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Issue 20
Nov 2014
SPECI ALS
REMINDER:
THE TOP 3
INSIDE THIS ISSUE:
Specials reminder
– Top 3
1
Electronic
Prescribing
Service—caution
1
Appliance
contractors
update
2
Gender identity—
shared care
update
2
In the past months, the Medicines Management Team have observed a
recurring trend of unlicensed/specials products which are being prescribed across the health economy that can be switched to more cost
effective choices. The top 3 include:
1. Melatonin: There is only one licensed preparation: melatonin 2mg m/r
tablet. All other forms (capsules, liquids) and strengths are unlicensed.
Use the licensed product (off—label where required) preferentially
2. Acetylcysteine 600mg tablets or capsules: OroNAC 600mg tablet/
capsule though an unlicensed brand, has a Drug Tariff price and therefore a fixed cost. A certificate of analysis is also kept on file by the MMT
3. Magnesium Glycerophosphate 4mmol or 97.2mg tablets: Magnaphate 4mmol tablets is an unlicensed brand which however has a Drug
Tariff price and therefore a fixed cost unlike other preparations. A certificate of analysis is kept on file by the MMT.
Action for prescribers
1. Review all patients on the above specials prescriptions and switch to
the alternatives if appropriate
2. Information is available in the Specials guide on the MM webpage
(link). Contact your prescribing advisor if you require further support
ELECTRONIC
Back issues of ‘The
Prescription Pad’
are archived at:
http://www.redbridgeccg
.nhs.uk/Aboutus/Medicinesmanagement/prescribingnewsletters.htm
PRESCRIBING SERVICE—C AUTION
NHS Prescription Services has advised that when using the Electronic
Prescription Service (EPS), prescribers should avoid adding supplementary information to the prescribed order in the dosage instructions (link).
This may be to indicate that a sugar free or preservative free version is
required or that a particular manufacturer’s product is to be dispensed.
For example: “Hypromellose Eye Drops 0.3% x 10ml. Insert one drop in
both eyes four times a day preservative free”.
Prescribers are advised to select products from the appropriate list of
drugs. This is because each product within the list is allocated a unique
product code which is used to calculate payments to the pharmacy contractor. Adding free text to the dosage instructions to indicate a different
product is required will not change the reimbursement to the pharmacy.
Action for prescribers
1. When prescribing via EPS ensure the correct product required is selected to avoid incorrect charges.
1
Pa g e 2
APPLI ANCE
C O N T R AT O R S — U P D AT E
A number of queries have arisen from patients and practices regarding
requests for prescriptions and consequent supply of appliances from appliance contractors following communication from the Medicines Management Team to Dispensing Appliance Contractors (DACs) as notified in the
August edition of The Prescription Pad. A follow up letter has since been
sent to all DACs to support patients who wish to request their prescription
from their appliance contractor by clarifying the following:
A. The first supply may be initiated by the hospital through their
contracted DAC
B. Once care is transferred to the GP, the patient can choose who to
send their prescription to
Patients may nominate a Dispensing Appliance Contractor (DAC) OR a
community pharmacy to provide this service. The patient should provide
written consent to the practice authorising their preferred service provider
to collect prescriptions and this nomination will be noted in the GP records.
The DAC or pharmacy will request a prescription from the GP practice on
behalf of the patient (before a supply is made). Emergency supplies can be
issued prior to a receipt of a prescription but will be monitored and reviewed with the patient to ensure future supplies are better controlled.
Action for practices:
1.
Discuss with patients (new and current) how they wish to order prescriptions for appliances
2.
Ensure the patients preferred provider is noted in their records
GENDER
New requests to
prescribe for
gender
dysphoria should
be discussed
with the MMT
I D E N T I T Y — S H A R E D C A R E U P D AT E
A request for shared care for gender dysphoria for trans women (male to
female transsexuals) was considered by the Barking and Dagenham, Havering and Redbridge Area Prescribing sub-committees at its meeting in
September 2014.
The Committees were unable to support the participation in the shared
care arrangement of GPs for three reasons:1). Gender Identity Clinic (GIC) specialists would not be initiating treatment
or stabilising patients. This was agreed as delegation of responsibility and
therefore the shared care request contravenes GMC guidance
2). Upon consideration of the North East London shared care guideline
flowchart, the drugs to be prescribed followed a ‘hospital-only’ pathway,
being for unlicensed use
3). Limited evidence was available to support the use of the treatments
For existing patients being prescribed medication for gender dysphoria,
prescribing is allowed to continue until both the patient and their doctor
consider it suitable to stop.
Action for practices
1. All NEW requests to share care for gender dysphoria prescribing should
be referred back to the specialist centre
2. If you have any questions, please contact your prescribing advisor
References
Please note that references to articles are
embedded in hyperlinks
within the text. Look out
for underlined text. Click
on the link to see full
articles or references.
For further information regarding this
newsletter, contact:
Lola Apakama. Prescribing Advisor,
Lola.apakama@
onel.nhs.uk or 0208
822 3074
2
Please note: This information is intended to support prescribing, not dictate it.