Prescription Clerk Training 27th September 2017 Jonathan Andrews & Rina Desai

Learning Objectives The learning objectives of this session are to provide information about: Formulary drugs Traffic light drugs Specials Policy statements Prescribing Incentive Scheme

Prescribing Incentive Scheme

Meds Management webpage http://www.thurrockccg.nhs.uk/medicines-management2 Contains formulary, policies, newsletters, Prescribing Incentive Scheme, Traffic lights, shared care guidelines etc. New resources being added http://basildonandbrentwoodccg.nhs.uk/your-health/medicines-management

Policies See Meds Management Webpage for policies on: Vitamin D Co-proxamol Sunscreens Glucosamine Low dose naltrexone Medical devices Drugs for erectile dysfunction Multivitamins Fluoride toothpastes …….plus many more

Safe? Primary MMT consideration Admission/discharge GPs should not be initiating certain drugs (although often pressurised to do so) GPs should not be continuing many specialist drugs eg adalimumab, ponatinib, tenofovir, linezolid etc Signing prescription means GP assumes all clinical responsibility even if on “Specialist advice” Prescribers must prescribe within competence Licensed products/indications

Requests to prescribe in primary care?

Traffic lights Yellow drugs -Specialist initiation, GP continuation eg antiepileptics, NOACs, drugs for Parkinson’s, diabetes etc Amber drugs - Specialist initiation and GP continuation under shared care arrangement eg drugs for prostate cancer, rheumatological conditions, inflammatory bowel disease ie “DMARDS” Red drugs – includes high risk drugs which shouldn’t be prescribed by GPs, oncology drugs, “biologicals” and NHSE commissioned drugs For local guidance, please refer to South West Essex responsibility for prescribing document.

Effective or cost-effective? Limited evidence for vitamins and minerals, glucosamine, fluoride toothpastes, cannabinoids, silk garments, liothyronine, “natural” thyroid extracts, complementary therapies, herbal supplements and homeopathy etc Premium–priced products eg branded products, doxazosin MR, tadalafil (Cialis) NHS England consultation for “low value medicines” currently underway For local guidance, please refer to South West Essex Grey list

Grey list 2016/2017

Unlicensed Specials Used when licensed formulation is unavailable or unsuitable Liquids, preservative-free eye drops, powders, creams etc Can be extremely expensive, and costs can vary significantly Clinical system shows cost warning or “zero cost”

Local examples of Specials 1,000 Magnesium oxide capsules 100mg – £3,763 168 Co-proxamol tablets – £496 100 Melatonin capsules – £257 30 Naltrexone 4.5mg capsules – £240 10ml Pilocarpine eye drops pres/free 2% – £93 30 St Marks Electrolyte sachets – £320 500g Coal tar and Betnovate/Ung Merck – £529 20ml Midazolam Liq special 50mg/5ml – £1,079 100 Liothyronine tablets 5mcg – £594

Summary If you need clarification then contact prescribing.mailbox@nhs.net Look at information/policies on the website Let us know if your practice experiences any prescribing issues Let us know if anything you would like to see on the Medicines Management webpage