Author: Nancy Kane

Updated shared care protocols: potassium binders and atypical antipsychotics

December 19, 2022

Following approval by CRG and GMMMG, and by the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following revised GMMMG shared care protocols for adult patients are now available:

  • Sodium zirconium cyclosilicate for hyperkalaemia
  • Patiromer sodium for hyperkalaemia
  • Oral atypical antipsychotics

The formulary has been updated to assign an AMBER status sodium zirconium cyclosilicate, patiromer sodium, lurasidone, and paliperidone.

The updated documents can be found on the shared care page, along with all other currently active SCPs.

Consultation: actions from December meeting of CRG

December 15, 2022

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the December 2022 CRG meeting.

Actions in this consultation include:

  • Donepezil, galantamine and rivastigmine for mild to moderate Alzheimer’s disease, Lewy body dementia, and Parkinson’s disease: Green (specialist advice)
  • Cyclogest added to formulary as an option for vaginal micronised progesterone for prevention of miscarriage

All links to MHRA drug safety updates will be added to formulary as appropriate.

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 26th January 2023.

Updated shared care protocol: melatonin for children and adolescents

November 24, 2022

Following approval by CRG and GMMMG, and the first meeting of the Greater Manchester ICS Clinical Effectiveness and Governance Committee on Thursday 22nd September, a shared care protocol for melatonin in children adolescents has been updated.

All of the currently active shared care protocols in Greater Manchester are available on the shared care page.

Formulary and subgroup decision updates

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following decisions have been approved and published:

  • Ranibizumab biosimilar added to formulary as RED and made first choice anti-VEGF-A treatment for NICE-approved indications. An updated GM macular pathway is also expected.
  • Faricimab added to formulary as RED for diabetic macular oedema and wet age-related macular degeneration.
  • Adaflex tablets added to formulary as first choice option for melatonin.
  • Mexiletine capsules added to formulary as RED for life-threatening ventricular arrhythmias.
  • Filgotinib added to formulary as RED for moderately to severely active ulcerative colitis.
  • Diroximel fumarate added to formulary as RED for relapsing-remitting multiple sclerosis.
  • Teduglutide added to formulary as RED for short bowel syndrome.

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts. For full details please see the formulary change log, which is available on the formulary page.

For more information on these and other decisions, please see GMMMG decision summaries.

Updated shared care protocol: apomorphine for adult patients

November 21, 2022

Following approval by CRG and GMMMG, and by the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the revised GMMMG shared care protocol for apomorphine for adult patients is now available.

The updated document can be found on the shared care page, along with all other currently active SCPs.

Consultation: actions from November meeting of CRG

November 11, 2022

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the November 2022 CRG meeting.

Actions in this consultation include:

  • Ozanimod for moderately to severely active ulcerative colitis – RED
  • Relugolix / estradiol / norethisterone for moderate to severe symptoms of uterine fibroids – GREEN (following specialist advice)
  • Remove fostamatinib from DNP list and assign a RED status
  • Replace links to superseded NICE clinical guideline CG177 with links to NG226: Osteroarthritis in over 16s. Formulary note regarding glucosamine updated to read “Do not offer glucosamine products or strong opioids for the management of osteoarthritis.”

All links to MHRA drug safety updates will be added to formulary as appropriate.

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Friday 23rd December 2022.

Formulary and subgroup decision updates

November 7, 2022

Following approval by CRG, GMMMG, the Greater Manchester ICS Clinical Effectiveness and Governance Committee, and Greater Manchester Management Executive, the following decisions have been approved and published:

  • Dapagliflozin for chronic kidney disease added to formulary as a GREEN drug
  • Edoxaban approved as first-line DOAC in atrial fibrillation, and DOAC statement published.
  • Sitagliptin approved as first-choice DPP-4 inhibitor
  • Romosozumab for severe osteoporosis added to formulary as a RED drug, as an alternative first-choice option alongside teriparatide
  • Simple eye ointment assigned a Do Not Prescribe status

Decision summaries from the July, August, and September meetings of GMMMG are also available, with further details on these and other decisions from those meetings. The formulary and RAG list change log has been updated accordingly and is available on the formulary page.

Inclisiran leaflet & lipid pathway

November 2, 2022

Two new resources have been added to the GMMMG website to support prescribing for lipid management:

Consultation: actions from October meeting of CRG

October 17, 2022

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the October 2022 CRG meeting.

Actions in this consultation include:

  • Estradiol and testosterone for gender dysphoria (when under NHS care) – GREEN (following specialist initiation)
  • Dexcom One real-time CGM system – to be available as an alternative first-line option to FreeStyle Libre.
  • Chloral hydrate & chloral betaine – RED
  • Dexamethasone intravitreal implant for diabetic macular oedema – update links to reflect latest NICE technology appraisal
  • Avacopan for severe active granulomatosis with polyangitis or microscopic polyangitis – added to RAG list only as RED
  • Upadacitinib for active ankylosing spondylitis – RED

All links to MHRA drug safety updates will be added to formulary as appropriate.

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Monday 28th November 2022.

GMMMG charter

September 27, 2022

Following the first meeting of the Greater Manchester ICS Clinical Effectiveness and Governance Committee on Thursday 22nd September, the GMMMG charter has been approved and published.

The charter is available on the website by clicking here.