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.


New consultation: CRG actions February 2024

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

  • Riluzole 50mg orodispersible tablets added as AMBER
  • Diclofenac 50mg tablets made 3rd line choice, after ibuprofen and naproxen
  • Sebeliplase alfa added as RED

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

This consultation will run for six weeks and closes at 5pm on Thursday 28th March 2024. To take part, visit the consultations page.


GMMMG updates: January 2024

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

Updates to guidelines include:

Formulary and RAG updates include:

  • Tocilizumab added as RED for COVID-19. Casirivimab / imdevimab (Ronapreve) for COVID-19 removed from formulary. Other medicines for COVID-19 updated to link to current guidance.
  • DNP entry for prednisolone enteric coated tablets amended to include only the 1mg tablets
  • Mavacamten 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:

  • Micronised progesterone (Gepretix) to be added to formulary for HRT
  • Temporary suspension of certain conditions from GM commissioning statement on conditions for which over the counter items should not routinely be prescribed, and permanent amendments to the policy to reflect the national Pharmacy First scheme.

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

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.


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.