GMMMG shared care consultation extended

Please note: the GMMMG consultation on the adoption of the suite of national shared care protocols has been extended.

The consultation will now run for 10 weeks, to facilitate gathering of feedback from across all sectors of the ICS. The consultation will now run until Monday 3rd October 2022. Please follow the link above for more information, and to submit comments.


Consultation: actions from July meeting of CRG

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

Actions in this consultation include:

  • Ranibizumab biosimilar to be added to formulary as RED, and ranibizumab to be first choice anti-VEGF therapy for NICE-approved indications.
  • Melatonin (Adaflex) to be added to formulary as AMBER (children) and GREEN (specialist advice) for adults with REM sleep behaviour disorder in Parkinson’s disease.
  • Mexiletine – RED for life-threatening ventricular arrhythmias
  • Filgotinib – RED for moderately to severely active ulcerative colitis
  • Faricimab – RED for diabetic macular oedema and wet age-related macular degeneration
  • Diroximel fumarate – RED for relapsing-remitting multiple sclerosis
  • Teduglutide – RED for short bowel syndrome
  • NICE clinical guideline for gout, NG219, to add to formulary.

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 5th September 2022.


GMMMG Consultation on the Adoption of the National Shared Care Protocols

On 8th July 2022 NHS England published a suite of 18 shared care protocols: https://www.england.nhs.uk/medicines-2/regional-medicines-optimisation-committees-advice/shared-care-protocols/.

These have been developed by the Regional Medicines Optimisation Committee (RMOC) North in conjunction with the Shared Care Working Group and the Regional Drug and Therapeutics Centre.

Before being published they underwent a national consultation and approval process by RMOC North and ultimately by the relevant NHSE National Clinical Directors and the Chief Pharmaceutical Officer. Further information on this process can be found on the NHSE website using the link above.

The GMMMG Clinical Reference Group (CRG) are now seeking comments from stakeholders on the potential barriers to implementation of these 18 shared care protocols. The clinical content has been approved nationally with representation from all regions including Greater Manchester, with input during the development, and via the consultation process undertaken by RMOC.

For this reason CRG are not seeking comments on the clinical content of the documents but are looking to the GM Integrated Care System to provide feedback on how these should now be used to replace the current shared care protocols.

GMMMG are keen to understand what barriers, if any, may prevent all GM localities from being able to adopt these national shared care protocols. These could include, but may not be limited to:

  • Specialist service design and capacity
  • Resource implications in both primary care and specialist clinics
  • Compatibility with current digital communication methods
  • Appropriateness of the listed indications for use of the medicine

Therefore CRG on behalf of GMMMG invite all GM stakeholders to submit comments using the link below before the closing date of 3rd October 2022. A downloadable copy of this text is also available via the link.

Comments submitted on clinical content of the documents are unlikely to be addressed at a GM level unless GMMMG agree that there are significant safety concerns. Any other comments will be collated and submitted to the NHSE Medicines Policy Team to inform future work to manage and update the documents.

Consultation comments can be submitted via the feedback form at https://gmmmg.nhs.uk/consultations/136-consultation-national-shared-care/.

* Please note: this news item was updated on 17th August 2022 to reflect the new closing date for this consultation. The consultation period has been extended from 8 to 10 weeks, and will now close on Monday 3rd October 2022.


Consultations: DOAC statement and hypersalivation pathway

Two new consultations have been opened on the GMMMG site; see details below. Both consultations will run until 5pm on Monday 1st August 2022. Comments can be submitted using the feedback forms on the GMMMG consultations page, and comments are invited from all stakeholders.

DOAC statement

CRG seek comments from Greater Manchester on this position statement regarding the prescribing of best value direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation. When developing the statement CRG carefully considered, amongst other things:

  • The financial savings associated with increased edoxaban use,
  • A clinician’s freedom to prescribe the treatment they think is most appropriate for their patient
  • The available evidence base to support (or not) the use of one medicine over another.
  • The Investment and Impact Fund indicators
  • The high court ruling that has invalidated the patent for apixaban, and may yet be subject to appeal.

CRG want edoxaban to be the first choice DOAC for use in non-valvular AF, and an alternative used where edoxaban would not be safe or appropriate. This position is still current at the time of publication of the draft statement, despite the legal issues surrounding apixaban.

GMMMG therefore seek feedback from a wide range of stakeholders regarding this statement.

Hypersalivation pathway

CRG seek comments from Greater Manchester on this draft pathway for the management of hypersalivation. It has been developed and approved by MFT and CRG are seeking to adapt it for use across GM, particularly in primary care.

It looks to provide evidence-based, cost-effective recommendations on the management of hypersalivation in a number of conditions.

GMMMG therefore seek feedback from a wide range of stakeholders regarding this pathway

Consultation: actions from June meeting of CRG

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

Actions in this consultation include:

  • Minoxidil foam to be DNP, and formulary updated to clarify that other topical minoxidil preparations are not prescribable
  • Lixisenatide to be removed from formulary following discontinuation of initiation packs
  • Romosozumab for severe osteoporosis to be RED, and added to formulary as a first line anabolic treatment alongside teriparatide
  • Selumetinib for symptomatic and inoperable plexiform neurofibromas to be RED
  • Links to NICE clinical guidance on baricitinib for COVID-19 to be added to formulary in chapters 10 & 13.

For information:

  • Epiduo gel: strength to be removed from formulary, to align with primary care dermatology acne pathway
  • Brand name and formulation for topical calcipotriol / betamethasone to be removed from formulary, and replaced with a statement that prescribers should choose the most cost-effective option.
  • Formulary restriction to macrogol 3350 to be removed, replaced with a statement that prescribers should choose the most cost-effective macrogol formulations.

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

Consultation: actions from May meeting of CRG

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

Actions in this consultation include:

  • Sitagliptin to replace alogliptin as first choice DPP4 inhibitor
  • Anti-reflux formula milks to be DNP
  • Nirmatrelvir & ritonavir (Paxlovid) to be added to formulary as RED
  • Links to NICE clinical guidance to be added to formulary: NG215 (medicines associated with dependence or withdrawal symptoms) and NG217 (epilepsies in children, young people and adults).
  • Links to MHRA safety advice to be added to formulary: pregabalin: findings of safety study on risks during pregnancy

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 30th June 2022.

Consultations: CRG actions and draft shared care protocol

Two new consultations have been opened on the GMMMG consultations page

CRG actions

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the April 2022 CRG meeting. Actions in this consultation include:

  • Simple eye ointment – DNP
  • Goserelin and leuprorelin for male early or advanced breast cancer – AMBER (see also consultation on updated draft shared care protocol)
  • Empagliflozin for chronic heart failure – GREEN following specialist advice
  • Dapagliflozin for chronic kidney disease – GREEN
  • Phenazone/lidocaine eardrops – add to formulary for treatment of otitis media
  • Pitolisant for excessive daytime sleepiness caused by obstructive sleep apnoea – DNP
  • Solriamfetol for excessive daytime sleepiness caused by obstructive sleep apnoea – DNP
  • Pegcetacoplan for paroxysmal nocturnal haemoglobinuria – RED
  • Atidarsagene autotemcel for metachromatic leukodystrophy – RED

Shared care protocol: GnRH analogues for breast cancer

CRG seek comments on this updated shared care protocol for the treatment of breast cancer.

The main changes are:

  • The addition of leuprorelin within the indications listed in the SCP
  • The SCP now includes the treatment of male breast cancer within the indications detailed in the SCP
  • A move to the new approved GM shared care protocol format.

Both consultations will run until 5pm on Wednesday 25th May 2022. Comments can be submitted using the feedback forms on the GMMMG consultations page, and comments are invited from all stakeholders.

Consultation: inclisiran information for primary care prescribers

A new consultation has been opened on the GMMMG consultations page on a draft information leaflet for inclisiran. 

The draft provides additional advice and information for prescribers, and is intended to support primary care prescribers and ensure a quality standard for the prescribing of inclisiran.

The consultation will be open until 5pm on Tuesday 3rd May 2022, and comments are invited from all stakeholders.

Consultation: actions from March meeting of CRG

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

Actions in this consultation include:

  • Moxonidine – GREEN following specialist initiation
  • Ponesimod for relapsing-remitting multiple sclerosis – RED
  • Upadacitinib for active psoriatic arthritis – RED
  • Palforzia for peanut allergy in children and young people – RED on the paediatric RAG list, and GREY and RED on the adult RAG list, only for use in people aged 18 and over if treatment is started between the ages of 4 and 17, as per NICE guidance
  • Odevixibat for progressive familial intrahepatic cholestasis – RED

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 21st April 2022.

Consultation: actions from February meeting of CRG

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

Actions in this consultation include:

  • Modafinil for narcolepsy and in Parkinson’s disease: GREEN following specialist initiation
  • Dacepton (apomorphine): AMBER; to be added to existing shared care protocol
  • Bempedoic acid: GREEN following specialist advice (previously specialist initiation)
  • Sotrovimab for COVID-19: RED
  • Mexiletine for myotonia: RED
  • Liraglutide for obesity in people aged 12-17: Do Not Prescribe
  • Dupilumab for severe asthma: RED
  • Belimumab for SLE: RED
  • Cenobamate for epilepsy: GREEN following specialist initiation (by a tertiary epilepsy service)
  • Risdiplam for spinal muscular atrophy: RED
  • Solriamfetol for narcolepsy: RED
  • Fostamatinib for chronic ITP: Do Not Prescribe

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Monday 4th April 2022.