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.


New and updated resources

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

The GMMMG Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack has been reviewed and updated. The updated resource pack is available on the Clinical Guidelines and Pathways page.

Terms of reference for the Workforce subgroup have also been approved, and are available on the Membership and Terms of Reference page.

The formulary and RAG list have been updated to remove fostamatinib from the RAG list and assign a RED RAG status, and to reflect updated NICE guidelines and MHRA advice. See formulary change log for more details.

Outstanding decisions

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

  • Dexamethasone intravitreal implant for diabetic macular oedema
  • Avacopan to severe active granulomatosis with polyangitis or microscopic polyangitis
  • Ozanimod for moderately to severely active ulcerative colitis
  • Upadacitinib for active ankylosing spondylitis
  • Relugolix–estradiol–norethisterone acetate for treating moderate to severe symptoms of uterine fibroids
  • Implementation of NICE guidance on Continuous Blood Glucose Monitoring (CGM)
  • Dexcom ONE rtCGM device
  • GMMMG antimicrobial guidance

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, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following decisions have been approved and published:

  • Insuman Comb 50 removed from formulary – product discontinued
  • Abrocitinib, tralokinumab & upadacitinib added for formulary as RED drugs in chapter 13

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: melatonin for children and adolescents

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.


Inclisiran leaflet & lipid pathway

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


Updated headache pathway

Following review and Greater Manchester-wide consultation, the GMMMG headache pathway has been updated and is now available on the Clinical Guidance and Pathways page. The formulary and RAG list have also been updated to reflect the guidance, including:

  • Additional options for simple analgesia and antiemetics
  • Clearer guidance on choice of triptan
  • Additional options for migraine prophylaxis in primary care, including metoprolol, amitriptyline, nortytipyline, candesartan. Zonisamide has also been added, for use following specialist advice
  • Flunarazine added as a RED drug
  • Additional options for acute treatment of cluster headache: zolmitriptan nasal spray, and oxygen.
  • Additional option for cluster headache prophylaxis: verapamil (following specialist advice)

Neuropathic pain guidance updated

Following technical review and Greater Manchester-wide consultation, the GMMMG neuropathic pain guidance has been updated and is now available on the Clinical Guidance and Pathways page. The formulary has also been updated to reflect the guidance.

Updated asthma pathway published

Following GM-wide consultation and approval by chief finance officers and directors of commissioning, an updated GMMMG asthma guideline is now available on the Clinical Guidance and Pathways page.

The guideline has been updated in response to a request from GMHSCP to produce an updated asthma management plan to support the move to lower carbon inhalers. This includes consciously reducing the propellants contained in metered-dose inhalers which is a significant contributor to enabling the Greater Manchester Combined Authority’s and Greater Manchester Joint Commissioning Board’s commitment to sustainability.

An updated inhaler guide to support the pathway is in production, and will be available in due course.