GMMMG updates – May 2024

Following the May meetings of GMMMG and CEGC, the following actions have been published to the GMMMG website:

Links to NICE guidance and MHRA safety advice added as appropriate. For full details of formulary and RAG updates, see the formulary change log available on the formulary page.


GMMMG updates – April 2024

Following the April meetings of GMMMG and CEGC, the following actions have been published to the GMMMG website:

  • Shared care protocols for amiodarone and dronedarone published; see full list of shared care protocols.
  • FreeStyle Libre 3 – added to RAG list as RED
  • Levonorgestrel 20 micrograms / 24 hours intrauterine delivery system (Benilexa) – added as a first-line option alongside Kyleena, Levosert, and Mirena.
  • Secukinumab for hidradenitis suppurativa – added as RED
  • Velmanase alfa – added as RED

Links to NICE guidance and MHRA safety advice added as appropriate. For full details of formulary and RAG updates, see the formulary change log available on the formulary page.


GMMMG updates: November 2023

Following the November meetings of GMMMG and CEGC, the following actions have been published to the GMMMG website.

Updates to guidelines include:

  • New guidance: Safe Management of Medicines Within GP Practices

Formulary and RAG updates include:

  • Bempedoic acid – GREEN (previously green following specialist advice)
  • Betamethasone, dexamethasone, prednisolone and fluorometholone eye drops – GREEN (following specialist initiation)
  • Semaglutide for obesity in 12-17 year olds – DNP

Links to NICE guidance and MHRA safety advice added as appropriate. For full details of formulary and RAG updates, see the formulary change log available on the formulary page.

Following approval by the GM ICB Executive, the following have also been published:

  • Rimegepant for prevention of migraine – GREEN (following specialist initiation)
  • Sodium chloride 5% eye drops for corneal oedema – GREEN (following specialist advice)
  • An updated pathway for wet AMD was also approved, and will be published shortly

More details of the published decisions are available from the decision summaries page.


Formulary and RAG updates – June 2023

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following updates have been made to GMMMG guidelines, formulary, and RAG list.

  • Note added to entry for aspirin in chapter 2 : “do not routinely offer aspirin for primary prevention of CVD”, with link to NICE CG181.
  • Upadacitinib for non-radiographic axial spondyloarthritis added as RED as per NICE TA861
  • Somatrogon added as RED (pending shared care) as per NICE TA863
  • Vutisiran added as RED, as per NICE TA868
  • Ataluren added as RED, as per NICE HST22

The formulary has also been updated to reflect relevant safety alerts and NICE guidelines. For full details, see the GMMMG decision summary for June 2023, or the formulary change log available on the formulary page.


Formulary and RAG list updates – May 2023

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following updates have been made to GMMMG guidelines, formulary, and RAG list.

  • GMMMG antimicrobial guidelines have been updated
  • Upadacitinib for Crohn’s disease added as RED
  • IQoro neuromuscular training device added to DNP list
  • Colestyramine and colesevelam for CVP prevention in hypercholesterolaemia added to GREY list as Green (specialist advice), only for use when there is no alternative treatment option due to intolerance, or ineligibility for PCSK9i or inclisiran treatment
  • Maribavir for refractory CMV post-transplant added as RED
  • Discontinued Insuman preparations removed from formulary
  • Potassium permanganate tablets for solution assigned a status of RED
  • Trifarotene for acne added as GREEN

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


New guidelines and Terms of Reference

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, two new GMMMG guidelines have been published;

  • HRT Guidance for Menopause Management
  • Hypersalivation and Sialorrhoea in Adult Patients

Both guidelines are available on the clinical guidance and pathways page.

The formulary and RAG list have been updated to reflect the recommendations in these guidelines. For details of the updates, see the GM formulary change log, available on the formulary page.

The Terms of Reference for GMMMG and its subgroups have also been approved, and are available here. These include:

  • Clinical reference group
  • Medicines safety group
  • Population health management and health inequalities group
  • Digital group

Formulary and subgroup decision updates

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.


Formulary and subgroup decision updates

Following the first meeting of the Greater Manchester ICS Clinical Effectiveness and Governance Committee on Thursday 22nd September, the website and formulary have been updated to reflect decisions made by GMMMG and the Clinical Reference Group (CRG). This includes:

  • Empagliflozin for heart failure added as GREEN (specialist advice)
  • Pitolisant and solriamfetol for obstructive sleep apnoea added to DNP list (criterion 1)
  • Nirmatrelvir / ritonavir (Paxlovid) added as RED
  • Micronised progesterone vaginal capsules for management of miscarriage added as GREEN (specialist initiation)
  • Emollient section of chapter 13 updated to align with primary care emollient ladder
  • Minoxidil foam added to DNP list (criterion 3). Formulary updated to clarify that other minoxidil preparations are included in the Drug Tariff part XVIIIA (the “black list”).
  • Anti-reflux milks added to paediatric DNP list (criterion 3)
  • Phenazone / lidocaine eardrops for acute otitis media added to paediatric RAG list as GREEN, for use only if an immediate oral antibiotic prescription is not given, and there is no eardrum perforation or otorrhoea
  • Pegcetacoplan for paroxysmal nocturnal haemoglobinuria added to RAG list as RED
  • Atidarsagene autotemce for metachromatic leukodystrophyl added to RAG list as RED
  • Selumetinib for inoperable plexiform neurofibromas associated with type 1 neurofibromatosis added to RAG list as RED
  • Lixisenatide removed from formulary for new patients following discontinuation of the 10 microgram pen and initiation pack. Patients who are clinically stable on lixisenatide may continue and should not be switched without clinical reason

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts. For full details of the changes, please see the Formulary Change Log.

Outstanding decisions

Outstanding decisions expected to have a financial impact for the ICS are pending approval by GM Directors of Finance, and will be published once approved:

  • Dapagliflozin for chronic kidney disease
  • Sitagliptin formulary position following patent expiry
  • Romosozumab for severe osteoporosis
  • Simple eye ointment DNP status

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.

Formulary and subgroup decision updates

Following the February meeting of GMMMG, the formulary has been updated to reflect decisions made by the Clinical Reference Group (CRG) and Medicines and Guidelines Subgroup (MGSG). Changes include:

  • Addition of NICE guidance and MHRA drug safety updates to formulary
  • Duloxetine 90mg and 120mg capsules added to grey list as a GREEN drug
  • Insulin degludec added to grey list as a GREEN (specialist initiation) drug
  • Isoniazid for tuberculosis prophylaxis in renal patients added to RAG list as GREEN (specialist initiation)
  • Dapsone 50mg and 100mg tablets for PCP prophylaxis added to RAG list as GREEN (specialist initiation)

For full details of the changes, please see the Formulary Change Log.