, then amber once SCP approved.

The following DNP assessments were considered:

  • Herbal medicines – proposed for DNP inclusion
  • Homeopathic medicines – proposed for DNP inclusion

Pathways and Guidelines Development Subgroup (PaGDSG)


The September minutes from this group are now available.

GMMMG considered the following SCPs which were approved in principle:

  • Ethinylestradiol the induction of delayed puberty SCP
  • Lithium SCP
  • Green+ Drug information leaflet: nalmefene for reduction of alcohol consumption in adults.

High Cost Drugs Subgroup (HCDSG)


GMMMG approved the items submitted below

The GMMMG High Cost Drugs Subgroup (HCDSG) met on the 25th October and the 22nd November. There will be no December 2017 meeting.

The minutes of the Sept meeting are provided for information.

At the Oct and Nov meetings the group:

Approved position statements for using biologic therapies to treat adult patients with Juvenile Idiopathic Arthritis and for funding of High Cost Drugs when patients transition from Children or adolescent services to adult services, these are submitted now to GMMMG for approval

Approved the “IBD pathway” which is now submitted for GMMMG approval.

The group continued discussions regarding the BSR register and its availability to all biosimilar products. CS and DT agreed to approach those maintaining the register to clarify the situation.

“Free of Charge Medicines (FOC) Scheme” – SJ presented a draft paper to the group proposing a FOC policy. CS had presented the paper at the National Medicines Optimization CRG meeting the day before, where it had been well received and so thanked Sarah for her work. Final comments were being received following which a final version will be drafted.

NHSE Commissioning Framework for Biologics – the group have received comments back from the GM Chief Pharmacists meeting, who were generally happy that GM would look to “a positive uptake of the best value biosimilar product in month 1 and growing, to reach 80% of total by drug to be the best value product by month 12 from the agreed gain share start date, across GM. Amendments to the paper will return to HCDSG in January and then a final paper to GMMMG in February.

GM wide optimum management of biologics – CS and CV are leading on this work with the GM rheumatology network, a paper will return to HCDSG in January or February.

BG from the GMSS presented the latest version of the biosimilar dashboard to the group. This had been developed by a task and finish group identified by HCDSG. The group was pleased that good progress had been made, they asked whether potential savings or lost opportunity could be included, and also whether gain share arrangements could be illustrated. Following these changes and a check on the data accuracy, the dashboard would return to the January meeting following which HCDSG will present it to GMMMG in February.

The group considered and approved a timeline for horizon scanning and financial planning. It was agreed that GMMMG would undertake formal horizon scanning going forward, supported by the subgroups.

The group considered an evidence summary for the use of dupilumab for dermatitis and agreed that a recommendation be drafted and returned to the Jan meeting for approval.

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