Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Additional NICE Guidance - March 2019

The National Institute of Health and Care Excellence (NICE) have published additional new or updated guidance for the month of March 2019. There are two additional guidelines that impact upon primary care.

The Lung cancer: diagnosis and management guideline has been updated. It covers diagnosing and managing non-small-cell and small-cell lung cancer. It aims to improve outcomes for patients by ensuring that the most effective tests and treatments are used, and that people have access to suitable palliative care and follow-up. The new recommendations supplement the existing recommendations on diagnosis, treatment and palliative care.

The Ertugliflozin as monotherapy or with metformin for treating type 2 diabetes technology appraisal has been published. Ertugliflozin is recommended for use as monotherapy when metformin is contraindicated or not tolerated, when diet and exercise alone do not provide adequate glycaemic control, only if:

  • a dipeptidyl peptidase 4 (DPP‑4) inhibitor would otherwise be prescribed and
  • a sulfonylurea or pioglitazone is not appropriate

It is also recommended for use as an option in combination with metformin to improve glycaemic control, only if:

  • a sulfonylurea is contraindicated or not tolerated or
  • the person is at significant risk of hypoglycaemia or its consequences

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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Drug Safety Update - March 2019

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for March 2019 (PDF).

This issue advises clinicians of new restrictions and precautions for use of fluoroquinolone antibiotics. This is due to due to very rare reports of disabling and potentially long-lasting or irreversible side effects. Following an EU wide review it is now recommended that these antibiotics are not used for mild to moderate infections unless other antibiotics that are commonly recommended for these infections are considered inappropriate.

This issue also contains new guidance on effective contraception and pregnancy testing during use of teratogenic medication. This guidance notes that effective or highly effective contraceptives methods are defined by the typical failure rate in the first year with highly effective methods defined as a failure rate of less than 1%. This includes male and female sterilisation and long-acting reversible contraceptive (LARC) methods. A table is linked in this section that is useful in determining if pregnancy testing should be performed and categorises the efficacy of different methods of contraception.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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NICE Guidance - March 2019

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of March 2019. This month there is one guideline that impacts upon primary care.

The Delirium: prevention, diagnosis and management guideline has been updated. It covers diagnosing and treating delirium in people aged 18 and over in hospital and in long-term residential care or a nursing home. It also covers identifying people at risk of developing delirium in these settings and preventing onset. It aims to improve diagnosis of delirium and reduce hospital stays and complications. The update removed the recommendation to use of olanzapine for the treatment of delirium in people who are distressed or considered a risk to themselves or others.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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Prescription Charges for 2019

The Department of Health announced in February that the price for an NHS prescription in England will increase by 20p to £9.00 with effect from the 1st April 2019.

The prices for 3 and 12 month pre-payment certificates are frozen and have remained the same at £29.10 and £104 respectively. For anyone requiring more than 3 items in 3 months or more than 12 in a year these certificates can provide significant savings.

Other NHS charges such as for dental work, wigs and fabric supports are also being increased in line with inflation.

Action: Clinicians should be aware of the current prescription charge and also the value for money represented by pre-payment certificates.

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CKS Updates - February 2019

During February 2019 Clinical Knowledge Summaries were published or updated in the following areas.

The majority of topics have undergone reviews and minor restructures. The Blackouts topic is new. The most significant changes are to the Diarrhoea - adult's assessment topic where new recommendations have been added to the referral section in line with recommendations on the recognition and referral of suspected cancer. The Urinary tract infection (lower) - women topic has also been updated in line with antimicrobial prescribing guidance.

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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