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

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

3. Prescribing Incentive Scheme

4. Meds Management webpage
Contains formulary, policies, newsletters, Prescribing Incentive Scheme, Traffic lights, shared care guidelines etc.
New resources being added

6. 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

7. 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

8. Requests to prescribe in primary care?

9. 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.

10. 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

11. Grey list 2016/2017

12. 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”

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

14. Summary
If you need clarification then contact
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