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.


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

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

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

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

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


Consultation: actions from October meeting of CRG

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

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.


Updated shared care protocols

Following approval by CRG and GMMMG, and the first meeting of the Greater Manchester ICS Clinical Effectiveness and Governance Committee on Thursday 22nd September, the following shared care protocols have been updated:

  • GnRH analogues for breast cancer – now includes both goeserelin and leuprorelin, and applies to all adult patients
  • Somatropin for paediatric patients – updated to reflect the available products
  • DMARDs in dermatology, including azathioprine, hydroxychloroquine, oral methotrexate and mycophenolate – updated to reflect current contact details for dermatology clinic at MFT.

All of the currently active shared care protocols are available on the shared care 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