New consultation: statins for primary CV prevention in HIV

Following discussion at the February 2024 meeting of CRG, we now seek comments on a draft position statement on prescribing statins for primary prevention in HIV.

This consultation will run for six weeks and closes at 5pm on Friday 12th April 2024. To take part, visit the consultations page.


New consultation: updated Primary Care Rebate Scheme ethical framework

On behalf of the GMMMG Medicines Value Group, we now seek comments on an update to the GMMMG Ethical Framework for Considering Rebate Applications from Pharmaceutical, Nutrition and Device Companies in primary care.

Please note this consultation includes two documents, provided in a zipped folder.

This consultation will run for six weeks and closes at 5pm on Wednesday 3rd April 2024. To take part, visit the consultations page.


New consultation: DOAC switching guide

On behalf of the GMMMG Clinical Reference Group, we now seek comments on a draft guide on DOAC review and switch to apixaban for NVAF patients.

This consultation period is open until 5pm on Friday 29th March 2024. To take part, visit the consultations page.


Greater Manchester Pain Management Resources Hub

Greater Manchester healthcare professionals have collaborated to design the Greater Manchester Pain Management Resources Hub that gathers helpful tools and resources in one place. The Hub brings together a variety of useful resources including guidance to support effective consultations, patient self-management information to share, clinician aids and tools, shared learning and education, how to use data to understand the local population, and information to access related services across the conurbation.

“Pain Killers” do not stop pain, they mask it, and prolonged use can lead to lasting harm including addiction. Healthcare professionals can use the new NHS Greater Manchester Pain Management Resources Hub to support their patients to safely reduce opioids and identify alternatives. Take a look and explore more here: Greater Manchester Pain Management Resources Hub.


New consultations: CRG actions and rimegepant factsheet

CRG actions

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at their January 2024 meeting. Actions in this consultation include:

  • FreeStyle Libre 3 – add as RED
  • Levonorgestrel 20 micrograms / 24 hours intrauterine delivery system (Benilexa) – add as GREEN for contraception and heavy menstrual bleeding, and for endometrial protection as part of HRT (off-label)
  • Melatonin 1 mg/mL SF oral solution – add Consilient brand as preferred liquid for children aged 5 years and younger, and Ceyesto as preferred liquid for patients aged 6 and older. Use of these products should be limited to when crushing Adaflex tablets is not suitable.
  • Rimegepant for migraine – amend RAG status to GREEN (specialist advice). Currently on formulary as GREEN (specialist initiation). A separate consultation for a supporting factsheet is also underway; see below.
  • Secukinumab for hidradenitis suppurativa – RED
  • Targeted-release budesonide for primary IgA nephropathy – RED
  • Empagliflozin for CKD – GREEN
  • Velmanase alfa – RED

All links to NICE clinical guidelines and MHRA drug safety updates will be added to formulary as appropriate.

Rimegepant factsheet

A supporting document has been produced: Rimegepant (Vydura) factsheet for primary care clinicians, including prescribing criteria, when to refer to neurology, how to review treatment and when to stop treatment.

These consultations will run for six weeks and close at 5pm on Friday 23rd February 2024. To take part, visit the consultations page.


GMMMG updates: December 2023

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

Updates to guidelines include:

Formulary and RAG updates include:

  • Apixaban – first choice DOAC in non-valvular atrial fibrillation
  • Luforbec MDI replaces Fostair MDI as an alternative choice for asthma and COPD
  • DNP entry for herbal medicines updated to include other natural products
  • Cipaglucosidase alfa added to the RAG list 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.

The following decisions await approval by the GM ICB Executive:

  • Tadalafil once daily 5mg tablets for erectile dysfunction to be removed from DNP list

Consultation: actions from December 2023 meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at their December 2023 meeting. Actions in this consultation include:

  • Cytisine 1.5mg tablets for smoking cessation – add as GREEN
  • Empagliflozin for chronic heart failure with preserved or mildly reduced ejection fraction – GREEN (following specialist advice)
  • Foslevodopa-foscarbidopa for advanced Parkinson’s disease with motor symptoms – RED

All links to NICE clinical guidelines and MHRA drug safety updates will be added to formulary as appropriate.

The consultation will run for six weeks and closes at 5pm on Tuesday 23rd January 2024. To take part, visit the consultations page.


Consultation: actions from November 2023 CRG meeting

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at their November 2023 meeting. Actions in this consultation include:

  • Carbimazole 10mg & 15mg tablets – Do Not Prescribe (criterion 2)
  • Acetylcysteine 600mg effervescent tablets to be GREEN and first choice mucolytic for people with COPD. Carbocisteine 375mg capsules to be GREEN, and placed as an alternative choice.
  • Bimekizumab for psoriatic arthritis and axial spondyloarthritis – RED
  • Rimegepant for treating migraine – GREEN following specialist advice.
  • Tofacitinib for ankylosing spondylitis – RED
  • Daridorexant for long-term insomnia – to add to formulary as a GREEN or GREEN following specialist advice medicine in this indication.
  • Tirzepatide for type 2 diabetes – GREEN
  • Mirikizumab for ulcerative colitis – RED
  • Baricitinib for alopecia areata – Do Not Prescribe (criterion 1) in this indication

All links to NICE clinical guidelines and MHRA drug safety updates will be added to formulary as appropriate.

The consultation will run for six weeks and closes at 5pm on Friday 29th December 2023. To take part, visit the consultations page.


GM guidance: ADHD medicines shortages

In response to the National supply shortage of prescribed medication for ADHD, a GM task and finish group led the development of the following supporting guidance:

  • National Supply Shortage of prescribed medication for ADHD – A Guide for Secondary Care
  • GM Pathway for the management of patients prescribed medicines for ADHD during the national shortage – primary care guidance
  • Patient information – “National Supply Shortage of your prescribed medication for ADHD”

This guidance is now available through the GMMMG website here.  

Thanks go to the GM working group who developed this guidance who are detailed below. Also to GMMMG and the wider GM pharmacy and medicines system for supporting this accelerated development and approval process to enable the rapid dissemination of this information intended to support patients through this medicines shortage. Please cascade this information across your systems.

GM task and finish group:

–              Sana Alam – Senior Clinical Pharmacist |Lead CAMHS Pharmacist (GMMH)

–             Arifa Azmi – Clinical Pharmacist CAMHS/Antimicrobial and Infection Control  (Pennine Care)

–             Khadija Mansoorali – Paediatric Mental Health Pharmacist (MFT)

–             Nicola Smith – Senior Medicines Optimisation Pharmacist (Trafford)

–             Zoe Paine – Senior Medicines Optimisation Pharmacist – Women and Children Lead (Manchester)

–             Leigh Lord – Head of Medicines Optimisation and Governance (MFT)

–             Jennifer Seal – Senior Medicines Optimisation Pharmacist (Bury)


GMMMG Updates: October 2023

The decisions made at the Greater Manchester Medicines Management Group (GMMMG) October 2023 meeting have now been reviewed by GM Executive and can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/. This includes the recommendations made by GMMMG in October 2023 and NICE Technology appraisals published in June 2023.

The following decisions were approved and can be found at:

Please could you disseminate for implementation within your organisations.

Drugs with a NICE recommendation published in July have been considered by CRG at its October 2023 meeting, and will be considered for approval by GMMMG and CEGC at their November 2023 meetings. All approved CRG and GMMMG meeting minutes can be found at: https://gmmmg.nhs.uk/meetings/clinical-reference-group/ and https://gmmmg.nhs.uk/meetings/gmmmg-meetings/.