Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - September 2016

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of September 2016. This month there are three guidelines and one clinical guideline that impact upon primary care.

The Multimorbidity: clinical assessment and management guideline covers optimising care for adults with multimorbidity (multiple long-term conditions) by reducing treatment burden (polypharmacy and multiple appointments) and unplanned care. It aims to improve quality of life by promoting shared decisions based on what is important to each person in terms of treatments, health priorities, lifestyle and goals. The guideline sets out which people are most likely to benefit from an approach to care that takes account of multimorbidity, how they can be identified and what the care involves.

The Harmful sexual behaviour among children and young people guideline covers children and young people who display harmful sexual behaviour, including those on remand or serving community or custodial sentences. It aims to ensure these problems don’t escalate and possibly lead to them being charged with a sexual offence. It also aims to ensure no-one is unnecessarily referred to specialist services.

The Dementia clinical guideline was updated and covers preventing, diagnosing, assessing and managing dementia in health and social care, and includes recommendations on Alzheimer’s disease. It aims to improve care for people with dementia by promoting accurate diagnosis and the most effective interventions, and improving the organisation of services. The update replaces a recommendation with links to the Mental health problems in people with learning disabilities guideline.

The Mental health problems in people with learning disabilities guideline covers preventing, assessing and managing mental health problems in people with learning disabilities in all settings (including health, social care, education, and forensic and criminal justice). It aims to improve assessment and support for mental health conditions, and help people with learning disabilities and their families and carers to be involved in their care.

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

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CKS Updates - August 2016

During August 2016 Clinical Knowledge Summaries were updated for the following topics:

There were no major changes but sections were added on the prognosis and diagnosis of bunions and there were some minor changes to the recommendations on management of greater trochanteric pain syndrome.

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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NICE Guidance - August 2016

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of August 2016. This month there are four clinical guidelines that impact upon primary care.

The Heavy menstrual bleeding clinical guideline was updated to include new recommendations for drug treatments for women with large fibroids based on new evidence.

The Autism spectrum disorder in adults clinical guideline was reviewed and while no new recommendations were made, two research recommendations were removed.

The Fertility problems clinical guideline has been reviewed in particular on intrauterine insemination however the new evidence did not justify a change to the recommendation.

The Palliative care for adults: strong opioids for pain relief clinical guideline was reviewed and updated to include links to the Controlled drugs: safe use and management guideline. Two out of date research recommendations were also deleted.

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

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CKS Updates - July 2016

During July 2016 Clinical Knowledge Summaries were updated for the following topics:

There were no major changes other than to the Head injury topic that was updated in line with NICE 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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Vitamin D advice issued

Public Health England has issued new advice on vitamin D based on the recommendations of the Scientific Advisory Committee on Nutrition.

The advice notes that vitamin D is made in the skin on exposure to UVB in sunlight but since this is difficult to quantify a daily dietary intake of 10 micrograms is being recommended.

It is noted that in spring and summer the majority of the population get enough vitamin D through sunlight on the skin and a healthy, balanced diet. In autumn and winter months it is difficult for people to meet the 10 microgram recommendation from consuming foods naturally containing or fortified with vitamin D so people should consider taking a daily supplement containing 10 micrograms of vitamin D.

The advice also considers people whose skin has little or no exposure to the sun, like those in institutions such as care homes, or who always cover their skin when outside and recommends that they need to take a supplement throughout the year.

Ethnic minority groups with dark skin, from African, Afro-Caribbean and South Asian backgrounds, may not get enough vitamin D from sunlight in the summer and therefore should consider taking a supplement all year round.

Recommendations are also made for children under 5. Children from birth to 1 year old who are breast feed should be given a daily supplement containing 8.5 to 10 micrograms of vitamin D. Formula fed children of this age consuming 500ml or more each day do not require a daily supplement because infant formula is fortified with vitamin D. Children aged 1 to 4 years should be given a daily supplement containing 10 micrograms of vitamin D. It is noted that low-income families can access vitamin D free of charge via Healthy Start schemes.

Action: Clinicians should be aware of this new advice. The advice consistently refers to "dietary sources" of vitamin D including foods naturally containing or fortified with vitamin D and supplements. As such prescribing of vitamin D purely for supplementation following this advice should be resisted.

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