Responsibility for prescribing between primary and secondary/tertiary care

Responsibility for prescribing between primary and secondary/tertiary care


NHS England guidance aims to provide clarity on the responsibilities of all professionals involved in commissioning and prescribing across primary, secondary and tertiary care, and to provide support in developing shared care agreements and in the transfer of care.
Read the guidance at: https://www.england.nhs.uk/publication/responsibility-for-prescribing-between-primary-and-secondary-tertiary-care/

Glecaprevir–pibrentasvir for treating chronic hepatitis C [TA 499]

New:  Technology appraisal guidance


Glecaprevir–pibrentasvir is recommended, within its marketing authorisation, as an option for treating chronic hepatitis C in adults, only if the company provides the drug at the same price or lower than that agreed with the Commercial Medicines Unit.


It is recommended that the decision to treat and prescribing decisions are made by multidisciplinary teams in the operational delivery networks put in place by NHS England, to prioritise treatment for people with the highest unmet clinical need.




Why the committee made these recommendations
  
Current treatment options for chronic hepatitis C depend on genotype, cirrhosis status and treatment history. Glecaprevir–pibrentasvir is suitable for all genotypes and has a shorter treatment duration than most other direct-acting antiviral treatments.

Electronic prescribing to be piloted in integrated urgent care

NHS Digital has announced trials of the electronic prescription service (EPS) in integrated urgent care settings.

This will mean that patients seeking care out of hours or in urgent care settings can have their prescriptions sent directly to a pharmacy of their choice, rather than relying on paper prescriptions.

The service will reduce the time spent by doctors and others issuing prescriptions and by pharmacists dispensing prescriptions.

NIHR Signal A strategy of 'delayed antibiotic prescribing' for respiratory infections may reduce antibiotic use

Delaying antibiotic prescribing made little difference to most symptoms of respiratory infection. It reduced antibiotic use and did not affect patient satisfaction compared with immediate prescribing of antibiotics.

Increasing antibiotic resistance is a global health concern. Many people don’t realise that viruses cause most respiratory infections and that antibiotics won’t help. The strategy allows some time for symptoms to improve naturally.

From the NIHR Dissemination Centre

NHS England consults on freeing up 136 million to boost frontline NHS care by curbing prescription costs

NHS England has launched a public consultation on proposals to rein in prescriptions for some ‘over the counter’ products such as dandruff shampoo and drops for tired eyes, freeing-up up to £136 million to expand other treatments for major conditions such as cancer and mental health problems.

An uncommon approach: four organisations selected to replicate health and social care interventions

Four organisations have each been awarded £145,000 by the Health Foundation to replicate successful health and care interventions using social franchising and licensing techniques. Social franchising and licensing are methods to replicate and scale interventions that have not yet been used widely in health care in the UK.

The projects are:

Scaling and replicating IRIS through social franchising

Lead organisation: IRISi

IRIS is a successful general practice-based training, support and referral programme that improves the identification and support offered to people with experience of domestic violence and abuse (DVA). One in four women and one in six men will experience DVA during their lifetime, with DVA against women being more frequent and more severe, with long-lasting effects that also have an impact on children. IRIS will be replicated through social franchising so that the programme can be implemented more widely, and more people can be supported. IRISi, a social enterprise set up to house the programme, will support other sites to engage commissioners, and recruit and train staff.

Replicating Pathway’s homeless health hospital team model to towns and cities experiencing significant homelessness

Lead organisation: Pathway

Homeless patients attend emergency departments four times more often than the general population, are admitted eight times more often and stay three times as long. Ten hospitals have implemented Pathway’s integrated care model ensuring that homeless patients admitted to hospital have access to the health care they need and support to recover. Pathway will use social franchising or licensing to replicate the model in places with significant homeless populations that would benefit from adopting it.

Scale up, replication and licensing of the PINCER intervention

Lead organisation: The University of Nottingham

In a recent study, prescribing errors were identified in 5% of prescription items, with one in 550 items containing a severe (potentially life threatening) error. This equates to around 1.8 million serious prescribing errors in English general practices each year. PINCER is a successful pharmacist-led information technology intervention for reducing common medication errors in general practice prescribing, and has been incorporated into national guidelines to support medicines optimisation. PINCER will be replicated in GP surgeries across the country; helping them to protect patients at risk of errors, and reduce medication-related hospital admissions and deaths.

Developing a licensed, social franchising model for regional hubs to roll out effective local multi-professional maternity training

Lead organisation: PROMPT Maternity Foundation

The PRactical Obstetric Multi-Professional Training (PROMPT) programme has been associated with a significant reduction in the number of babies with a low oxygen level at birth and also babies born with a permanent nerve injury following difficulties with their shoulders. Through social franchising and using a regional hub system, it is hoped that this improved implementation model will ensure that PROMPT training may be associated with the same improvements in outcomes across the country.

The new projects are currently subject to contracts being finalised.

NIHR Signal Computerised decision support can improve antibiotic prescribing in hospitals

Using a computerised decision support tool (software used by hospital prescribers) improved the adequacy of antibiotic coverage and adherence to guidelines, and may have reduced the risk of people dying. Only four studies reported on resistance to antibiotics, so no conclusions can be drawn about the impact of this tool on resistance.

Antibiotic stewardship programmes aim to get prescribers to think before they decide to prescribe antibiotics, then consider the type and dose of antibiotic. Computerised decision support aims to support this practice by embedding these principles into everyday practice.

From the NIHR Dissemination Centre

Electronic Prescription Service (EPS) to be piloted in urgent care settings

NHS Digital and partners will shortly begin trialling use of the Electronic Prescription Service (EPS) by prescribers in urgent care settings.

A pilot will take place for selected users of the Adastra system, the clinical software used in many urgent care settings. Care settings will include NHS 111, GP out of hours services, clinical

RCOphth welcomes EU Court of Justice Advocate General’s new opinion on the use of ‘off-label’ drug Avastin

The Royal College of Ophthalmologists (RCOphth) believes that ophthalmologists should have the discretion to prescribe Bevacizumab (Avastin) or alternatives such as Ranibizumab (Lucentis) or Aflibercept (Eylea), whichever is the most appropriate treatment of age related macular degeneration (AMD) for the patient, and provided the patient gives informed consent.

The RCOphth has long petitioned a review on Bevacizumab being available for wider use for AMD in the NHS. Not only does this cheaper alternative to Ranibizumab or Aflibercept potentially save the NHS over £100million a year, as identified by the IVAN study in 2012 but is clinically proven as safe and as effective by two major studies, CATT and IVAN, and the Cochrane review in 2014.

Sinusitis (acute): antimicrobial prescribing [NG 79]

New Guidance from NICE:

This guideline sets out an antimicrobial prescribing strategy for acute sinusitis.  It aims to limit antibiotic use and reduce antimicrobial resistance. Acute sinusitis is usually caused by a virus, lasts for about 2 to 3 weeks, and most people get better without antibiotics. Withholding antibiotics rarely leads to complications.

This guideline includes recommendations on:

• managing symptoms, including advice when an antibiotic is not needed and the use of corticosteroids and nasal sprays
• choice of antibiotic when a back-up or immediate prescription is needed
• self-care

Learning from others: good practice when prescribing opioids in chronic pain

Long-term opioid prescribing for chronic non-cancer pain is becoming an increasing issue in England.

Faye's story puts these potential dangers into reality by describing, from her parents' perspective, the sequence of events that ultimately led to her untimely death from respiratory depression. They also outline the lessons learned by the GP practice involved in the case that they want to share with all healthcare professionals.

Please share these resources with those in your team involved in managing patients with long term pain, and encourage them to reflect on their own, and their teams, practice.

The latest from NHS Improvement's improvement hub

NHS Improvement is continuing to add resources to its improvement hub. Here's some of the most recent:

• Medway NHS Foundation Trust: orthopaedics handover
• How do boards govern for quality improvement?
• Supporting junior doctors in safe prescribing
• Learning disability and human rights

Have your say on which products should be available on prescription

The NHS wants to know which drugs and treatments patients think should be made available on prescription. 

The consultation is focusing on medicines deemed to be a low priority for NHS funding, and could see items currently available on prescription no longer offered in this way.

3,200 items are being reviewed, including products such as sunscreen, laxatives, eye drops and eczema cream. In the future, people may have to buy such things over the counter.

Consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum

Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk.

These consensus guidelines from the British Association of Psychopharmacology aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.

Heath and Justice mental health services: Safer use of mental health medicines

This document provides a background to prescribing and mental health medicines in secure environments with some common principles that apply throughout the medicines optimisation pathway, and more detailed information within the pathway to support safer practice.

Guideline for the prescription and monitoring of non-biologic Disease-Modifying Anti-Rheumatic Drugs

The mainstay of treatment for inflammatory rheumatic disease involves DMARDs. The last 30 years have seen enormous shifts in the use of DMARDs, with earlier initiation in disease course as well as combination strategies. Many of the drugs used have potential for harm as well as benefit. Appropriate screening prior to DMARD initiation, as well as vigilant monitoring during therapy, are required to minimize the risk of harm. This current guideline supersedes the previous 2008 BSR/BHPR guideline.

The pharmacy contribution to antimicrobial stewardship

This report from the Royal Pharmaceutical Society focuses on the pharmacist’s role as part of a multidisciplinary approach in tackling the challenges of inappropriate use of antibiotics.

The recommendations in this policy have been produced in order to contribute to wider efforts in meeting the challenge set by the UK Government in 2016 of reducing inappropriate antibiotic prescribing by 50 per cent by 2020.

RCP releases prescribing support for junior doctors

The Royal College of Physicians (RCP) has released Supporting Junior Doctors in Safe Prescribing, a new guide for supporting junior doctors when prescribing in hospitals.

The resource calls for the provision of more practical and interactive prescribing training for junior doctors to help reduce errors, as well as greater support from hospital trusts to create safer working environments for junior doctors to prescribe. It also recommends that postgraduate medical education leads work collaboratively with medication safety officers to identify opportunities to cover safe prescribing within medical education, while highlighting the need to address the safety culture around prescribing, by encouraging active efforts to learn from errors, both at an individual and system level.

Prescribing regular drugs to prevent febrile convulsions risks more harm than benefit

The benefits of giving anti-epileptic medication to children aged between six months and seven years who have had a convulsion while feverish, do not outweigh the harms. While diazepam given when a child becomes feverish reduced the chance of a convulsion from about 25% to 18% after a year, one in three children experienced adverse effects. Therefore, the authors suggest benefits do not seem to outweigh the harms.Prescribing regular drugs to prevent febrile convulsions risks more harm than benefit

From the NIHR Dissemination Centre

New NICE advice about when to give antibiotics for common infections

For the first time NICE is giving specific advice for doctors and nurses about when and how to prescribe antibiotics for conditions such as sore throats and colds.

The new series of 30 guidelines will help frontline healthcare workers in the battle against antimicrobial resistance (AMR) by preventing unnecessary use of the drugs.

Draft guidance on sinusitis (commonly known as a ‘stuffy nose’) and acute sore throats has been published with final recommendations for sinusitis due in August 2017.