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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - October 2021

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of October 2021. This month there is one technology appraisal and one guideline that impact upon primary care.

The Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia technology appraisal has been published. This treatment is recommended as an option for treating primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia as an adjunct to diet in adults. It is recommended only if:

  • there is a history of any of the following cardiovascular events:
    • acute coronary syndrome (such as myocardial infarction or unstable angina needing hospital admission)
    • coronary or other arterial revascularisation procedures
    • coronary heart disease
    • ischaemic stroke or
    • peripheral arterial disease, and
  • low-density lipoprotein cholesterol (LDL-C) concentrations are persistently 2.6 mmol/l or more, despite maximum tolerated lipid-lowering therapy, that is:
    • maximum tolerated statins with or without other lipid-lowering therapies or,
    • other lipid-lowering therapies when statins are not tolerated or are contraindicated, and
  • the company provides inclisiran according to the commercial arrangement.

It would be expected that treatment would be commenced and supervised by a clinician with a special interest however there is a unique funding arrangement in place that includes a new section in the Drug Tariff (DT) that will encourage use in primary care.

The Looked-after children and young people guideline has been published. It covers how organisations, practitioners and carers should work together to deliver high-quality care, stable placements and nurturing relationships for looked-after children and young people. It aims to help these children and young people reach their full potential and have the same opportunities as their peers.

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

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CKS Updates - September 2021

During September 2021 Clinical Knowledge Summaries were updated in the following areas.

All topics have been reviewed and updated in keeping with current guidance with minor layout changes. The Breast pain - cyclical topic has added a new section on differential diagnosis and the Bunions topic has been restructured and a section on surgical management has been added.

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 - September 2021

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of September 2021. This month is one technology appraisal and one COVID-19 rapid guideline that impact upon primary care.

The Sapropterin for treating hyperphenylalaninaemia in phenylketonuria technology appraisal has been published. This treatment is recommended as an option for treating hyperphenylalaninaemia that responds to sapropterin (response as defined in the summary of product characteristics) in people with phenylketonuria (PKU), only if they are:

  • under 18 and a dose of 10 mg/kg is used, only using a higher dose if target blood phenylalanine levels cannot be achieved at 10 mg/kg
  • aged 18 to 21 inclusive, continuing the dose they were having before turning 18 or at a maximum dose of 10 mg/kg
  • pregnant (from a positive pregnancy test until birth).

It is also noted that sapropterin is recommended only if the company provides it according to the commercial arrangement. It would be expected that treatment would be commenced and supervised by a specialist.

The COVID-19 rapid guideline: managing COVID-19 guideline has been updated. The update this month adds new recommendations on non-invasive respiratory support and doxycycline, and updated recommendations on heparins. Specifically for primary care it is recommended that doxycycline is not used to treat COVID-19 in the community.

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 2021

During August 2021 Clinical Knowledge Summaries were updated in the following areas.

All topics have been reviewed and updated in keeping with current guidance with minor layout changes. The Carpal tunnel syndrome recommendations on follow up in primary care have been amended to reflect pragmatic clinical practice. The Haemorrhoids topic has been updated to recommend that topical preparations for haemorrhoids which should be purchased over the counter in line with NHS Clinical Commissioners (2018). And the Pancreatitis - chronic topic has been 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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NICE Guidance - August 2021

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of August 2021. This month are five guidelines and one COVID-19 rapid guideline that impact upon primary care.

The Bronchiolitis in children: diagnosis and management guideline has been updated. It covers diagnosing and managing bronchiolitis in babies and children. It aims to help healthcare professionals diagnose bronchiolitis and identify if babies and children should be cared for at home or in hospital. The update reviewed the evidence and updated the recommendations on oxygen saturation thresholds for referral to hospital.

The Antenatal care guideline has been published. It covers the routine antenatal care that women and their babies should receive. It aims to ensure that pregnant women are offered regular check‑ups, information and support.

The Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s guideline has been published. It covers the diagnosis and management of obstructive sleep apnoea/hypopnoea syndrome (OSAHS), obesity hypoventilation syndrome (OHS) and chronic obstructive pulmonary disease with OSAHS (COPD-OSAHS overlap syndrome) in people over 16. It aims to improve recognition, investigation and treatment of these related conditions.

The Babies, children and young people's experience of healthcare guideline has been published. It describes good patient experience for babies, children and young people, and makes recommendations on how it can be delivered. It aims to make sure that all babies, children and young people using NHS services have the best possible experience of care.

The Chronic kidney disease: assessment and management guideline has been published, replacing previous guidelines. It covers care and treatment for people with, or at risk of, chronic kidney disease (CKD). It aims to prevent or delay the progression and reduce the risk of complications and cardiovascular disease. It also covers managing anaemia and hyperphosphataemia associated with chronic kidney disease.

The COVID-19 rapid guideline: managing COVID-19 guideline has been updated. The update corrects an error in the recommended dose of prednisolone for children with a greater than 44-week corrected gestational age.

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

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