Committee Decisions

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping mirabegron" can be found in the documents section.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves empagliflozin as a treatment option for treating chronic kidney disease in line with NICE TA942.

 NB: Check NICE guidance for recommended patient cohorts regarding eGFR.

Empagliflozin will be considered GREEN on the traffic light system.

Key considerations:

• If a patient with diabetes were on insulin and on multiple other treatments, a discussion with the specialist diabetes team may be prudent prior to empagliflozin initiation.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approve the updated Interface Prescribing Policy 2024/2025 for inclusion in the acute provider contracts for the next financial year.

The Surrey Heartlands Integrated Health System Area Prescribing Committee (APC) has agreed that topical testosterone should be prescribed generically, ideally using Drug Tariff descriptions.

This drug/device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug/device has not yet been evaluated by the Surrey Heartlands ICS Area Prescribing Committee (APC).  As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug / device.

The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsicb.APC@nhs.net  if they wish to make a submission.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves rimegepant for the acute treatment of Migraine with or without aura in adults in line with NICE TA919.

A GREEN traffic light status has been agreed.

Treatment with rimegepant for acute migraine is recommended by NICE, only if for previous migraines:

• at least 2 triptans were tried and these did not work well enough or
• triptans were contraindicated or not tolerated, and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough.

Patients receiving 8 or more tablets per month should be considered for preventative treatment.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves daridorexant for the treatment of long-term insomnia in line with NICE TA922

A BLUE traffic light status has been agreed after Cognitive Behavioural Therapy for insomnia (CBTi) where available.

Specialist clinics will need to provide the medicines for the first 4 months (if clinically indicated), providing a review at 3 months to confirm whether treatment should be continued, and prescribing an extra month for those who will continue on treatment to allow for transfer of care to Primary Care

The length of treatment should be as short as possible.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP. The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the brand, if so patients will need to be instructed on the correct use of the device

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves empagliflozin:

• as an option for treating adult chronic heart failure with reduced ejection fraction in addition to standard care (NICE TA773)
• as an option for treating adult chronic heart failure with preserved or mildly reduced ejection fraction in addition to standard care (NICE TA929)

Treatment should be initiated or recommended by a heart failure specialist in patients with a formal diagnosis of heart failure as per NICE guideline on Chronic Heart Failure in adults

Heart Failure specialist defined as:

 • Cardiology consultant, specialist, or registrar

 • Heart failure specialist nurse

 • GP with a specialist interest in heart failure or GP cardiologist

 • General physician with heart failure expertise

 • Renal physician

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approved a change in traffic light status from BLUE to GREEN for testosterone gel.

The following testosterone products are NON-FORMULARY as they are either unlicensed in the UK or not available in biologically appropriate doses for the indication: Androfeme, Testogel, Testavan

Please note; Testim has been discontinued.

The Surrey Heartlands Area Prescribing Committee agreed to adopt the South West London (SWL) migraine prophylaxis drug pathway for chronic and episodic migraine.

NOTE: updates and new additions to the pathway are provided in addendums at the end of the document. 

See the Migraine (prophylaxis) Drug Pathway for full information.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves bimekizumab as a treatment option in line with the recommendations made in NICE TA918, for treating axial spondyloarthritis.

Bimekizumab for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves bimekizumab as a treatment option in line with the recommendations made in NICE TA918, for treating axial spondyloarthritis.

Bimekizumab for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves tofacitinib as a treatment option in line with the recommendations made in NICE TA920, for treating ankylosing spondylitis.

Tofacitinib for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Area Prescribing Committee agreed to adopt the South West London (SWL) migraine prophylaxis drug pathway for chronic and episodic migraine.

(Botulinum for chronic migraine only)

NOTE: updates and new additions to the pathway are provided in addendums at the end of the document. 

See the Migraine (prophylaxis) Drug Pathway for full information.

The Surrey Heartlands Area Prescribing Committee agreed to adopt the South West London (SWL) migraine prophylaxis drug pathway for chronic and episodic migraine.

NOTE: updates and new additions to the pathway are provided in addendums at the end of the document. 

See the Migraine (prophylaxis) Drug Pathway for full information.

The Surrey Heartlands Area Prescribing Committee agreed to adopt the South West London (SWL) migraine prophylaxis drug pathway for chronic and episodic migraine.

NOTE: updates and new additions to the pathway are provided in addendums at the end of the document. 

See the Migraine (prophylaxis) Drug Pathway for full information.

The Surrey Heartlands Area Prescribing Committee agreed to adopt the South West London (SWL) migraine prophylaxis drug pathway for chronic and episodic migraine.

NOTE: updates and new additions to the pathway are provided in addendums at the end of the document. 

See the Migraine (prophylaxis) Drug Pathway for full information.

The Surrey Heartlands Area Prescribing Committee agreed to adopt the South West London (SWL) migraine prophylaxis drug pathway for chronic and episodic migraine.

(Rimegepant for episodic migraine only)

NOTE: updates and new additions to the pathway are provided in addendums at the end of the document. 

See the Migraine (prophylaxis) Drug Pathway for full information.

December 2023 (updated 17/01/24) - Update on availability of Wegovy® (semaglutide) to support weight loss

In Surrey Heartlands, we have begun discussions locally about the use of Wegovy® and this has included a discussion at our Area Prescribing Committee. Due to a number of complexities, and some wider implications we would need to consider, implementation will be discussed at a meeting of NHS Surrey Heartland’s Commissioning, Contracting and Commercial Committee in February 2024. We will provide a further update following this meeting.
 

Please see further information in the update on availability of Wegovy below.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves mirikizumab as a treatment option in line with the recommendations made in NICE TA925, for treating moderately to severely active ulcerative colitis.

Mirikizumab for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

In December 2023, a guide to support primary care prescribing for people who access gender identity services was agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

In December 2023, a guide to support primary care prescribing for people who access gender identity services was agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

In December 2023, a guide to support primary care prescribing for people who access gender identity services was agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

In December 2023, a guide to support primary care prescribing for people who access gender identity services was agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

In December 2023, a guide to support primary care prescribing for people who access gender identity services was agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed  that the decision made by APC in March 2016 still stands and a RED traffic light status for Liothyronine (T3) as an option for treatment resistant depression in a niche group of adults whose depression has failed to respond to several antidepressants and is intolerant to lithium augmentation.

Where liothyronine is prescribed for the treatment of depression only, this should be under the care of an NHS consultant psychiatrist.

The most cost-effective formulation should be prescribed at initiation.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) have reviewed and agreed the updated apomorphine AMBER shared care document.

NHS England guidance to support clinicians on the prescribing of cannabis-based products for medicinal use:

https://www.england.nhs.uk/medicines-2/support-for-prescribers/cannabis-based-products-for-medicinal-use/

NHS England guidance to support clinicians on the prescribing of cannabis-based products for medicinal use:

https://www.england.nhs.uk/medicines-2/support-for-prescribers/cannabis-based-products-for-medicinal-use/

NHS England guidance to support clinicians on the prescribing of cannabis-based products for medicinal use:

https://www.england.nhs.uk/medicines-2/support-for-prescribers/cannabis-based-products-for-medicinal-use/

NHS England guidance to support clinicians on the prescribing of cannabis-based products for medicinal use:

https://www.england.nhs.uk/medicines-2/support-for-prescribers/cannabis-based-products-for-medicinal-use/

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that baricitinib for severe alopecia areata will be given a NON-FORMULARY traffic light status following publication of NICE TA926.

Baricitinib is not recommended, by NICE, within its marketing authorisation, for treating this indication

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed that treatment of low sexual desire in menopausal women with testosterone 1% cream will be given a NON-FORMULARY traffic light status.

Androfeme 1% cream is unlicensed in the UK and there are licensed testosterone preparations available that are being used off-label.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves dapagliflozin as recommended by NICE TA902 as an option for treating chronic heart failure with preserved or mildly reduced ejection fraction in addition to standard care.

Dapagliflozin for this indication will be considered as BLUE on the traffic light system (treatment should be initiated or recommended by a heart failure specialist in patients with a formal diagnosis of heart failure with preserved or moderately reduced ejection fraction as per NICE guideline on Chronic Heart Failure in adults)

Heart Failure specialist definition as per current BLUE information sheet for dapagliflozin/empagliflozin in HFrEF:

 • Cardiology consultant, specialist, or registrar

 • Heart failure specialist nurse

 • GP with a specialist interest in heart failure or GP cardiologist

 • General physician with heart failure expertise

 • Renal physician

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the Community Guidelines for prescribing thickeners in children.

See separate guides now available for adults and children.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed that treatment of low sexual desire in menopausal women with testosterone 1% cream will be given a NON-FORMULARY traffic light status.

Androfeme 1% cream is unlicensed in the UK and there are licensed testosterone preparations available that are being used off-label.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves real time continuous glucose monitoring (RTCGM) devices for patients with congenital hyperinsulinism (CHI) who are under the care of one of the 3 nationally commissioned centres:

·       Great Ormond Street Hospital for Children NHS Foundation Trust

·       Manchester University NHS Foundation Trust

·       Alder Hey Children’s NHS Foundation Trust

AND who require overnight continuous enteral glucose delivery via a gastrostomy feed pump.  rtCGM acts as an additional alert in case of gastrostomy feed pump failure.

RTCGM will be given a RED traffic light status for this indication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves deucravacitinib as a treatment option in line with the recommendations made in NICE TA907, for treating moderate to severe plaque psoriasis.

Deucravacitinib for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves rimegepant  in line with the recommendations made in NICE TA906, for  preventing migraine.

Rimegepant for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves risankizumab as a treatment option in line with the recommendations made in NICE TA888, for previously treated moderately to severely active Crohn’s disease.

Risankizumab for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated high cost immunomodulator psoriasis treatment pathway.

Availability of Omnipod 5 Hybrid Closed Loop (HCL) Insulin Pump for Surrey Heartlands patients living with Type I diabetes.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that they will not make any decision about Omnipod 5 availability until National Guidance is published (expected December 2023).

Please see the statement attached below from the APC for further information

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

Solifenacin is the 1st line treatment option.

Mirabegron is reserved for patients:

• in whom an antimuscarininc is contraindicated
• requiring (and can tolerate) a more potent treatment
• 3rd line where experiencing CNS adverse effects (confusion, drowsiness, hallucinations)

See Selection Tool for locally agreed OAB treament options

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that real time Continuous Glucose Monitoring (rtCGM) or intermittently scanned Continuous Glucose Monitoring (isCGM) is offered to children and young people with type II diabetes in line NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management).

However a NON-FORMULARY traffic light status  has been agreed for the following device.

A8 Touch Care Nano

• Has accuracy concerns
• There is no publicly available data in children
• Requires calibration

Please see flow charts for guidance on treatment choices.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that real time Continuous Glucose Monitoring (rtCGM) or intermittently scanned Continuous Glucose Monitoring (isCGM) is offered to children and young people with type II diabetes in line NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management).

However a NON-FORMULARY traffic light status  has been agreed for the following device.

GlucoRx Aidex:

• Is not licensed for insulin dosing (non-adjunctive use)
• Requires the user to verify their sensor glucose level with a capillary blood glucose test before insulin bolus for a meal. This adds to the diabetes burden for the patient and increases the CGM cost for capillary glucose test strips.
• Has accuracy concerns

Please see flow charts for guidance on treatment choices.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that real time Continuous Glucose Monitoring (rtCGM) or intermittently scanned Continuous Glucose Monitoring (isCGM) is offered to children and young people with type II diabetes in line NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management).

However a NON-FORMULARY traffic light status  has been agreed for the following device.

The manufacturer of Glucomen Day is no longer supporting initiations of new patients and there are accuracy concerns

Please see flow charts for guidance on treatment choices.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that real time Continuous Glucose Monitoring (rtCGM) or intermittently scanned Continuous Glucose Monitoring (isCGM) is offered to children and young people with type II diabetes in line NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management).

However a NON-FORMULARY traffic light status  has been agreed for the following device.

Medtronic Guardian is high in cost and less costly CGM devices are available.

Please see flow charts for guidance on treatment choices

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that real time Continuous Glucose Monitoring (rtCGM) or intermittently scanned Continuous Glucose Monitoring (isCGM) is offered to children and young people with type II diabetes in line NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management).

CGM devices have been given the following traffic light status:

BLUE traffic light status (with an information sheet)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

• Freestyle Libre 2 (isCGM)     
• Dexcom One (rtCGM)

RED traffic light status

Initiation and continued supplies will be through the specialist diabetes service

• Freestyle Libre 3 (rtCGM)      
• Dexcom G7 (rtCGM)  

Use the flow chart to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that real time Continuous Glucose Monitoring (rtCGM) or intermittently scanned Continuous Glucose Monitoring (isCGM) is offered to children and young people with type II diabetes in line NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management).

CGM devices have been given the following traffic light status:

BLUE traffic light status (with an information sheet)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

• Freestyle Libre 2 (isCGM)     
• Dexcom One (rtCGM)

RED traffic light status

Initiation and continued supplies will be through the specialist diabetes service

• Freestyle Libre 3 (rtCGM)      
• Dexcom G7 (rtCGM)  

Use the flow chart to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that real time Continuous Glucose Monitoring (rtCGM) or intermittently scanned Continuous Glucose Monitoring (isCGM) is offered to children and young people with type II diabetes in line NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management).

CGM devices have been given the following traffic light status:

RED traffic light status

Initiation and continued supplies will be through the specialist diabetes service

• Freestyle Libre 3 (rtCGM)      
• Dexcom G7 (rtCGM)  

BLUE traffic light status (with an information sheet)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

• Freestyle Libre 2 (isCGM)     
• Dexcom One (rtCGM)

Use the flow chart to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that real time Continuous Glucose Monitoring (rtCGM) or intermittently scanned Continuous Glucose Monitoring (isCGM) is offered to children and young people with type II diabetes in line NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management).

CGM devices have been given the following traffic light status:

RED traffic light status

Initiation and continued supplies will be through the specialist diabetes service

• Freestyle Libre 3 (rtCGM)      
• Dexcom G7 (rtCGM)  

BLUE traffic light status (with an information sheet)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

• Freestyle Libre 2 (isCGM)     
• Dexcom One (rtCGM)

Use the flow chart to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that real time Continuous Glucose Monitoring (rtCGM) or intermittently scanned Continuous Glucose Monitoring (isCGM) is offered to children and young people with type II diabetes in line NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management).

However a NON-FORMULARY traffic light status  has been agreed for this CGM device.

Dexcom G6 is high in cost and less expensive options are available for patients to use.

Please see flow charts for guidance on treatment choices.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed methenamine hippurate as a prophylaxis and treatment option for recurrent UTIs in men and women.

Methenamine Hippurate will be given a BLUE (under specialist recommendation) for this indication.

This is an interim position and will be reviewed when NICE guidance on UTI prophylaxis is published.

The Antimicrobial Guidelines resources can be found here Guidelines : Antimicrobial guidelines (res-systems.net)

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a change in traffic light status for hydroxychloroquine for patients within adult services from BLUE to AMBER.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that real time Continuous Glucose Monitoring (rtCGM) or intermittently scanned Continuous Glucose Monitoring (isCGM) is offered to children and young people with type II diabetes in line NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management).

CGM devices have been given the following traffic light status:

BLUE traffic light status (with an information sheet)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

• Freestyle Libre 2 (isCGM)     
• Dexcom One (rtCGM)

RED traffic light status

Initiation and continued supplies will be through the specialist diabetes service

• Freestyle Libre 3 (rtCGM)     
• Dexcom G7 (rtCGM) 

NON-FORMULARY

These CGM devices are not recommended for use across Surrey Heartlands for children and young people with type II diabetes.  

• GlucoRx Aidex (rtCGM)        
• Glucomen Day (rtCGM)        
•  A8 Touchcare Nano (rtCGM)
• Dexcom G6 (rtCGM) 
• Medtronic Guardian 3 (rtCGM)         
• Medtronic Guardian 4 (rtCGM)

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a change in traffic light status for hydroxychloroquine for patients within adult services from BLUE to AMBER.

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends upadacitinib for previously treated moderately to severely active Crohn’s Disease in line with NICE TA905.

Upadacitinib will be given a RED traffic light status for this indication. Prescribing will be by hospital specialists only, in line with NICE TA905.

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

With current services and future service transformation under review, prescribing in children and young people (CYP) should be in line with the interim Cass review.

For current patients:

• Please continue to prescribe in line with any agreed shared care protocols in place 

For new patients:

Do not prescribe puberty blockers as per the interim service specification for CYP with gender incongruence.

There is not yet any specific recommendation for prescribing gender affirming hormones. These are expected to be published by NHSE. 

In the meantime, prescribers should be mindful of the recommendations of the interim Cass Review when receiving prescribing requests for young people under 16 years. The Cass Review highlights the need for health professionals to explore the child or young person’s wellbeing, gender distress and any other challenges they may be facing. This includes being curious about safeguarding issues such as bullying or abuse. Concerns about addressing needs or sharing information can be discussed with your Named GP for Safeguarding.

Always ensure that appropriate shared care protocols are in place before prescribing

With current services and future service transformation under review, prescribing in children and young people (CYP) should be in line with the interim Cass review.

For current patients:

• Please continue to prescribe in line with any agreed shared care protocols in place 

For new patients:

Do not prescribe puberty blockers as per the interim service specification for CYP with gender incongruence.

There is not yet any specific recommendation for prescribing gender affirming hormones. These are expected to be published by NHSE. 

In the meantime, prescribers should be mindful of the recommendations of the interim Cass Review when receiving prescribing requests for young people under 16 years. The Cass Review highlights the need for health professionals to explore the child or young person’s wellbeing, gender distress and any other challenges they may be facing. This includes being curious about safeguarding issues such as bullying or abuse. Concerns about addressing needs or sharing information can be discussed with your Named GP for Safeguarding.

Always ensure that appropriate shared care protocols are in place before prescribing

With current services and future service transformation under review, prescribing in children and young people (CYP) should be in line with the interim Cass review.

For current patients:

• Please continue to prescribe in line with any agreed shared care protocols in place 

For new patients:

Do not prescribe puberty blockers as per the interim service specification for CYP with gender incongruence.

There is not yet any specific recommendation for prescribing gender affirming hormones. These are expected to be published by NHSE. 

In the meantime, prescribers should be mindful of the recommendations of the interim Cass Review when receiving prescribing requests for young people under 16 years. The Cass Review highlights the need for health professionals to explore the child or young person’s wellbeing, gender distress and any other challenges they may be facing. This includes being curious about safeguarding issues such as bullying or abuse. Concerns about addressing needs or sharing information can be discussed with your Named GP for Safeguarding.

Always ensure that appropriate shared care protocols are in place before prescribing

With current services and future service transformation under review, prescribing in children and young people (CYP) should be in line with the interim Cass review.

For current patients:

• Please continue to prescribe in line with any agreed shared care protocols in place 

For new patients:

Do not prescribe puberty blockers as per the interim service specification for CYP with gender incongruence.

There is not yet any specific recommendation for prescribing gender affirming hormones. These are expected to be published by NHSE. 

In the meantime, prescribers should be mindful of the recommendations of the interim Cass Review when receiving prescribing requests for young people under 16 years. The Cass Review highlights the need for health professionals to explore the child or young person’s wellbeing, gender distress and any other challenges they may be facing. This includes being curious about safeguarding issues such as bullying or abuse. Concerns about addressing needs or sharing information can be discussed with your Named GP for Safeguarding.

Always ensure that appropriate shared care protocols are in place before prescribing

With current services and future service transformation under review, prescribing in children and young people (CYP) should be in line with the interim Cass review.

For current patients:

• Please continue to prescribe in line with any agreed shared care protocols in place 

For new patients:

Do not prescribe puberty blockers as per the interim service specification for CYP with gender incongruence.

There is not yet any specific recommendation for prescribing gender affirming hormones. These are expected to be published by NHSE. 

In the meantime, prescribers should be mindful of the recommendations of the interim Cass Review when receiving prescribing requests for young people under 16 years. The Cass Review highlights the need for health professionals to explore the child or young person’s wellbeing, gender distress and any other challenges they may be facing. This includes being curious about safeguarding issues such as bullying or abuse. Concerns about addressing needs or sharing information can be discussed with your Named GP for Safeguarding.

Always ensure that appropriate shared care protocols are in place before prescribing

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed prescribing of generic estradiol 10microgram vaginal pessaries as a topical treatment option for vaginal atrophy due to oestrogen deficiency in postmenopausal women.

Generic estradiol 10microgram vaginal pessaries will be given a GREEN traffic light status.

All patients prescribed branded estradiol 10mcg vaginal tablets / pessaries (Vagifem®, Vagirux® and Gina®) can be switched to generic estradiol 10mcg vaginal pessaries to realise QIPP savings

Mild dry eye

Hypromellose 0.3% eye drops should be prescribed by brand:

• 1st line: AaproMel 0.3% or Aaculose 0.3%
• 2nd line: Lumecare 0.3%

Preservative free options

• 1st line: Evolve Hypromellose preservative free 0.3%
• 2nd line: Hypromol preservative free 0.3%

Unit dose containers:

Lumecare Singles Hypromellose (unit dose preservative free) are reserved for occasional use (e.g. convenient to carry in bag) for patients on long-term, frequent dosing. 
Regular treatment should be provided in the form of a 10ml bottle, preservative free as follows:

• 1st line: Evolve Hypromellose preservative free 0.3%
• 2nd line: Hypromol preservative free 0.3%

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a local adaptation of the National Shared Care document, in reference to the routine monitoring of CRP (rather than ESR) in primary care for inflammatory indications

The Surrey Heartlands Integrated Care System  Area Prescribing Committee have reviewed the traffic light status' of treatments used for transgender health in adults.

Nafarelin (Nasal Spray) has been given an AMBER traffic light status.

In line with NHS England’s guidance on conditions for which over the counter items should not be routinely prescribed, NHS Surrey Heartlands Integrated Care System Area Prescribing Committee does not support the routine prescribing of medicines or preparations for dental conditions (including toothpastes such as Duraphat®, ulcer healing preparations, antibiotics and analgesics) on GP FP10 prescriptions except in the following circumstances: 

•  After head and neck cancer treatment on the recommendation of a Head & Neck or Restorative Dental Consultant; OR 
• For patients receiving palliative care as part of ongoing symptom control. 

This is because: 

Dentists are usually best placed to assess dental problems and prescribe and monitor medicines to treat them. 

High concentration fluoride toothpaste is an effective preventative intervention for those giving concern to their dentist and are at particular risk of developing dental decay. 

The use of high concentration fluoride toothpaste should be a part of other professional oral health promotion interventions. Patients using high concentration fluoride toothpaste should be under the care of a dentist. 

If a GP prescribes medicines for dental conditions, the GP is then responsible for both the prescribing and any consequent monitoring required, for which they may not be the most appropriate clinical practitioner. 

GPs should consider discontinuing the prescribing of dental products, and recommend patients purchase over the counter as self-care or visit their dentist for advice and prescribing, where appropriate. However, as with all prescribing interventions, individual patient circumstances need to be borne in mind.

Dentists must signpost patients to purchase products or issue prescriptions (NHS or private) for medicines to meet the identified dental needs of their patients. If a patient receives treatment as a private patient, they must always be given a private prescription.

CGM for patients with type 2 diabetes has not been evaluated, with the exception of :

Pregnant women with T2DM on insulin and problematic hypoglycaemia / difficult to control blood glucose:

• Profile : Dexcom ONE (Real-time continuous glucose monitoring) - Pregnancy - NON Type I Diabetes requiring insulin (res-systems.net)
• Profile : FreeStyle Libre 3 (Real-time continuous glucose monitoring) - Pregnancy - NON Type I Diabetes requiring insulin (res-systems.net)

Insulin treated T2DM in people living with a learning disability and recorded on their GP Learning Disability register:

•  https://surreyccg.res-systems.net/PAD/Search/DrugConditionProfile/5674)

A Medicines Shortage Notification has been issued in relation to the supply shortages of GLP-1s.

See GLP-1 Medicine Shortage document below for full details

A Medicines Shortage Notification has been issued in relation to the supply shortages of GLP-1s.

See GLP-1 Medicine Shortage document below for full details

A Medicines Shortage Notification has been issued in relation to the supply shortages of GLP-1s.

See GLP-1 Medicine Shortage document below for full details

A Medicines Shortage Notification has been issued in relation to the supply shortages of GLP-1s.

See GLP-1 Medicine Shortage document below for full details

A Medicines Shortage Notification has been issued in relation to the supply shortages of GLP-1s.

See GLP-1 Medicine Shortage document below for full details

A Medicines Shortage Notification has been issued in relation to the supply shortages of GLP-1s.

See GLP-1 Medicine Shortage document below for full details

A Medicines Shortage Notification has been issued in relation to the supply shortages of GLP-1s.

See GLP-1 Medicine Shortage document below for full details

A Medicines Shortage Notification has been issued in relation to the supply shortages of GLP-1s.

See GLP-1 Medicine Shortage document below for full details

Darifenacin is non-formulary.

The APC agreed that darifenacin could be switched to solifenacin or an alternative formulary treatment option if solifenacin is contraindicated:

• In patients with reduced renal function
• Patients with CNS adverse effects (confusion, drowsiness, halucinations) 
• Where there is the potential of interactions at Cytochrome P450 3A4
• in patients where anticholinergics are contraindicated
• In patients that require a more potent treatment

See Selection Tool for locally agreed OAB treatments.

Fesoterodine is recommended as a 3rd line option in patients who require, and can tolerate, a more potent treatment.

Solifenacin is the 1st line treatment option.

Tolterodine immediate release tablets or Trospium are 2nd line options in patients for whom solifenacin is not suitable.

See Selection Tool for locally agreed OAB treatment options

Flavoxate is not recommended for treating overactive bladder in line with NICE NG123 - guidance can be found below.

Flavoxate is non-formulary.

Solifenacin is the 1st line treatment option.

Tolterodine immediate release tablets or Trospium are 2nd line options in patients for whom solifenacin is not suitable.

See Selection Tool for locally agreed OAB treatments

Oxybutynin immediate-release and modified-release tablets are non-formulary. A switch from oxybutinin tablets to solifenacin is recommended (where appropriate).

Patients with swallowing difficulties

Solifenacin oral SUSPENSION 1mg/ml sugar free is the preferred treatment option.

Oxybutynin patches should be reserved for patients in whom an oral route is not suitable. 

See Selection Tool for locally agreed OAB treatment options

Oxybutynin patches should be reserved for patients in whom an oral route is not suitable. 

Patients with swallowing difficulties

Solifenacin oral SUSPENSION 1mg/ml sugar free is the preferred treatment option.

See Selection Tool for locally agreed OAB treatment options

Propiverine is non-formulary.

Solifenacin is the 1st line treatment option.

Tolterodine immediate release tablets or Trospium are 2nd line options in patients for whom solifenacin is not suitable.

See Selection Tool for locally agreed OAB treatment options

Solifenacin is the 1st line treatment option.

Patients with swallowing difficulties

Solifenacin 1mg/ml oral SUSPENSION sugar free is the preferred option in patients with swallowing difficulties.

Solifenacin 5mg/5ml oral solution is non-formulary due to it being significantly more expensive than the suspension in primary care.

See Selection Tool for locally agreed OAB treatment options

Solifenacin is the 1st line treatment option.

Tolterodine immediate release is an alternative 1st line treatment option in patients with renal impairment (GFR <30mls/min)) and can be commenced at lower doses.

See Selection Tool for locally agreed OAB treatment options

Tolterodine modified release tablets are non-formulary. It was agreed by the APC that tolterodine MR can be switched to solifenacin (or an alternative formulary option) if approrpiate.

Solifenacin is the 1st line treatment option.

Trospium immediate release or modified release are recommended as suitable treatment options where solifenacin is not suitable.

See Selection Tool for locally agreed OAB treatment options

Tolterodine modified release tablets are non-formulary. It was agreed by the APC that tolterodine MR can be switched to solifenacin (or an alternative formulary option) if approrpiate.

Solifenacin is the 1st line treatment option.

Tolterodine immediate release is an alternative 1st line treatment option in patients with renal impairment (GFR <30mls/min)) and can be commenced at lower doses.

See Selection Tool for locally agreed OAB treatment options

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Atopic Dermatitis treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the Atopic Dermatitis treatment pathway below

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the Atopic Dermatitis treatment pathway below

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Atopic Dermatitis treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Atopic Dermatitis treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Psoriatic arthritis high cost immunomodulator treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agree that patients with the following conditions can be prescribed specific sunscreens under the Advisory Committee on Borderline Substances (ACBS) advice.

• Photoaggravated dermatoses: pre-existing skin conditions that can be aggravated or exacerbated by sunlight on exposed areas of skin.
• Photodermatoses: skin disorders that are caused (rather than aggravated) by exposure to sunlight

For patients with these conditions, the following specific brands should be prescribed, namely: Anthelios® Sunscreen Lotion SPF 50+, Sunsense Ultra Lotion, SPF 50+ Uvistat® Lipscreen SPF 50, Uvistat® Suncream SPF 30 and 50. These brands of sunscreen will therefore be GREEN for ACBS indications only.

All other brands and uses of sunscreen will therefore be NON-FORMULARY.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agree that patients with the following conditions can be prescribed specific sunscreens under the Advisory Committee on Borderline Substances (ACBS) advice.

• Photoaggravated dermatoses: pre-existing skin conditions that can be aggravated or exacerbated by sunlight on exposed areas of skin.
• Photodermatoses: skin disorders that are caused (rather than aggravated) by exposure to sunlight.

For patients with these conditions, the following specific brands should be prescribed, namely: Anthelios® Sunscreen Lotion SPF 50+, Sunsense Ultra Lotion, SPF 50+ Uvistat® Lipscreen SPF 50, Uvistat® Suncream SPF 30 and 50. These brands of sunscreen will therefore be GREEN for ACBS indications only.

All other brands and uses of sunscreen will therefore be NON-FORMULARY.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed Denosumab Prescribing Information to support initiation and ongoing administration in primary care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway below

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway 

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Rheumatology Immunomodulator pathways (axial spondyloarthritis, psoriatic arthritis and rheumatoid arthritis (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway

The Surrey Heartlands Area Prescribing Committee has agreed Trimbow® NEXThaler® as an option where triple therapy is indicated in the treatment of COPD. See COPD Guidelines for more information.

The locally preferred triple-therapy devices for COPD are:

Low carbon:
Trimbow NEXThaler (dry powder)
Trelegy Ellipta (dry powder)

Alternative devices:
Trimbow (pMDI). To be used with a spacer.

Prescribe devices by brand.

The locally preferred triple-therapy devices for COPD are as follows:

Low carbon:

• Trimbow NEXThaler (dry powder)
• Trelegy Ellipta (dry powder)

Alternative devices:

• Trimbow (pMDI). To be used with a spacer.

Triple therapy combination inhalers are recommended as a treatment option in COPD, where clinically appropriate, in line with NICE guidance (NG115 –updated July 2019) and GOLD guidelines.

See local COPD guidelines for further details

Carmellose eye drops should be prescribed by brand:

• 1st line: AaqEye carmellose 0.5%
• 2nd line: Lumecare Advance Carmellose 0.5%

Preservative free options

• 1st line: Eyeaze Carmellose 0.5%, 1% PF or VIZcellose 0.5%, 1% PF
• 2nd line: Carmellose 0.5% PF or Ocu-Lube or Cellusan 1% PF

Unit dose eye containers

Lumecare Singles Carmellose (unit dose preservative free) are reserved for occasional use (e.g. convenient to carry in bag) for patients on long-term, frequent dosing. 
Regular treatment should be provided in the form of a 10ml bottle, preservative free as above.

Carbomer 0.2% eye gel should be prescribed by brand:

• 1st line: Aacomer 0.2% eye gel or Aacarb Carbomer 0.2% eye gel
• 2nd line: Clinitas carbomer 0.2% eye gel or Lumecare carbomer 0.2% eye gel

Preservative free options

• 1st line: Evolve Carbomer 980 preservative free 0.2% eye gel
• 2nd line: Xailin 0.2% eye gel

Unit dose option is Ocu-Lube Carbomer 0.2% and is reserved for occasional use (e.g. convenient to carry in bag) for patients on long-term, frequent dosing. 
Regular treatment should be provided in the form of a 10ml bottle, preservative free as follows

• 1st line: Evolve Carbomer 980 prefervative free 0.2% eye gel
• 2nd line: Xailin 0.2% eye gel

Moderate dry eye.

Sodium hyaluronate eye drops / preservative free eye drops should be prescribed by brand:

1st line:
Eyeaze preservative free (0.1%, 0.2%, 0.4%)
VIZhyal preservative free (0.1%, 0.2%, 0.4%)

2nd line:
Hy-Opti 0.2%
Clinitas Multi preservative free (0.2%, 0.4%)

NHSE commissioning statement: https://www.england.nhs.uk/wp-content/uploads/2020/07/Serum-eye-drops-for-the-treatment-of-severe-ocular-surface-disease-all-ages-1.pdf?UNLID=1034161232022120171028

For initiation and conitnuation by specialist ophthalmology teams only.

Acetylcysteine 5% and 10% preservative free eye drops are unlicensed and are reserved for specialist use when symptoms are persistent / severe.
Not for Primary Care prescribing.

Moderate dry eye.

Paraffin-based, preservative free eye ointment should be prescribed by brand:

1st line:
HydraMed Night preservative free eye ointment

2nd line:
Moistueyes preservative free eye ointment
Xailin Night preservative free eye oitment

Severe dry eye.

Prescribe by brand.

Aeon Repair 0.15% preservative free eye drops.

For use where there is reduced sensations to corneal nerves or the corneal epithelium is slow to heal

Severe dry eye

Prescribe by brand.

Optive Fusion 0.1% eye drops.

For use where there is reduced sensations to corneal nerves or the corneal epithelium is slow to heal

Severe dry eye

Prescribe by brand.

Systane Balance eye drops.

For use where there is reduced sensations to corneal nerves or the corneal epithelium is slow to heal

Severe dry eye.

Prescribe by brand.

Thealoz Duo eye drops.

For use where there is reduced sensations to corneal nerves or the corneal epithelium is slow to heal

Do not prescribe Ozempic® for the treatment of obesity.

Weight Management Guidelines - for advice see Guidelines : Weight management in adults (res-systems.net)

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the somatrogon AMBER shared care document for the treatment of growth disturbance in children and young people, in line with NICE TA 863.The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the somatrogon AMBER shared care document for the treatment of growth disturbance in children and young people, in line with NICE TA 863.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations.

The local adaptation is:

Specialist Responsibilities

• The initiating specialist will be expected to initiate and optimise treatment and prescribe the maintenance treatment for at least 12 weeks and until optimised.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations.

The local adaptation is:

Specialist Responsibilities

• The initiating specialist will be expected to initiate and optimise treatment and prescribe the maintenance treatment for at least 12 weeks and until optimised.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed to adopt the following statement from the Royal College of General Practitioners

"The Royal College of General Practitioners (RCGP) and the British Society for Genetic Medicine (BSGM) recommend that health professionals should exercise caution when asked to offer, or provide, clinical expertise about the results of Direct to Consumer (DTC) genomic or genetic testing. The analytical validity, sensitivity and clinical utility of such testing may be much lower than is popularly perceived. For certain types of DTC results, there is a very high chance of false positive or false negative results. This means that patients should be offered the NHS care which would otherwise have been offered (e.g., family history and risk assessment, healthy lifestyle advice, or referral to specialist care) regardless of their DTC result.”

Do not prescribe semaglutide tablets (Rybelsus) for the treatment of obesity.

Guidelines for weight management can be found here: Guidelines : Weight management in adults (res-systems.net)

For use in diabetes - see recommendations below.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approve the Surrey Heartlands Community Guide to Prescribing Thickeners for Dysphagia in Adults

Preferred products are:
- Nutilis Clear     175g tin; or
- Resource ThickenUp Clear    127g tin

Other brands and formulations (sachets, pre-thickened drinks etc) should only be prescribed on advice from a Speech and Language Team 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that GlucoRx Aidex, real time Continuous Glucose Monitoring (rtCGM) is NOT offered to adults, or children and young people with TYPE I DIABETES, across Surrey Heartlands

A NON-FORMULARY traffic light status has been agreed.

Glucorx Aidex:

• Is not licensed for insulin dosing (non-adjunctive use)
• Requires the user to verify their sensor glucose level with a capillary blood glucose test before insulin bolus for a meal. This adds to the diabetes burden for the patient and increases the CGM cost for capillary glucose test strips.
• Has accuracy concerns and limited data to support use in Type I Diabetes

Please see flow charts for guidance on treatment choices.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that GlucoRx Aidex, real time Continuous Glucose Monitoring (rtCGM) is NOT offered to Pregnant women with TYPE I DIABETES, across Surrey Heartlands

A NON-FORMULARY traffic light status  has been agreed.

Glucorx Aidex:

• Is not licensed for insulin dosing (non-adjunctive use)
• Requires the user to verify their sensor glucose level with a capillary blood glucose test before insulin bolus for a meal. This adds to the diabetes burden for the patient and increases the CGM cost for capillary glucose test strips.
• Has accuracy concerns and limited data to support use in Type I Diabetes

Please see flow charts for guidance on treatment choices.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that GlucoRx Aidex, real time Continuous Glucose Monitoring (rtCGM) is NOT offered to Pregnant women with NON TYPE I DIABETES requiing insulin, across Surrey Heartlands

A NON-FORMULARY traffic light status  has been agreed.

Glucorx Aidex:

• Is not licensed for insulin dosing (non-adjunctive use)
• Requires the user to verify their sensor glucose level with a capillary blood glucose test before insulin bolus for a meal. This adds to the diabetes burden for the patient and increases the CGM cost for capillary glucose test strips.
• Has accuracy concerns and limited data to support use in Type I Diabetes

Please see flow charts for guidance on treatment choices.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Glucomen Day, real time Continuous Glucose Monitoring (rtCGM) is NOT offered to adults or children and young people with TYPE I DIABETES across Surrey Heartlands

A NON-FORMULARY traffic light status  has been agreed.

The manufacturer of Glucomen Day is no longer supporting initiations of new patients and there are accuracy concerns


Please see flow charts for guidance on treatment choices.

 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Glucomen Day, real time Continuous Glucose Monitoring (rtCGM) is NOT offered to Pregnant Women with  TYPE I DIABETES across Surrey Heartlands

A NON-FORMULARY traffic light status  has been agreed.

The manufacturer of Glucomen Day is no longer supporting initiations of new patients and there are accuracy concerns


Please see flow charts for guidance on treatment choices.

 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Glucomen Day, real time Continuous Glucose Monitoring (rtCGM) is NOT offered to Pregnant women with NON Type I Diabetes requiring insulin, across Surrey Heartlands

A NON-FORMULARY traffic light status  has been agreed.

The manufacturer of Glucomen Day is no longer supporting initiations of new patients and there are accuracy concerns


Please see flow charts for guidance on treatment choices.

 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that 8 Touchcare Nano, real time Continuous Glucose Monitoring (rtCGM) is NOT offered to adults or children and young people with TYPE I DIABETES across Surrey Heartlands 

A NON-FORMULARY traffic light status  has been agreed.

A8 Touch Care Nano

• Has accuracy concerns
• There is no publicly available data in children
• Requires calibration

Please see flow charts for guidance on treatment choices.
 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that 8 Touchcare Nano, real time Continuous Glucose Monitoring (rtCGM) is NOT offered to Pregnant women with TYPE I DIABETES across Surrey Heartlands

A NON-FORMULARY traffic light status  has been agreed.

A8 Touch Care Nano

• Has accuracy concerns
• There is no publicly available data in children
• Requires calibration

Please see flow charts for guidance on treatment choices.
 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that 8 Touchcare Nano, real time Continuous Glucose Monitoring (rtCGM) is NOT offered to Pregnant women with NON TYPE I DIABETES requiring insulin, across Surrey Heartlands 

A NON-FORMULARY traffic light status  has been agreed.

A8 Touch Care Nano

• Has accuracy concerns
• There is no publicly available data in children
• Requires calibration

Please see flow charts for guidance on treatment choices.
 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to adults and children and young people with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to Pregnant women with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time) is offered to Pregnant women with NON Type I Diabetes requiring insulin with problematic severe hypoglycaemia or unstable blood glucose  in line with NICE guidance 
The following CGM devices have been recommended by APC:

RED traffic light status

• Freestyle Libre 3 (rtCGM)     

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet) 

• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care. 

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to adults and children and young people with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to adults and children and young people with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to adults and children and young people with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to adults and children and young people with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to adults and children and young people with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to adults and children and young people with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee  continues to recommend FreeStyle Libe 2, intermittently scanned Continuous Glucose Monitoring (isCGM) for insulin treated type 2 diabetes patients who are living with a learning disability which is recorded on their GP learning disability register, in line with updated NHS England guidance from November 2020

On Thursday 31st March 2022, the National Institute for Health and Care Excellence (NICE) updated the recommendations in their Diabetes guidance in relation to glucose monitoring for patients with Type II Diabetes and there is a team working on implementation of this guidance.

Further information will be uploaded here in due course.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to Pregnant women with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to Pregnant women with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to Pregnant women with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to Pregnant women with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to Pregnant women with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time and intermittently scanned) is offered to Pregnant women with TYPE I DIABETES in line with NICE guidance
The following CGM devices have been recommended by APC:
RED traffic light status

• Freestyle Libre 3 (rtCGM)
• Dexcom G7 (rtCGM)
• Dexcom G6 (rtCGM)
• Medtronic Guardian 3 (rtCGM)
• Medtronic Guardian 4 (rtCGM)

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet)

• Freestyle Libre 2 (isCGM)
• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Continuous Glucose Monitoring (real time) is offered to Pregnant women with NON Type I Diabetes requiring insulin with problematic severe hypoglycaemia or unstable blood glucose  in line with NICE guidance 
The following CGM devices have been recommended by APC:

RED traffic light status

• Freestyle Libre 3 (rtCGM)     

Initiation and continued supplies will be through the specialist diabetes service.

BLUE traffic light status (with an information sheet) 

• Dexcom One (rtCGM)

Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care. 

Use the flow charts below to ensure the most appropriate and cost-effective CGM devices are used to meet patient need

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends eptinezumab as a treatment option for preventing migraine in line with NICE TA871. Eptinezumab will be given a RED traffic light status for this indication. Prescribing will be by hospital specialists only, in line with NICE TA871. Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

A NHS Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC) is now available to be bought. Not all HRT medicines are covered. Please see link below for full list of medicines covered and other useful information.

A NHS Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC) is now available to be bought. Not all HRT medicines are covered. Please see link below for full list of medicines covered and other useful information.

A NHS Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC) is now available to be bought. Not all HRT medicines are covered. Please see link below for full list of medicines covered and other useful information.

A NHS Hormone Replacement Therapy Prescription Prepayment Certificate (HRT PPC) is now available to be bought. Not all HRT medicines are covered. Please see link below for full list of medicines covered and other useful information.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that aspirin will not be recommended as a treatment option for the primary prevention of cardiovascular disease, in line with NICE Clinical guideline 181 (CG181).
Aspirin has been given a NON-FORMULARY traffic light status for this indication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed an information sheet developed by the Surrey Heartlands Antimicrobial Medicines Optimisation Group to assist GPs to understand recent changes made to some antimicrobial sensitivity reports.
Prescribing Antibiotics for Patients with a ‘S*’ Microbiological Culture Sensitivity Result

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the use of phenazone 40mg/g with lidocaine 10mg/g ear drops as a treatment option for acute otitis media in line NICE NG91 (acute otitis media antimicrobial prescribing), where oral analgesia has been used and has been ineffective.

A GREEN traffic light status has been agreed for this preparation.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following:
•    Isosorbide mononitrate standard release – is GREEN (preferred). Note asymmetric dosing required.
•    Isosorbide mononitrate modified release – is GREEN (restricted to when isosorbide mononitrate standard release is not suitable).  Prescribe the most cost-effective brand – preferred brand is Monomil® XL 60mg tablets.
Switching
•    Patients currently taking Monomax XL® 60mg can be changed to Monomil XL® 60mg
•    Patients currently taking generic isosorbide mononitrate MR 60mg tablets can be changed to Monomil XL® 60mg.

Acrivastine capsules need to be taken three times a day and are therefore less desirable from an adherence to therapy perspective.
It is also considered to be less cost effective and is therefore not recommended as a routine treatment option in local guidelines - see below.
Available to purchase over the counter

Azelastine is the only intranasal antihistamine that is licensed in the UK for the treatment of allergic rhinitis.
It was agreed as a treatment option for intermittent mild symptoms where it has a fast onset of action.
See local guidelines below

Bilastine tablets for allergic rhinitis have not been recommended for use within the local guidelines.
Bilastine is considerably more expensive and is not considered a cost-effective treatment option.

Once daily Benacort (budesonide) or generic budesonide 64mcg/dose  may be considered reasonable second line options for corticosteroid nasal sprays in allergic rhinitis - see local guidelines below    

GENERIC Cetirizine has been considered by the APC and has been agreed as a 1st-line treatment option.
Available to purchase.

Liquids reserved for patients unable to swallow solid dose forms.
Loratadine liquid (5mg/5ml) suger free is the 1st-line choice (from 2 years)

Cetirizine liquid (1mg/ml) is 2nd-line option. Safe and effective and can be prescribed from age of 2.

Cetirizine capsules are considerably more costly and are therefore not recommended for routine use within local guidelines

GENERIC loratadine has been considered by the APC and has been agreed as a 1st line treatment option
Available to purchase

Liquids reserved for patients unable to swallow solid dose forms.
Loratadine liquid (5mg/5ml) suger free is the 1st-line choice (from 2 years)

Cetirizine liquid (1mg/ml) is 2nd-line option. Safe and effective and can be prescribed from age of 2.
 

Desloratadine and levocetirizine are not recommended 1st line as there is little evidence that they confer any additional benefit over the more established non-sedating antihistamines and are more costly - see local guidelines below

Cetirizine or loratadine are the 1st line non-sedating antihistamines

Desloratadine liquid is non-formulary

The APC agreed Dymista (azelastine hydrochloride / fluticasone propionate) nasal spray as a treatment option for the treatment of perennial and seasonal allergic rhinitis in circumstances where:

• fluticasone alone has demonstrated benefit
• other corticosteroids are ineffective/not tolerated

In addition, patients requiring dose adjustments should remain on separate components.

Fluticasone is considered to be a 3rd line agent for nasal allergic rhinitis - see local guidelines below. 

If fluticasone is necessary, prescribe as Avamys (fluticasone furoate 27.5mcg/dose).

Avamys is approxiamtely 40% less expensive than generic scripts for fluticasone propionate or branded Flixonase.

Generic mometasone furoate (once daily) nasal spray was agreed as a 1st line treatment option for intranasal corticosteroids.
Generic beclometasone or Beconase nasal spray (200 dose container) is an appropriate 1st line alternative.

Consider mometasone if an intranasal corticosteroid is required for short term use due to systemic absorption (6-18years).

Fexofenadine is recommended as a 2nd line treatment option.

Prescribe generically

NOTE - the 180mg tablets are NOT licensed for allergic rhinitis

Intranasal ipratropium is an add-on treatment option for those with a runny nose associated with allergic rhinitis.
Use in caution in those at risk of closed angle glaucoma

Mizolastine is not recommended as a routine treatment in local guidelines - see below.

Mizolastine 10mg MR tablets have been implicated in causing abnormal prolongation of the QT interval

Rupatadine tablets for allergic rhinitis have not been recommended for use within the local guidelines.
Rupatadine is considerably more expensive and is not considered a cost-effective treatment option.

Depot steroids should not be prescribed for hay fever. Evidence of safety is lacking, and there is a significant risk of prolonged side-effects (e.g. osteoporosis) which cannot be mitigated by withdrawal of the drug

Triamcinolone is considered to be a 3rd / 4th line agent for nasal allergic rhinitis - see local guidelines below. 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the addition of Xaggitin XL® to the preferred brands of Methylphenidate modified release preparations.

Xaggitin XL® is a bioequivalent preparation to Concerta® and adding Xaggitin XL® to the recommended list of products will reduce the risk of disruption to treatment should stock shortages recur.

Xaggitin XL®, Delmosart and Xenidate XL have an AMBER traffic light status and are the preferred alternatives to Concerta®.

Other brands; Matoride XL, and Concerta® XL will not be non-formulary but, it is anticipated that these brands will not be initiated by Surrey & Borders Partnership NHS Foundation Trust moving forwards.

NB : This guidance does not apply to other strengths of modified release methylphenidate (including Equasym XL® and Medikinet XL® brands) as these have different release characteristics.

The SABP letter to GPs notes that this switch can be undertaken in primary care but ideally switches should be undertaken with direct contact with patients (face to face). Communications should be done according to individual patient requirements. 

Patients may be under the care of other  providers, therefore it may be appropriate to discuss with them before making a switch. 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the addition of Xaggitin XL® to the preferred brands of Methylphenidate modified release preparations.

Xaggitin XL® is a bioequivalent preparation to Concerta® and adding Xaggitin XL® to the recommended list of products will reduce the risk of disruption to treatment should stock shortages recur.

Xaggitin XL®, Delmosart and Xenidate XL have an AMBER traffic light status and are the preferred alternatives to Concerta®.

Other brands; Matoride XL and Concerta® XL will not be non-formulary but, it is anticipated that these brands will not be initiated by Surrey & Borders Partnership NHS Foundation Trust moving forwards.

NB : This guidance does not apply to other strengths of modified release methylphenidate (including Equasym XL® and Medikinet XL® brands) as these have different release characteristics.

The SABP letter to GPs notes that this switch can be undertaken in primary care but ideally switches should be undertaken with direct contact with patients (face to face). Communications should be done according to individual patient requirements. 

Patients may be under the care of other  providers, therefore it may be appropriate to discuss with them before making a switch. 

Desloratadine and levocetirizine are not recommended 1st line as there is little evidence that they confer any additional benefit over the more established non-sedating antihistamines and are more costly - see local guidelines below

Cetirizine or loratadine are the 1st line non-sedating antihistamines

Levocetirizine liquid is non-formulary

Generic sodium cromoglicate 2% eye drops, preservative free (10ml bottle) may support prolonged control of symptoms in allergic conjunctivitis.

Available to buy over the counter (OTC). 

Otrivine-Antistin (Xylometazoline and antazoline sulfate) is suitable for rapid, short-term relief of infrequent ocular symptoms - avoid in angle-closure glaucoma

Available to buy over the counter (OTC). 

Intranasal decongestant for up to 7 days if nasal blockage is a problem to allow penetration of intranasal corticosteroid 

This drug falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends upadacitinib as a treatment option for the treatment of moderately to severely active Ulcerative Colitis in line with NICE TA856

Upadacitinib will be considered RED on the traffic light system. Prescribing will be by hospital specialists only, in line with NICE TA856.

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends upadacitinib as a treatment option for the treatment of active non-radiographic axial spondyloarthritis in line with NICE TA861

Upadacitinib will be considered RED on the traffic light system. Prescribing will be by hospital specialists only, in line with NICE TA861.
Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends somatrogon as a treatment option for the treatment of growth disturbance caused by growth hormone deficiency in children and young people aged 3 years and over in line with NICE TA863

Somatrogon will be considered AMBER on the traffic light system 

Patients should not be referred for a switch to somatrogon from other growth hormone preparations but can consider switch on discussion with the specialist team at their next routine follow up appointment.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed that the following insulin pumps will be available in line with NICE TA151 for patients with Type I Diabetes.

• Medtronic 780g insulin Pump (Medtronic)
• T-Slim insulin Pump (Air Liquide Healthcare Ltd)
• Ypsopump insulin pump (Ypsomed Ltd)
• Omnipod DASH patch pump (Insulet International Ltd)
• Dana I (Advanced Therapeutics (UK) Ltd) – replaces Dana RS insulin pump (upgrade)
• GlucoMen® Day Insulin Patch Pump (A. Menarini Diagnostics)
• A8 TouchCare Nano (Medtrum Ltd)

A RED traffic light status for the insulin pumps and the consumables is agreed by APC.

Trusts should work with their procurement leads to sign up to the NHS Supplies framework so that national agreed discounts and associated savings can be realised.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed that the following insulin pumps will be available for patients with a non-autoimmune cause for deficiency of beta cells.

The decion to agree the use of insulin pumps in patient with non-autoimmune cuase for deficiency of beta cells was made by APC following the publication of the South East Coast & London Paediatric Diabetes Network guidelines in December 2018.

• Medtronic 780g insulin Pump (Medtronic)
• T-Slim insulin Pump (Air Liquide Healthcare Ltd)
• Ypsopump insulin pump (Ypsomed Ltd)
• Omnipod DASH patch pump (Insulet International Ltd)
• Dana I (Advanced Therapeutics (UK) Ltd) – replaces Dana RS insulin pump (upgrade)
• GlucoMen® Day Insulin Patch Pump (A. Menarini Diagnostics)
• A8 TouchCare Nano (Medtrum Ltd)

A RED traffic light status for the insulin pumps and the consumables is agreed by APC.

Trusts should work with their procurement leads to sign up to the NHS Supplies framework so that national agreed discounts and associated savings can be realised.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees that loteprednol etabonate eye drops  should only be used on a short-term basis (maximum of 2 weeks duration) to treat post-operative inflammation as per its product license.

Therefore, loteprednol etabonate  a RED traffic light status is agreed by APC.

Sufficient quantities should be supplied through secondary care as part of a package of post-operative care.”

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends avatrombopag as a treatment option for the treating primary chronic immune thrombocytopenia in line with NICE TA853

Avatrombopag will be considered RED on the traffic light system. Prescribing will be by hospital specialists only

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends candesartan as a treatment option for migraine prophylaxis.

Note - candesartan is not licensed for this indication (off-label use)

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated resource pack for use by primary care prescribers for managing non-cognitive symptoms in people living with dementia.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated resource pack for use by primary care prescribers for managing non-cognitive symptoms in people living with dementia.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated resource pack for use by primary care prescribers for managing non-cognitive symptoms in people living with dementia.
Risperidone has been agreed as GREEN for agression, agitation or anxiety.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated resource pack for use by primary care prescribers for managing non-cognitive symptoms in people living with dementia.
Risperidone has been agreed as BLUE for psychosis

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated resource pack for use by primary care prescribers for managing non-cognitive symptoms in people living with dementia.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated resource pack for use by primary care prescribers for managing non-cognitive symptoms in people living with dementia.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated resource pack for use by primary care prescribers for managing non-cognitive symptoms in people living with dementia.

The Surrey Heartlands Integrated Care System approves the use of relugolix-estradiol-norethisterone as recommended by NICE TA832 as an option for  treating moderate to severe symptoms of uterine fibroids in adults of reproductive age.

Relugolix-estradiol-norethisterone will be given a BLUE (no information sheet) traffic light status for this indication with specialist initiation and continued prescribing for at least 3 months prior to transfer of care to primary care prescribers.

A DXA scan is recommended after the first 52 weeks of treatment to verify that the patient does not have an unwanted degree of BMD loss, that exceeds the benefit of treatment. This DXA scan will be organised & performed by the specialist team responsible for the ongoing care of the patient.
 

Colecalciferol is recommended for the treatment of vitamin D deficiency and insufficiency in line with the local guidelines below.

The 25,000iu tablets are agreed for use in an Acute setting and have been assigned a RED traffic light status.

For primary care, the following colecalciferol presentations have been agreed for use and have a Green traffic light status when prescribed in accordance with the local guidelines below:

Colecalciferol 1,000iu tablets
Colecalciferol 50,000iu capsules
Colecalciferol 4,000iu tablets (reserved for patients who are unable to comply with weekly dosing)
Colecalciferol 50,000 units/ml oral solution unit dose ampoules (reserved for patients who are unable to swallow tablets / capsules)
Colecalciferol 10,000 units/ml oral drops sugar free (reserved for patients who are unable to swallow tablets / capsules)

All other colecalciferol preparations (including unlicensed) should not be initiated in new patients. 
Patients receiving unlicensed preparations, or those NOT included in the list above, may be reviewed and switched to a locally recommended preparation as appropriate.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for Amiodarone (with some local adaption) for patients within adult services.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed an algorithm for prescribing PPIs in children (see below).  Included medicines are:
 

Omeprazole oral powder for suspension is BLUE (on recommendation of a specialist) 

• ONLY for children under 10kg and with enteral feeding tubes (less than 8Fr) in place.
• Consider using the higher strength preparation, 20mg/5ml as proportion of sodium,  potassium and preservatives per dose is less. 
• Switch to alternative PPI as per algorithm when enteral feeding tube is removed or larger gauge used

Omeprazole dispersible tablets are GREEN

• 1st line treatment option in children unable to swallow omeprazole capsules.
• Mezzopram® brand is preferred due to the smaller granule sizes. If Mezzopram® is out of stock or unavailable Losec Mups® should be used as an alternative.
• Disperse the tablets in water, then mix with orange/apple/ pineapple juice, apple sauce or yoghurt 

Omeprazole capsules are GREEN

• 1st line treatment option in children who are able to swallow capsules; OR
• For children who cannot swallow capsules, most capsules can be opened (licensed) and mixed with water or a slightly acidic fluid e.g. fruit juice, apple sauce

Lansoprazole capsules are GREEN 

• 2nd line treatment option in children who are able to swallow capsules
• For children who cannot swallow capsules, some capsules are licensed to be opened and have their contents mixed with water, apple/tomato juice or sprinkled on soft food (e.g. yoghurt, apple puree)

Lansoprazole orodispersible tablets are GREEN

• 2nd line treatment option in children unable to swallow omeprazole or lansoprazole capsules.
• Oro-dispersible tablets disperse in the mouth to release gastro-resistant granules. Lansoprazole is NOT absorbed sublingually. The gastro-resistant granules must be swallowed for the medicine to be effective. The FasTabs® can also be administered in apple or orange juice.

Esomeprazole granules are GREEN 

• ONLY for children 10kg or more, with enteral feeding tubes (6Fr or larger) in place. 
• For children unable to swallow tablets,  omeprazole or lansprazole capsules or orodispersible tablets would be  preferred alternative options.

Aclomep® powder is RED

• Only for use by Ashford & St Peters NICU

All other unlicensed oral  PPI suspension preparations should be considered NON-Formulary
 

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed an algorithm for prescribing PPIs in children (see below).  Included medicines are:
 

Omeprazole oral powder for suspension is BLUE (on recommendation of a specialist) 

• ONLY for children under 10kg and with enteral feeding tubes (less than 8Fr) in place.
• Consider using the higher strength preparation, 20mg/5ml as proportion of sodium,  potassium and preservatives per dose is less. 
• Switch to alternative PPI as per algorithm when enteral feeding tube is removed or larger gauge used

Omeprazole dispersible tablets are GREEN

• 1st line treatment option in children unable to swallow omeprazole capsules.
• Mezzopram® brand is preferred due to the smaller granule sizes. If Mezzopram® is out of stock or unavailable Losec Mups® should be used as an alternative.
• Disperse the tablets in water, then mix with orange/apple/ pineapple juice, apple sauce or yoghurt 

Omeprazole capsules are GREEN

• 1st line treatment option in children who are able to swallow capsules; OR
• For children who cannot swallow capsules, most capsules can be opened (licensed) and mixed with water or a slightly acidic fluid e.g. fruit juice, apple sauce

Lansoprazole capsules are GREEN 

• 2nd line treatment option in children who are able to swallow capsules
• For children who cannot swallow capsules, some capsules are licensed to be opened and have their contents mixed with water, apple/tomato juice or sprinkled on soft food (e.g. yoghurt, apple puree)

Lansoprazole orodispersible tablets are GREEN

• 2nd line treatment option in children unable to swallow omeprazole or lansoprazole capsules.
• Oro-dispersible tablets disperse in the mouth to release gastro-resistant granules. Lansoprazole is NOT absorbed sublingually. The gastro-resistant granules must be swallowed for the medicine to be effective. The FasTabs® can also be administered in apple or orange juice.

Esomeprazole granules are GREEN 

• ONLY for children 10kg or more, with enteral feeding tubes (6Fr or larger) in place. 
• For children unable to swallow tablets,  omeprazole or lansprazole capsules or orodispersible tablets would be  preferred alternative options.

Aclomep® powder is RED

• Only for use by Ashford & St Peters NICU

All other unlicensed oral  PPI suspension preparations should be considered NON-Formulary

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed an algorithm for prescribing PPIs in children (see below).  Included medicines are:
 

Omeprazole oral powder for suspension is BLUE (on recommendation of a specialist) 

• ONLY for children under 10kg and/or with enteral feeding tubes (less than 8Fr) in place.
• Consider using the higher strength preparation, 20mg/5ml as proportion of sodium,  potassium and preservatives per dose is less. 
• Switch to alternative PPI as per algorithm when enteral feeding tube is removed or larger gauge used

Omeprazole dispersible tablets are GREEN

• 1st line treatment option in children unable to swallow omeprazole capsules.
• Mezzopram® brand is preferred due to the smaller granule sizes. If Mezzopram® is out of stock or unavailable Losec Mups® should be used as an alternative.
• Disperse the tablets in water, then mix with orange/apple/ pineapple juice, apple sauce or yoghurt 

Omeprazole capsules are GREEN

• 1st line treatment option in children who are able to swallow capsules; OR
• For children who cannot swallow capsules, most capsules can be opened (licensed) and mixed with water or a slightly acidic fluid e.g. fruit juice, apple sauce

Lansoprazole capsules are GREEN 

• 2nd line treatment option in children who are able to swallow capsules
• For children who cannot swallow capsules, some capsules are licensed to be opened and have their contents mixed with water, apple/tomato juice or sprinkled on soft food (e.g. yoghurt, apple puree)

Lansoprazole orodispersible tablets are GREEN

• 2nd line treatment option in children unable to swallow omeprazole or lansoprazole capsules.
• Oro-dispersible tablets disperse in the mouth to release gastro-resistant granules. Lansoprazole is NOT absorbed sublingually. The gastro-resistant granules must be swallowed for the medicine to be effective. The FasTabs® can also be administered in apple or orange juice.

Esomeprazole granules are GREEN 

• ONLY for children 10kg or more, with enteral feeding tubes (6Fr or larger) in place. 
• For children unable to swallow tablets,  omeprazole or lansprazole capsules or orodispersible tablets would be  preferred alternative options.

Aclomep® powder is RED

• Only for use by Ashford & St Peters NICU

All other unlicensed oral  PPI suspension preparations should be considered NON-Formulary

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed an algorithm for prescribing PPIs in children (see below).  Included medicines are:
 

Omeprazole oral powder for suspension is BLUE (on recommendation of a specialist) 

• ONLY for children under 10kg and/or with enteral feeding tubes (less than 8Fr) in place.
• Consider using the higher strength preparation, 20mg/5ml as proportion of sodium,  potassium and preservatives per dose is less. 
• Switch to alternative PPI as per algorithm when enteral feeding tube is removed or larger gauge used

Omeprazole dispersible tablets are GREEN

• 1st line treatment option in children unable to swallow omeprazole capsules.
• Mezzopram® brand is preferred due to the smaller granule sizes. If Mezzopram® is out of stock or unavailable Losec Mups® should be used as an alternative.
• Disperse the tablets in water, then mix with orange/apple/ pineapple juice, apple sauce or yoghurt 

Omeprazole capsules are GREEN

• 1st line treatment option in children who are able to swallow capsules; OR
• For children who cannot swallow capsules, most capsules can be opened (licensed) and mixed with water or a slightly acidic fluid e.g. fruit juice, apple sauce

Lansoprazole capsules are GREEN 

• 2nd line treatment option in children who are able to swallow capsules
• For children who cannot swallow capsules, some capsules are licensed to be opened and have their contents mixed with water, apple/tomato juice or sprinkled on soft food (e.g. yoghurt, apple puree)

Lansoprazole orodispersible tablets are GREEN

• 2nd line treatment option in children unable to swallow omeprazole or lansoprazole capsules.
• Oro-dispersible tablets disperse in the mouth to release gastro-resistant granules. Lansoprazole is NOT absorbed sublingually. The gastro-resistant granules must be swallowed for the medicine to be effective. The FasTabs® can also be administered in apple or orange juice.

Esomeprazole granules are GREEN 

• ONLY for children 10kg or more, with enteral feeding tubes (6Fr or larger) in place. 
• For children unable to swallow tablets,  omeprazole or lansprazole capsules or orodispersible tablets would be  preferred alternative options.

Aclomep® powder is RED

• Only for use by Ashford & St Peters NICU

All other unlicensed oral  PPI suspension preparations should be considered NON-Formulary
 

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed an algorithm for prescribing PPIs in children (see below).  Included medicines are:
 

Omeprazole oral powder for suspension is BLUE (on recommendation of a specialist) 

• ONLY for children under 10kg and/or with enteral feeding tubes (less than 8Fr) in place.
• Consider using the higher strength preparation, 20mg/5ml as proportion of sodium,  potassium and preservatives per dose is less. 
• Switch to alternative PPI as per algorithm when enteral feeding tube is removed or larger gauge used

Omeprazole dispersible tablets are GREEN

• 1st line treatment option in children unable to swallow omeprazole capsules.
• Mezzopram® brand is preferred due to the smaller granule sizes. If Mezzopram® is out of stock or unavailable Losec Mups® should be used as an alternative.
• Disperse the tablets in water, then mix with orange/apple/ pineapple juice, apple sauce or yoghurt 

Omeprazole capsules are GREEN

• 1st line treatment option in children who are able to swallow capsules; OR
• For children who cannot swallow capsules, most capsules can be opened (licensed) and mixed with water or a slightly acidic fluid e.g. fruit juice, apple sauce

Lansoprazole capsules are GREEN 

• 2nd line treatment option in children who are able to swallow capsules
• For children who cannot swallow capsules, some capsules are licensed to be opened and have their contents mixed with water, apple/tomato juice or sprinkled on soft food (e.g. yoghurt, apple puree)

Lansoprazole orodispersible tablets are GREEN

• 2nd line treatment option in children unable to swallow omeprazole or lansoprazole capsules.
• Oro-dispersible tablets disperse in the mouth to release gastro-resistant granules. Lansoprazole is NOT absorbed sublingually. The gastro-resistant granules must be swallowed for the medicine to be effective. The FasTabs® can also be administered in apple or orange juice.

Esomeprazole granules are GREEN 

• ONLY for children 10kg or more, with enteral feeding tubes (6Fr or larger) in place. 
• For children unable to swallow tablets,  omeprazole or lansprazole capsules or orodispersible tablets would be  preferred alternative options.

Aclomep® powder is RED

• Only for use by Ashford & St Peters NICU

All other unlicensed oral  PPI suspension preparations should be considered NON-Formulary
 

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed an algorithm for prescribing PPIs in children (see below).  Included medicines are:
 

Omeprazole oral powder for suspension is BLUE (on recommendation of a specialist) 

• ONLY for children under 10kg and/or with enteral feeding tubes (less than 8Fr) in place.
• Consider using the higher strength preparation, 20mg/5ml as proportion of sodium,  potassium and preservatives per dose is less. 
• Switch to alternative PPI as per algorithm when enteral feeding tube is removed or larger gauge used

Omeprazole dispersible tablets are GREEN

• 1st line treatment option in children unable to swallow omeprazole capsules.
• Mezzopram® brand is preferred due to the smaller granule sizes. If Mezzopram® is out of stock or unavailable Losec Mups® should be used as an alternative.
• Disperse the tablets in water, then mix with orange/apple/ pineapple juice, apple sauce or yoghurt 

Omeprazole capsules are GREEN

• 1st line treatment option in children who are able to swallow capsules; OR
• For children who cannot swallow capsules, most capsules can be opened (licensed) and mixed with water or a slightly acidic fluid e.g. fruit juice, apple sauce

Lansoprazole capsules are GREEN 

• 2nd line treatment option in children who are able to swallow capsules
• For children who cannot swallow capsules, some capsules are licensed to be opened and have their contents mixed with water, apple/tomato juice or sprinkled on soft food (e.g. yoghurt, apple puree)

Lansoprazole orodispersible tablets are GREEN

• 2nd line treatment option in children unable to swallow omeprazole or lansoprazole capsules.
• Oro-dispersible tablets disperse in the mouth to release gastro-resistant granules. Lansoprazole is NOT absorbed sublingually. The gastro-resistant granules must be swallowed for the medicine to be effective. The FasTabs® can also be administered in apple or orange juice.

Esomeprazole granules are GREEN 

• ONLY for children 10kg or more, with enteral feeding tubes (6Fr or larger) in place. 
• For children unable to swallow tablets,  omeprazole or lansprazole capsules or orodispersible tablets would be  preferred alternative options.

Aclomep® powder is RED

• Only for use by Ashford & St Peters NICU

All other unlicensed oral  PPI suspension preparations should be considered NON-Formulary

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed that unlicensed PPI oral suspensions should not be prescribed in primary care and will be given a RED traffic light status

NICU at Ashford & St Peters NHS Foundation Trust have agreed to use unlicensed omeprazole suspension (Aclomep 20mg in 5ml) in their premature babies.

This unlicensed formulation will be supplied by the trust for as long as the child needs that particular formulation.

Colecalciferol is recommended for the treatment of vitamin D deficiency and insufficiency in line with the local guidelines below.

Only the following colecalciferol presentations have been agreed for use and have a Green traffic light status when prescribed in accordance with the local guidelines below:

• Colecalciferol 1,000iu tablets
• Colecalciferol 50,000iu capsules
• Colecalciferol 4,000iu tablets (reserved for patients who are unable to comply with weekly dosing)
• Colecalciferol 50,000 units/ml oral solution unit dose ampoules (reserved for patients who are unable to swallow tablets / capsules)
• Colecalciferol 10,000 units/ml oral drops sugar free (reserved for patients who are unable to swallow tablets / capsules)
• Colecalciferol 25,000iu tablets are agreed for use in an Acute setting = RED traffic light status

All other colecalciferol preparations (including unlicensed) should not be initiated in new patients.

Colecalciferol is recommended for the treatment of vitamin D deficiency and insufficiency in line with the local guidelines below.

Only the following colecalciferol presentations have been agreed for use and have a Green traffic light status when prescribed in accordance with the local guidelines below:

• Colecalciferol 1,000iu tablets
• Colecalciferol 50,000iu capsules
• Colecalciferol 4,000iu tablets (reserved for patients who are unable to comply with weekly dosing)
• Colecalciferol 50,000 units/ml oral solution unit dose ampoules (reserved for patients who are unable to swallow tablets / capsules)
• Colecalciferol 10,000 units/ml oral drops sugar free (reserved for patients who are unable to swallow tablets / capsules)
• Colecalciferol 25,000iu tablets are agreed for use in an Acute setting = RED traffic light status

All other colecalciferol preparations (including unlicensed) should not be initiated in new patients.

Colecalciferol is recommended for the treatment of vitamin D deficiency and insufficiency in line with the local guidelines below.

Only the following colecalciferol presentations have been agreed for use and have a Green traffic light status when prescribed in accordance with the local guidelines below:

• Colecalciferol 1,000iu tablets
• Colecalciferol 50,000iu capsules
• Colecalciferol 4,000iu tablets (reserved for patients who are unable to comply with weekly dosing)
• Colecalciferol 50,000 units/ml oral solution unit dose ampoules (reserved for patients who are unable to swallow tablets / capsules)
• Colecalciferol 10,000 units/ml oral drops sugar free (reserved for patients who are unable to swallow tablets / capsules)
• Colecalciferol 25,000iu tablets are agreed for use in an Acute setting = RED traffic light status

All other colecalciferol preparations (including unlicensed) should not be initiated in new patients.

Colecalciferol is recommended for the treatment of vitamin D deficiency and insufficiency in line with the local guidelines below.

Only the following colecalciferol presentations have been agreed for use and have a Green traffic light status when prescribed in accordance with the local guidelines below:

• Colecalciferol 1,000iu tablets
• Colecalciferol 50,000iu capsules
• Colecalciferol 4,000iu tablets (reserved for patients who are unable to comply with weekly dosing)
• Colecalciferol 50,000 units/ml oral solution unit dose ampoules (reserved for patients who are unable to swallow tablets / capsules)
• Colecalciferol 10,000 units/ml oral drops sugar free (reserved for patients who are unable to swallow tablets / capsules)
• Colecalciferol 25,000iu tablets are agreed for use in an Acute setting = RED traffic light status

All other colecalciferol preparations (including unlicensed) should not be initiated in new patients.

Colecalciferol is recommended for the treatment of vitamin D deficiency and insufficiency in line with the local guidelines below.

Only the following colecalciferol presentations have been agreed for use and have a Green traffic light status when prescribed in accordance with the local guidelines below:

• Colecalciferol 1,000iu tablets
• Colecalciferol 50,000iu capsules
• Colecalciferol 4,000iu tablets (reserved for patients who are unable to comply with weekly dosing)
• Colecalciferol 50,000 units/ml oral solution unit dose ampoules (reserved for patients who are unable to swallow tablets / capsules)
• Colecalciferol 10,000 units/ml oral drops sugar free (reserved for patients who are unable to swallow tablets / capsules)
• Colecalciferol 25,000iu tablets are agreed for use in an Acute setting = RED traffic light status

All other colecalciferol preparations (including unlicensed) should not be initiated in new patients.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed the following traffic lights status for iron preparations for iron deficiency anaemia as follows:

GREEN traffic light status - preferred
•    Ferrous Sulfate 200mg tablets
•    Ferrous Fumerate 210mg tablets
•    Ferrous Gluconate 300mg tablets

GREEN
•    Sodium Feredetate liquid – where a liquid is needed

GREEN
•    Ferric Maltol 30mg capsules – reserved as a last option before referral and if parenteral iron is being considered

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed the following traffic lights status for iron preparations for iron deficiency anaemia as follows:

GREEN traffic light status - preferred
•    Ferrous Sulfate 200mg tablets
•    Ferrous Fumerate 210mg tablets
•    Ferrous Gluconate 300mg tablets

GREEN
•    Sodium Feredetate liquid – where a liquid is needed

GREEN
•    Ferric Maltol 30mg capsules – reserved as a last option before referral and if parenteral iron is being considered

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed the following traffic lights status for iron preparations for iron deficiency anaemia as follows:

GREEN traffic light status - preferred
•    Ferrous Sulfate 200mg tablets
•    Ferrous Fumerate 210mg tablets
•    Ferrous Gluconate 300mg tablets

GREEN
•    Sodium Feredetate liquid – where a liquid is needed

GREEN
•    Ferric Maltol 30mg capsules – reserved as a last option before referral and if parenteral iron is being considered

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed the following traffic lights status for iron preparations for iron deficiency anaemia as follows:

GREEN traffic light status - preferred
•    Ferrous Sulfate 200mg tablets
•    Ferrous Fumerate 210mg tablets
•    Ferrous Gluconate 300mg tablets

GREEN
•    Sodium Feredetate liquid – where a liquid is needed

GREEN
•    Ferric Maltol 30mg capsules – reserved as a last option before referral and if parenteral iron is being considered

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed the following traffic lights status for iron preparations for iron deficiency anaemia as follows:

GREEN traffic light status - preferred
•    Ferrous Sulfate 200mg tablets
•    Ferrous Fumerate 210mg tablets
•    Ferrous Gluconate 300mg tablets

GREEN
•    Sodium Feredetate liquid – where a liquid is needed

GREEN
•    Ferric Maltol 30mg capsules – reserved as a last option before referral and if parenteral iron is being considered

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the use of Ventolin Accuhaler as a treatment option in the management of asthma & COPD.

Ventolin Accuhaler and Salbutamol Easyhaler are the locally preferred dry powder devices.

Salamol MDI is the locally preferred salbutamol MDI device and should be used with a spacer device.
It has a lower carbon footprint than the large volume MDIs such as Ventolin.

Branded prescribing of inhaler devices is recommended.

See local guidelines below

Salbutamol Easyhaler or Ventolin Accuhaler are the locally preferred dry powder devices

Salamol MDI is the locally preferred salbutamol MDI device and should be used with a spacer device.
It has a lower carbon footprint than the large volume MDIs such as Ventolin.

Branded prescribing of inhaler devices is recommended.
See guidelines below

Salamol MDI is the locally preferred salbutamol MDI device. It has a lower carbon footprint than the large volume MDIs such as Ventolin.

Note - the Salamol Easi-breathe is less cost effective and is NOT a locally preferred device

A spacer device should be used with MDI devices.

If an alternative device is necessary, the Ventolin Accuhaler (DPI) or Easyhaler Salbutamol (DPI) are the locally preferred options (prescribe by BRAND)

Branded prescribing of inhaler devices is recommended.

See Asthma guidelines below

The locally preferred salbutamol devices are as follows:

Low carbon:

• Salbutamol Easyhaler (dry powder inhaler)
• Ventolin Accuhaler (dry powder inhaler)

Alternative devices:

• Salamol (MDI) is the locally preferred salbutamol metered dose inhaler device and should be used with a spacer device. It has a lower carbon footprint than the large volume MDIs such as Ventolin.
• Ventolin Evohaler (MDI) 

Branded prescribing of inhaler devices is recommended.

See local COPD guidelines for more information

The locally preferred salbutamol devices are as follows:

Low carbon:

• Salbutamol Easyhaler (dry powder inhaler)
• Ventolin Accuhaler (dry powder inhaler)

Alternative devices:

• Salamol (MDI) is the locally preferred salbutamol metered dose inhaler device and should be used with a spacer device. It has a lower carbon footprint than the large volume MDIs such as Ventolin.
• Ventolin Evohaler (MDI) 

Note - the Salamol Easi-breathe is less cost effective and is NOT a locally preferred device

A spacer device should be used with MDI devices.

Branded prescribing of inhaler devices is recommended.

See COPD guidelines below

Salbutamol Easyhaler or Ventolin Accuhaler are the locally preferred, low carbon, dry powder devices

Alternative devices:

• Salamol (MDI) is the locally preferred salbutamol metered dose inhaler device and should be used with a spacer device. It has a lower carbon footprint than the large volume MDIs such as Ventolin.
• Ventolin Evohaler (MDI) 

Branded prescribing of inhaler devices is recommended.
See COPD guidelines below

Local resources have been developed (see below) to aid prescribers in the identification of locally preferred, lower-carbon inhaler devices.

There are also a range of nationally produced tools and education materials designed to improve the quality of care in Asthma while reducing carbon emissions. See link below to Greener Practice

https://www.greenerpractice.co.uk/high-quality-and-low-carbon-asthma-care/

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve upadacitinib as recommended by NICE TA829 as an option for treating active ankylosing spondylitis that is not controlled well enough with conventional therapy in adults.

Upadacitinib for this indication will be considered as RED on the traffic light status (treatment should be initiated and continued by specialist clinicians).

Please see the current treatment pathway below.

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a Wet Age Related Macular Degeneration (wet-AMD) treatment pathway attached below for information.

PLEASE NOTE: The most cost-effective anti-VEGF treatment is biosimilar ranibizumab which will be counted as a ‘free switch’ for patients where monthly injections is clinically appropriate.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a Wet Age Related Macular Degeneration (wet-AMD) treatment pathway attached below for information.

PLEASE NOTE: The most cost-effective anti-VEGF treatment is biosimilar ranibizumab which will be counted as a ‘free switch’ for patients where monthly injections is clinically appropriate.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a Wet Age Related Macular Degeneration (wet-AMD) treatment pathway attached below for information. 

PLEASE NOTE: The most cost-effective anti-VEGF treatment is biosimilar ranibizumab which will be counted as a ‘free switch’ for patients where monthly injections is clinically appropriate.

The Surrey Heartlands Integrated Care System Area Prescribing Committee approve the increased access to THREE switches for existing NICE approved anti-VEGF treatments to optimise response. A Wet Age Related Macular Degeneration (wet-AMD) treatment pathway was also agreed by the APC and is attached  for information.

PLEASE NOTE: The most cost-effective anti-VEGF treatment is biosimilar ranibizumab which will be counted as a ‘free switch’ for patients where monthly injections is clinically appropriate.

The Surrey Heartlands Integrated Care System Area Prescribing Committee approve the increased access to THREE switches for existing NICE approved anti-VEGF treatments to optimise response. A Diabetic Macular Oedema (DMO) treatment pathway was also agreed by the APC and is attached  for information.

PLEASE NOTE: The most cost-effective anti-VEGF treatment is biosimilar ranibizumab which will be counted as a ‘free switch’ for patients where monthly injections is clinically appropriate.

The Surrey Heartlands Integrated Care System Area Prescribing Committee approve the increased access to THREE switches for existing NICE approved anti-VEGF treatments to optimise response. A Diabetic Macular Oedema (DMO) treatment pathway was also agreed by the APC and is attached  for information.

PLEASE NOTE: The most cost-effective anti-VEGF treatment is biosimilar ranibizumab which will be counted as a ‘free switch’ for patients where monthly injections is clinically appropriate.

The Surrey Heartlands Integrated Care System Area Prescribing Committee approve the increased access to THREE switches for existing NICE approved anti-VEGF treatments to optimise response. A Diabetic Macular Oedema (DMO) treatment pathway was also agreed by the APC and is attached  for information.

PLEASE NOTE: The most cost-effective anti-VEGF treatment is biosimilar ranibizumab which will be counted as a ‘free switch’ for patients where monthly injections is clinically appropriate.

The Surrey Heartlands Integrated Care System Area Prescribing Committee approve the increased access to THREE switches for existing NICE approved anti-VEGF treatments to optimise response. A Diabetic Macular Oedema (DMO) treatment pathway was also agreed by the APC and is attached  for information.

PLEASE NOTE: The most cost-effective anti-VEGF treatment is biosimilar ranibizumab which will be counted as a ‘free switch’ for patients where monthly injections is clinically appropriate.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve intravitreal dexamethasone as a treatment option for the treatment of Diabetic Macular Oedema in line with NICE TA824. A Diabetic Macular Oedema (DMO) treatment pathway was also agreed by the APC and is attached  for information.

Intravitreal dexamethasone will be considered RED on the traffic light system.

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a Diabetic Macular Oedema (DMO) treatment pathway attached below for information. 

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

The local adaptation excludes gastroenterology indications from shared care, as it is considered a short-term treatment requiring hospital led treatment, and therefore a RED traffic light status, and this is endorsed by the Surrey Heartlands clinicians. All other indications listed in the shared care document will be considered AMBER

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of ciclosporin is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

The local adaptation excludes gastroenterology indications from shared care, as it is considered a short-term treatment requiring hospital led treatment, and therefore a RED traffic light status, and this is endorsed by the Surrey Heartlands clinicians. All other indications listed in the shared care document will be considered AMBER

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of ciclosporin is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

The local adaptation excludes gastroenterology indications from shared care, as it is considered a short-term treatment requiring hospital led treatment, and therefore a RED traffic light status, and this is endorsed by the Surrey Heartlands clinicians. All other indications listed in the shared care document will be considered AMBER

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of ciclosporin is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

The local adaptation excludes gastroenterology indications from shared care, as it is considered a short-term treatment requiring hospital led treatment, and therefore a RED traffic light status, and this is endorsed by the Surrey Heartlands clinicians. All other indications listed in the shared care document will be considered AMBER

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of ciclosporin is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

The local adaptation excludes gastroenterology indications from shared care, as it is considered a short-term treatment requiring hospital led treatment, and therefore a RED traffic light status, and this is endorsed by the Surrey Heartlands clinicians. All other indications listed in the shared care document will be considered AMBER

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of ciclosporin is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

The local adaptation excludes gastroenterology indications from shared care, as it is considered a short-term treatment requiring hospital led treatment, and therefore a RED traffic light status, and this is endorsed by the Surrey Heartlands clinicians. All other indications listed in the shared care document will be considered AMBER

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of ciclosporin is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of methotrexate is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label (refer to section 3 for further information).

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of methotrexate is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label (refer to section 3 for further information).

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of methotrexate is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label (refer to section 3 for further information).

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of methotrexate is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label (refer to section 3 for further information).

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of methotrexate is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label (refer to section 3 for further information).

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve the RMOC national shared care protocol with ‘local adaptations’.

This shared care protocol applies to adults aged 18 and over.

This shared care protocol also includes treatment of chronic inflammatory conditions where off-label use of methotrexate is appropriate, including, but not limited to, the specialities and conditions described in Section 3 of the document.

These indications are off-label. The specialist must specify the indication for each patient when initiating shared care and clearly state when use is off-label (refer to section 3 for further information).

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a BLUE information sheet for empagliflozin and dapagliflozin for Adult Heart Failure with reduced ejection fraction (HFrEF) and a place in therapy document for these treatments in patients with Heart Failure.

 PLEASE NOTE THE CHANGE IN ADVICE:

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a BLUE information sheet for empagliflozin and dapagliflozin for Adult Heart Failure with reduced ejection fraction (HFrEF) (in line with NICE TA773 and NICE TA679), and a place in therapy document for these treatments in patients with Heart Failure.

The specialist should either:

• provide a minimum of one month supply OR
• provide advice and guidance and recommend to the patient’s primary care prescriber to initiate prescribing

DO NOT INITIATE dapagliflozin in patients with type I diabetes and heart failure as this is off label use (outside of license)

NOTE - 

Dapagliflozin for symptomatic heart failure (other than adult symptomatic chronic Heart Failure with reduced ejection fraction) has not yet been assessed for formulary status.

This is a license extension that has not yet been evaluated by NICE or the Surrey Heartlands ICS Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug for this extended indication.

NICE are due to publish further guidance on Dapagliflozin in June 2023 and this will be considered by the APC within NICE timelines

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Area Prescribing Committee have approved a Blood Glucose Testing Strip / Meter Fomulary for Surrey Heartlands.

Please refer to the formulary document for further information on the test strips and meters that have been agreed for:

• general use in adults (GlucoRx Q and FineTest Lite)
• paediatric use (Instant, 4SURE)
• gestational diabetes (WaveSense JAZZ)
• carbohydrate counting (4SURE, CareSens Pro)
• ketone testing (GlucoRx HCT Glucose, GlucoRx HCT Ketone, KetoSens, 4SURE beta-ketone)
• visually impaired (GlucoRx Nexus)
• manual dexterity issues (Instant)

Patients with flash glucose monitoring systems should be supplied with the strips recommended for general use in adults (GlucoRx Q or FineTest Lite)

NOTE - the formulary does NOT include recommendations for insulin pumps or CGM devices - ensure that compatible strips are prescribed. If there are no specific strip requirements, please prescribe strips recommended for general adult use (GlucoRx Q or FineTest Lite).

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve Icosapent ethyl with statin therapy as a treatment option for reducing the risk of cardiovascular events in people with raised triglycerides in line with NICE TA805.
Icosapent ethyl for this indication will be considered as GREEN on the traffic light status.
The committee noted an increased risk of atrial fibrillation or fluttter - prescribers should consider advice given in the Summary of Product Charcteristics available at https://www.medicines.org.uk/emc/product/12964

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the use of Roxadustat for treating symptomatic anaemia in chronic kidney disease in line with NICE TA807

Roxadustat will be given a RED traffic light status. Prescribing will be by hospital specialists only, in line with NICE TA807. 

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve brolucizumab as an option for treating Diabetic Macula Oedema in line with NICE TA820.  

Brolucizumab for this indication will be considered as RED on the traffic light status (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for azathioprine and mercaptopurine for patients in adult services (non- transplant indications)

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve guselkumab as an option for treating active psoriatic arthritis in adults whose disease has not responded well enough to disease-modifying antirheumatic drugs (DMARDs) or who cannot tolerate them, in line with NICE TA815.  Please see the current treatment pathway below.

Guselkumab for this indication will be considered as RED on the traffic light status (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.

The Area Prescribing Committee recommends the use of melatonin in children and adolescents with persistent sleep disorders (see approved formulations  and indications below).

The recommended products are:

Melatonin 2mg MR tablets (prescribed generically) are recommended 1st line (off-label use)
Licensed, immediate release tablets (available in strengths of 1mg-5mg)
Crushed immediate release tablets (available in strengths of 1mg-5mg) for children unable to swallow tablets
Melatonin 1mg/ml oral solution sugar free (the licensed liquid is also alcohol free) is reserved ONLY for those children who have a feeding tube in situ, or who have significant feeding difficulties, and the use of the whole or crushed tablets are unsuitable. Refer to Treatment Pathway below.

Prescribers are advised to check excipients of the oral solutions, as some may not be suitable for under 5s and to also check licensed indications.  It is possible that that the licensed liquid may be prescribed for an off-label indication, but this is considered preferable to using an unlicensed liquid.

Melatonin prescribing is supported by a number of resources, depending on indication as follows:

Children and young adolescents with ADHD (under the locally commissioned service arrangements) - AMBER shared care
Children and young adolescents with ADHD (NOT under the locally commissioned service arrangements) - AMBER shared care
Children and adolescents with neurodevelopmental disorders (excluding ADHD)  - BLUE information sheet

NON-FORMULARY 
- All other solid dose formulations of melatonin are not supported for use
- other liquid formulations
- Melatonin for use in jet lag
- The Slenyto® brand (1mg and 5 mg prolonged release tablets) has been assigned a BLACK status for all indications - see link for further information https://surreyccg.res-systems.net/PAD/Search/DrugConditionProfile/6243

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication
 

Unlicensed use.
The Area Prescribing Committee recommends the use of melatonin for sleep disorders in adults with neurodevelopmental disorders.

The recommended products are:

• Melatonin 2mg MR tablets (prescribed generically) are recommended 1st line (off-label use)
• Immediate release tablets (available in strengths of 1mg-5mg)
• Crushed immediate release tablets (available in strengths of 1mg-5mg)  for patients unable to swallow tablets
• Melatonin 1mg/ml oral solution sugar free (off-label use) may be considered, for example if the person has a feeding tube, or use of whole or crushed melatonin tablets is unsuitable due to significant difficulties with either the taste or texture. (Note - the liquid preparation, that is licensed in children and for jet lag, is also alcohol free)

Consideration should be given to switching existing melatonin patients to melatonin 2mg MR tablets, following review of treatment.

NON-FORMULARY 
- All other solid dose formulations of melatonin are not supported for use
- other liquid formulations
- Melatonin for use in jet lag
- The Slenyto® brand (1mg and 5 mg prolonged release tablets) has been assigned a BLACK status for all indications - see link for further information https://surreyccg.res-systems.net/PAD/Search/DrugConditionProfile/6243

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication

The use of melatonin in adult patients with other conditions has also been considered - please see links to "other conditions" at the top-right of this page
 

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed that all unlicensed liquid preparations of melatonin will be given a NON-FORMULARY traffic light status.
This includes those that are licensed for jet-lag (or other indications) but are NOT licensed for use in children and adolescents with sleep disorders.

Refer to the recommended products for sleep disorders in children and adolescents: https://surreyccg.res-systems.net/PAD/Search/DrugConditionProfile/4489

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the 1st line use of Angiotensin Receptor Blockers (ARBs) instead of an Angiotensin Converting Enzyme (ACE) inhibitor, for adults with hypertension where the use of an ARB or ACE is deemed equally appropriate.

Losartan or candesartan - 1st line

Alternative options:
Irebsartan - Green
Telmisartan - Green
Valsartan - Green
Olmesartan - Green

Azlisartan - do not initiate in new patients
Eprosartan - do not initiate in new patients

Local hypertension guidelines / pathways will be reviewed and updated in light of this decision

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the 1st line use of Angiotensin Receptor Blockers (ARBs) instead of an Angiotensin Converting Enzyme (ACE) inhibitor, for adults with hypertension where the use of an ARB or ACE is deemed equally appropriate.

Losartan or candesartan - 1st line

Alternative options:
Irebsartan - Green
Telmisartan - Green
Valsartan - Green
Olmesartan - Green

Azlisartan - do not initiate in new patients
Eprosartan - do not initiate in new patients

Local hypertension guidelines / pathways will be reviewed and updated in light of this decision

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the 1st line use of Angiotensin Receptor Blockers (ARBs) instead of an Angiotensin Converting Enzyme (ACE) inhibitor, for adults with hypertension where the use of an ARB or ACE is deemed equally appropriate.

Losartan or candesartan - 1st line

Alternative options:
Irebsartan - Green
Telmisartan - Green
Valsartan - Green
Olmesartan - Green

Azlisartan - do not initiate in new patients
Eprosartan - do not initiate in new patients

Local hypertension guidelines / pathways will be reviewed and updated in light of this decision

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the 1st line use of Angiotensin Receptor Blockers (ARBs) instead of an Angiotensin Converting Enzyme (ACE) inhibitor, for adults with hypertension where the use of an ARB or ACE is deemed equally appropriate.

Losartan or candesartan - 1st line

Alternative options:
Irebsartan - Green
Telmisartan - Green
Valsartan - Green
Olmesartan - Green

Azlisartan - do not initiate in new patients
Eprosartan - do not initiate in new patients

Local hypertension guidelines / pathways will be reviewed and updated in light of this decision

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the 1st line use of Angiotensin Receptor Blockers (ARBs) instead of an Angiotensin Converting Enzyme (ACE) inhibitor, for adults with hypertension where the use of an ARB or ACE is deemed equally appropriate.

Losartan or candesartan - 1st line

Alternative options:
Irebsartan - Green
Telmisartan - Green
Valsartan - Green
Olmesartan - Green

Azlisartan - do not initiate in new patients
Eprosartan - do not initiate in new patients

Local hypertension guidelines / pathways will be reviewed and updated in light of this decision

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the 1st line use of Angiotensin Receptor Blockers (ARBs) instead of an Angiotensin Converting Enzyme (ACE) inhibitor, for adults with hypertension where the use of an ARB or ACE is deemed equally appropriate.

Losartan or candesartan - 1st line

Alternative options:
Irebsartan - Green
Telmisartan - Green
Valsartan - Green
Olmesartan - Green

Azlisartan - do not initiate in new patients
Eprosartan - do not initiate in new patients

Local hypertension guidelines / pathways will be reviewed and updated in light of this decision

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the 1st line use of Angiotensin Receptor Blockers (ARBs) instead of an Angiotensin Converting Enzyme (ACE) inhibitor, for adults with hypertension where the use of an ARB or ACE is deemed equally appropriate.

Eprosartan and Azlisartan are not one of the locally preferred ARBs. See below

Losartan or candesartan - 1st line

Alternative options:
Irebsartan - Green
Telmisartan - Green
Valsartan - Green
Olmesartan - Green

Azlisartan - do not initiate in new patients
Eprosartan - do not initiate in new patients

Local hypertension guidelines / pathways will be reviewed and updated in light of this decision

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the 1st line use of Angiotensin Receptor Blockers (ARBs) instead of an Angiotensin Converting Enzyme (ACE) inhibitor, for adults with hypertension where the use of an ARB or ACE is deemed equally appropriate.

Eprosartan and Azlisartan are not one of the locally preferred ARBs. See below

Losartan or candesartan - 1st line

Alternative options:
Irebsartan - Green
Telmisartan - Green
Valsartan - Green
Olmesartan - Green

Azlisartan - do not initiate in new patients
Eprosartan - do not initiate in new patients

Local hypertension guidelines / pathways will be reviewed and updated in light of this decision

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed that lansoprazole capsules are a first choice option for people with no swallowing difficulties.  

Some lansoprazole capsules are licensed to be opened and have their contents mixed with water, apple/tomato juice, or sprinkled on soft food (e.g. yogurt, apple puree) to help people with swallowing difficulties. 

Some brands are licensed for enteral feeding tubes 14F or larger (check SPC) but other licensed options are available as per below.

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)
   

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed that lansoprazole orodispersible tablets are restricted for use in adults with swallowing difficulties/cannot swallow tablets. Licensed for administration via nasogastric feeding tubes.

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) DOES NOT RECOMMEND lansoprazole suspension and it will be considered NON-FORMULARY on the traffic light system. Please prescribe an alternative preparation. 

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) DOES NOT RECOMMEND lansoprazole oral solution and it will be considered NON-FORMULARY on the traffic light system. Please prescribe an alternative preparation. 

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed that omeprazole capsules are a first choice option for people with no swallowing difficulties.   
Most capsules can be opened, and granules dispersed in water (check individual SPC)

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) DOES NOT RECOMMEND omeprazole tablets and they will be considered NON-FORMULARY on the traffic light system. Please prescribe an alternative preparation. 

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) DOES NOT RECOMMEND omeprazole orodispersible tablets and they will be considered NON-FORMULARY on the traffic light system. Please prescribe an alternative preparation. 

Omeprazole orodispersible tablets are licensed for enteral feeding tubes however the granules in lansoprazole orodispersible tablets are smaller and therefore more appropriate to be used in enteral feeding tubes
 

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) DOES NOT RECOMMEND omeprazole suspension and it will be considered NON-FORMULARY on the traffic light system. Please prescribe an alternative preparation. 

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed that pantoprazole tablets should be restricted for use in patients that cannot have animal-derived products 

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) DOES NOT RECOMMEND esomeprazole tablets and they will be considered NON-FORMULARY on the traffic light system. Please prescribe an alternative preparation. 

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed that esomeprazole granules should be restricted for use in patients with swallowing difficulties or with large bore enteral feeding tube when other options are not clinically appropriate.

Most (but not all) brands of esomeprazole tablets, capsules and granules for oral suspension are licensed for administration via gastric tubes. They will disperse in water for administration. For patients with fine-bore enteral tubes, consider switching to lansoprazole orodispersible tablets, which have smaller micro-granules

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree the following immunomodulators for use in localised psoriasis

• Etanercept    
•  Infliximab
• Adalimumab    
•  Ustekinumab    
• Secukinumab
• Ixekizumab 
• Certolizumab   
• Guselkumab

For use in the following body areas
•    Head and neck – includes face and scalp
•    Nails
•    Genitals
•    Hands and feet
•    Flexures

These are all RED drugs, and the Dermatology teams will complete Blueteq forms for initiation and continuation.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the use of Risankizumab for treating active psoriatic arthritis after inadequate response to DMARDs in line with NICE TA803

Risankizumab will be given a RED traffic light status. Prescribing will be by hospital specialists only, in line with NICE TA803.
 
Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the use of Abrocitinib, tralokinumab and upadacitinib for the treatment of moderate to severe atopic dermatitis in line with NICE TA814

Abrocitinib, tralokinumab and upadacitinib will be given a RED traffic light status. Prescribing will be by hospital specialists only, in line with NICE TA814

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the use of Abrocitinib, tralokinumab and upadacitinib for the treatment of moderate to severe atopic dermatitis in line with NICE TA814

Abrocitinib, tralokinumab and upadacitinib will be given a RED traffic light status. Prescribing will be by hospital specialists only, in line with NICE TA814

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the use of Abrocitinib, tralokinumab and upadacitinib for the treatment of moderate to severe atopic dermatitis in line with NICE TA814

Abrocitinib, tralokinumab and upadacitinib will be given a RED traffic light status. Prescribing will be by hospital specialists only, in line with NICE TA814

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed to support the use of biosimilar ranibizumab to the Surrey Heartlands Health economy in the following licensed indications, in line with the National commissioning recommendations following the national procurement for medical retinal vascular medicines

• Wet Age-Related Macular degeneration (Wet AMD)
• Central Retinal Vein Occlusion (CRVO)
• Branch Retinal Vein Occlusion (BRVO)
• Diabetic Macular Oedema (DMO)
• Myopic Choroidal Revascularisation (CNV)

Ranibizumab biosimilar should be used (in line with original NICE guidance) instead of the originator ranibizumab (Lucentis®) where this is clinically appropriate and there is capacity to do so. If ranibizumab biosimilar is contraindicated or not clinically appropriate for the specific patient or there are specific clinical considerations then, subject to the criteria specified in the relevant NICE technology appraisal guidance, clinicians should consider aflibercept, brolucizumab or faricimab.

Originator ranibizumab should not be used for new initiations

Clinicians should consider switching patients on originator ranibizumab to biosimilar ranibizumab with patient consent.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed to support the use of biosimilar ranibizumab to the Surrey Heartlands Health economy in the following licensed indications, in line with the National commissioning recommendations following the national procurement for medical retinal vascular medicines

• Wet Age-Related Macular degeneration (Wet AMD)
• Central Retinal Vein Occlusion (CRVO)
• Branch Retinal Vein Occlusion (BRVO)
• Diabetic Macular Oedema (DMO)
• Myopic Choroidal Revascularisation (CNV)

Ranibizumab biosimilar should be used (in line with original NICE guidance) instead of the originator ranibizumab (Lucentis®) where this is clinically appropriate and there is capacity to do so. If ranibizumab biosimilar is contraindicated or not clinically appropriate for the specific patient or there are specific clinical considerations then, subject to the criteria specified in the relevant NICE technology appraisal guidance, clinicians should consider aflibercept, brolucizumab or faricimab.

Originator ranibizumab should not be used for new initiations

Clinicians should consider switching patients on originator ranibizumab to biosimilar ranibizumab with patient consent.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed to support the use of biosimilar ranibizumab to the Surrey Heartlands Health economy in the following licensed indications, in line with the National commissioning recommendations following the national procurement for medical retinal vascular medicines

• Wet Age-Related Macular degeneration (Wet AMD)
• Central Retinal Vein Occlusion (CRVO)
• Branch Retinal Vein Occlusion (BRVO)
•  Diabetic Macular Oedema (DMO)
• Myopic Choroidal Revascularisation (CNV)

Ranibizumab biosimilar should be used (in line with original NICE guidance) instead of the originator ranibizumab (Lucentis®) where this is clinically appropriate and there is capacity to do so. If ranibizumab biosimilar is contraindicated or not clinically appropriate for the specific patient or there are specific clinical considerations then, subject to the criteria specified in the relevant NICE technology appraisal guidance, clinicians should consider aflibercept, brolucizumab or faricimab.

Originator ranibizumab should not be used for new initiations

Clinicians should consider switching patients on originator ranibizumab to biosimilar ranibizumab with patient consent.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed to support the use of biosimilar ranibizumab to the Surrey Heartlands Health economy in the following licensed indications, in line with the National commissioning recommendations following the national procurement for medical retinal vascular medicines

• Wet Age-Related Macular degeneration (Wet AMD)
• Central Retinal Vein Occlusion (CRVO)
• Branch Retinal Vein Occlusion (BRVO)
•  Diabetic Macular Oedema (DMO)
• Myopic Choroidal Revascularisation (CNV)

Ranibizumab biosimilar should be used (in line with original NICE guidance) instead of the originator ranibizumab (Lucentis®) where this is clinically appropriate and there is capacity to do so. If ranibizumab biosimilar is contraindicated or not clinically appropriate for the specific patient or there are specific clinical considerations then, subject to the criteria specified in the relevant NICE technology appraisal guidance, clinicians should consider aflibercept, brolucizumab or faricimab.

Originator ranibizumab should not be used for new initiations

Clinicians should consider switching patients on originator ranibizumab to biosimilar ranibizumab with patient consent.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed esomeprazole capsules can continue to be prescribed for patients with no swallowing difficulty but should not be started in any new patients - alternatives are available as per below.

Most (but not all) brands of esomeprazole tablets, capsules and granules for oral suspension are licensed for administration via gastric tubes. They will disperse in water for administration. For patients with fine-bore enteral tubes, consider switching to lansoprazole orodispersible tablets, which have smaller micro-granules

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed that rabeprazole tablets should be restricted for use in patients that cannot have annimal-derived products.

Crushing is not recommended as stomach acid can destroy the active drug

For people with no swallowing difficulties:

• 1st Line: Lansoprazole capsules/Omeprazole capsules
• 2nd line: Pantoprazole tablets (Suitable for patients that cannot have animal-derived products) 
• 2nd line: Rabeprazole tablets (Suitable for patients that cannot have animal-derived products)
• 3rd line: Esomeprazole capsules – not for new initiation

For patients who cannot swallow tablets/have swallowing difficulties:

• 1st Line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules/omeprazole capsules (opened, and granules dispersed in water/yoghurt/apple puree)
• 3rd line: esomeprazole granule sachets

For patients with enteral feeding tubes:

• 1st line: lansoprazole orodispersible tablets
• 2nd line: lansoprazole capsules
• 3rd line: esomeprazole granule sachets (do not use if tube is less than 6F)

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the use of the dronedarone national shared care protocol  for primary care prescribers treating existing adult patients in primary care with Atrial Fibrillation. 

Dronedarone will continue to have a  RED traffic light status for this indication. 

The  use of the shared care protocol will support prescribers with the appropriate monitoring of these patients.
 

ADVICE UPDATE:             
The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the following in relation to prescribing of C.difficile treatments after a positive test for C.difficile.
Vancomycin oral treatment 

• GREEN traffic light status for treatment of C.diff. in adults as per NICE clinical guideline.  
• BLUE (on recommendation) traffic light status for children.  

For any patient requiring a liquid preparation, fidaxomicin granules should be prescribed.  The APC notes that although current NICE guidelines recommend vancomycin first line, it is recognised that this was based on cost and in exceptional cases when a liquid is required, fidaxomicin granules are appropriate to prescribe as a licensed preparation that supports timely treatment.

Follow link to Fidaxomicin information https://surreyccg.res-systems.net/PAD/Search/DrugConditionProfile/6508

SUPPLY

Vancomycin and fidaxomicin are not routinely stocked in community pharmacies but are usually obtainable on next-day delivery. However, at weekends and bank holidays, a local arrangement has been put in place whereby a small number of pharmacies will hold supplies. Please refer to the document below called "Supply of oral vancomycin and fidaxomicin for treating Clostridioides difficile in Primary Care - Mar 23"

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the following in relation to prescribing of C.difficile treatments after a positive test for C.difficile.
Fidaxomicin oral treatment 

• BLUE (on recommendation) of microbiology specialist) for treatment of C.diff. in adults and children as per NICE clinical guideline

For any patient requiring a liquid preparation, fidaxomicin granules should be prescribed.  The APC notes that although current NICE guidelines recommend vancomycin first line, it is recognised that this was based on cost and in exceptional cases when a liquid is required, fidaxomicin granules are appropriate to prescribe as a licensed preparation that supports timely treatment.

SUPPLY:

Vancomycin and fidaxomicin are not routinely stocked in community pharmacies but are usually obtainable on next-day delivery. However, at weekends and bank holidays, a local arrangement has been put in place whereby a small number of pharmacies will hold supplies. Please refer to the document below called "Supply of oral vancomycin and fidaxomicin for treating Clostridioides difficile in Primary Care - Mar 23"

This drug / device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug / device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug / device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission. 

This drug / device falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree the following immunomodulators for use in localised psoriasis

• Etanercept    
•  Infliximab
• Adalimumab    
•  Ustekinumab    
• Secukinumab
• Ixekizumab 
• Certolizumab   
• Guselkumab

For use in the following body areas
•    Head and neck – includes face and scalp
•    Nails
•    Genitals
•    Hands and feet
•    Flexures

These are all RED drugs, and the Dermatology teams will complete Blueteq forms for initiation and continuation.

The Surrey Heartlands Integrated Care System Area Prescribing Committee approve the increased access to THREE switches for existing NICE approved anti-VEGF treatments to optimise response.

Blueteq forms for initiation and continuation will be completed by retinal specialists in secondary care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee approve the increased access to THREE switches for existing NICE approved anti-VEGF treatments to optimise response.
N.B Surrey Heartlands Integrated Care System Area Prescribing Committee DO NOT SUPPORT dose intensification (injections every 4 weeks) of aflibercept, as per change in licence since NICE guidance was published

Blueteq forms for initiation and continuation will be completed by retinal specialists in secondary care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee approve the increased access to THREE switches for existing NICE approved anti-VEGF treatments to optimise response.

Blueteq forms for initiation and continuation will be completed by retinal specialists in secondary care.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree the following immunomodulators for use in localised psoriasis

• Etanercept    
•  Infliximab
• Adalimumab    
•  Ustekinumab    
• Secukinumab
• Ixekizumab 
• Certolizumab   
• Guselkumab

For use in the following body areas
•    Head and neck – includes face and scalp
•    Nails
•    Genitals
•    Hands and feet
•    Flexures

These are all RED drugs, and the Dermatology teams will complete Blueteq forms for initiation and continuation.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree the following immunomodulators for use in localised psoriasis

• Etanercept    
•  Infliximab
• Adalimumab    
•  Ustekinumab    
• Secukinumab
• Ixekizumab 
• Certolizumab   
• Guselkumab

For use in the following body areas
•    Head and neck – includes face and scalp
•    Nails
•    Genitals
•    Hands and feet
•    Flexures

These are all RED drugs, and the Dermatology teams will complete Blueteq forms for initiation and continuation.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree the following immunomodulators for use in localised psoriasis

• Etanercept    
•  Infliximab
• Adalimumab    
•  Ustekinumab    
• Secukinumab
• Ixekizumab 
• Certolizumab   
• Guselkumab

For use in the following body areas
•    Head and neck – includes face and scalp
•    Nails
•    Genitals
•    Hands and feet
•    Flexures

These are all RED drugs, and the Dermatology teams will complete Blueteq forms for initiation and continuation.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree the following immunomodulators for use in localised psoriasis

• Etanercept    
•  Infliximab
• Adalimumab    
•  Ustekinumab    
• Secukinumab
• Ixekizumab 
• Certolizumab   
• Guselkumab

For use in the following body areas
•    Head and neck – includes face and scalp
•    Nails
•    Genitals
•    Hands and feet
•    Flexures

These are all RED drugs, and the Dermatology teams will complete Blueteq forms for initiation and continuation.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree the following immunomodulators for use in localised psoriasis

• Etanercept    
•  Infliximab
• Adalimumab    
•  Ustekinumab    
• Secukinumab
• Ixekizumab 
• Certolizumab   
• Guselkumab

For use in the following body areas
•    Head and neck – includes face and scalp
•    Nails
•    Genitals
•    Hands and feet
•    Flexures

These are all RED drugs, and the Dermatology teams will complete Blueteq forms for initiation and continuation.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree the following immunomodulators for use in localised psoriasis

• Etanercept    
•  Infliximab
• Adalimumab    
•  Ustekinumab    
• Secukinumab
• Ixekizumab 
• Certolizumab   
• Guselkumab

For use in the following body areas
•    Head and neck – includes face and scalp
•    Nails
•    Genitals
•    Hands and feet
•    Flexures

These are all RED drugs, and the Dermatology teams will complete Blueteq forms for initiation and continuation.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed dienogest as a treatment option, after the optimisation of other hormonal treatments, for the management of endometriosis and associated pain symptoms.

Dienogest will be given a BLUE (with information sheet) traffic light status.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree that rivaroxaban is a treatment option for people with coronary or peripheral artery disease in line with NICE TA 607.

Rivaroxaban will be given a GREEN traffic light status for this indication

The APC recognises that the difference between the benefits and risks is small, but the APC supports prescribing for PAD or CAD, in those patients where the clinicians have identified (with shared decision making, and as part of a routine review) that the patient is likely to benefit from treatment with rivaroxaban.

The Surrey Heartland Integrated Care System Area Prescribing Committee has agreed that conventional NPWT should be specific to a system with an external suction pump, and a drainage tube connected to a cannister. It should include the ability to change dressings where these become saturated. The ‘conventional’ NPWT brands are Renasys ®, V.A.C® and KCI®.

GPs should not be requested to prescribe any component of NPWT on FP10. Dressings are available through ONPOS for those places that have local agreements.

NPWT will continue to be considered RED on the traffic lighsystem, unless there is a local agreement for use by Community Tissue Viability Nurses (TVNs), for the following cohorts of patients:
• Patients with dehisced surgical wounds
• Patients with diabetic foot wounds, following the locally
agreed Diabetic Foot pathway and
• Vascular graft wounds

Where there are local arrangements in place, discharge of patients on this treatment may be possible, but only when appropriateness for the individual patient has been assessed by the community TVNs to be suitable for conventional NPWT and are medically fit for discharge.

The Community TVNs must agree to take over treatment responsibility and monitor wound healing and assess when the wounds are suitable for conventional dressings. PICO® and other similar canister free dressings, V.A.C.Via® and SNaP®, should only be used in secondary care for closed surgical incisions, where they have been assessed and approved for the right type of surgical site in line with local governance. If they need to be replaced this should be carried out at the hospital where treatment was initiated.

Implementation of negative pressure wound therapy was originally agreed as requiring local agreement. Further work on aligning these local agreements is tabled in the Wound Formulary Work Plan

The Surrey Heartlands Area Prescribing Committee recommend:

sitagliptin (prescribed generically) as the preferred gliptin (DPP4) - GREEN traffic light status

linagliptin RESTRICTED USE - as an option in patients with deteriorating renal function where there is a risk that dose reduction of sitagliptin may not take place

Other gliptins (alogliptin, vildagliptin, saxagliptin) should NOT BE INITIATED in new patients
 

The Surrey Heartlands Area Prescribing Committee recommend:

sitagliptin (prescribed generically) as the preferred gliptin (DPP4) - GREEN traffic light status

linagliptin RESTRICTED USE - as an option in patients with deteriorating renal function where there is a risk that dose reduction of sitagliptin may not take place

Other gliptins (alogliptin, vildagliptin, saxagliptin) should NOT BE INITIATED in new patients
 

The Surrey Heartlands Area Prescribing Committee recommend:

sitagliptin (prescribed generically) as the preferred gliptin (DPP4) - GREEN traffic light status

linagliptin RESTRICTED USE - as an option in patients with deteriorating renal function where there is a risk that dose reduction of sitagliptin may not take place

Other gliptins (alogliptin, vildagliptin, saxagliptin) should NOT BE INITIATED in new patients
 

The Surrey Heartlands Area Prescribing Committee recommend:

sitagliptin (prescribed generically) as the preferred gliptin (DPP4) - GREEN traffic light status

Linagliptin RESTRICTED USE - as an option in patients with deteriorating renal function where there is a risk that dose reduction of sitagliptin may not take place

Other gliptins (alogliptin, vildagliptin, saxagliptin) should NOT BE INITIATED in new patients

The Surrey Heartlands Area Prescribing Committee recommend:

sitagliptin (prescribed generically) as the preferred gliptin (DPP4) - GREEN traffic light status

linagliptin RESTRICTED USE - as an option in patients with deteriorating renal function where there is a risk that dose reduction of sitagliptin may not take place

Other gliptins (alogliptin, vildagliptin, saxagliptin) should NOT BE INITIATED in new patients
 

The Surrey and North West Sussex Area Prescribing Committee (APC) recommends Melatonin (prescribed generically as 2mg modified release tablets) for the short term (up to 13 weeks) treatment of primary insomnia in patients aged 55 years or over.

The APC were supportive of switching patients from branded to generic 2mg modified release tablets.

Melatonin 2mg prolonged release tablets for this indication will be given a GREEN status on the traffic light system

Clonazepam or melatonin (generic 2mg MR tablets) may be considered to treat rapid eye movement sleep behaviour disorder (RBD) in people with Parkinson's Disease and sleep disturbance (unlicensed use).

A medicines review should first be undertaken to address any possible pharmacological causes.

Clonazepam or melatonin for this condition should only be initiated on request from a Parkinson's specialist

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends dapagliflozin for treating chronic kidney disease in line with NICE TA 775.

Dapagliflozin will be considered GREEN on the traffic light system.

Key considerations:
If a patient with diabetes were on insulin and on multiple other treatments, a discussion with the specialist team may be prudent prior to dapagliflozin initiation. 

NICE (TA 556) does not recommemd the use of this drug

1 Recommendations | Darvadstrocel for treating complex perianal fistulas in Crohn’s disease | Guidance | NICE

In March 2016 the APC (formerly PCN) agreed liothyronine (T3) as an option for the treatment of myxoedema coma and assigned it a RED traffic light status for this indication.

Licensed, bioequivalent liothyronine CAPSULES have entered the market at a considerably reduced price and the APC recommend that:

- the most cost effective preparation should be prescribed (currently capsules) in all new patients
- prescribers should consider switching existing patients from tablets to capsules - for discussion with the patient at next review

The APC noted the additional information provided in the Liothyronine capsules - briefing paper below

See narrative below (June 2019) for recommend use.

NOTE:
Licensed, bioequivalent liothyronine CAPSULES have entered the market at a considerably reduced price and the APC recommend that:

- the most cost effective preparation should be prescribed (currently capsules) in all new patients
- prescribers should consider switching existing patients from tablets to capsules - for discussion with the patient at next review

The APC noted the additional information provided in the Liothyronine capsules - briefing paper below

See narrative below (June 2019) for recommend use.

NOTE:
Licensed, bioequivalent liothyronine CAPSULES have entered the market at a considerably reduced price and the APC recommend that:

- the most cost effective preparation should be prescribed (currently capsules) in all new patients
- prescribers should consider switching existing patients from tablets to capsules - for discussion with the patient at next review

The APC noted the additional information provided in the Liothyronine capsules - briefing paper below

See narrative below (Aug 2019) for recommend use.

NOTE:
Licensed, bioequivalent liothyronine CAPSULES have entered the market at a considerably reduced price and the APC recommend that:

- the most cost effective preparation should be prescribed (currently capsules) in all new patients
- prescribers should consider switching existing patients from tablets to capsules - for discussion with the patient at next review

The APC noted the additional information provided in the Liothyronine capsules - briefing paper below

In March 2016 the APC (formerly PCN) agreed liothyronine (T3) as an option in the management of hypothyroid states occuring in the treatment of thyrotoxicosis and assigned it a RED traffic light status for this indication.

Licensed, bioequivalent liothyronine CAPSULES have entered the market at a considerably reduced price and the APC recommend that:

- the most cost effective preparation should be prescribed (currently capsules) in all new patients
- prescribers should consider switching existing patients from tablets to capsules - for discussion with the patient at next review

The APC noted the additional information provided in the Liothyronine capsules - briefing paper below

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission. 
 

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission. 
 

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission. 
 

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission. 
 

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission. 
 

INTERIM POSITION STATEMENT:
The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following statement for dapagliflozin with insulin for treating type 1 diabetes:

For existing patients: Continue with GP prescribing as AMBER status, with a view to developing an agreement with the specialists that treatment is reviewed at the patients next specialist diabetes review.  See risk minimisation materials below
 

For new patients: Do not initiate in new patients

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends Lenzetto® transdermal spray as a treatment option in the treatment of menopause

Lenzetto® will be considered GREEN on the traffic light system. 

Patients who may be switched to Lenzetto® for the duration of the product shortages would then have the option of remaining on Lenzetto® or reverting to their previous formulation.

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends solriamfetol as a treatment option in the treatment of excessive daytime sleepiness caused by narcolepsy (NICE TA758)

Solriamfetol will be considered RED on the traffic light system. Prescribing will be by hospital specialists only, in line with NICE TA758.

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agree the traffic light status of the antimuscarinic preparations as follows:

Note that advice provided in CKS should be followed prior to initiation of the treatments below:

Oxybutynin (off label for hyperhidrosis)
BLUE on recommendation by the specialist team 

• Immediate release (IR) preferred choice antimuscarinic treatment option 
• Modified release (MR) preparation may be used for patients with intolerable side effects to IR preparation.

All other oxybutynin formulations (Liquid and patches) for hyperhidrosis

• Non-formulary

Propantheline (licensed for hyperhidrosis)
BLUE on recommendation from the specialist team 

• Offered after oxybutynin if intolerable side effects or inefficacy to that treatment

Glycopyrronium oral (off label for hyperhidrosis)
RED traffic light status

• Treatment choice after oxybutynin and propantheline if they have not been tolerated or have not been effective
• More expensive than other treatment options in primary care, although significantly less costly in secondary care
   

These devices have not been evaluated and are not on the workplan for consideration by the Surrey Heartlands ICS Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and place in therapy are yet to be determined.

It is recommended that clinicians prescribe the specific device that is recommended by the specialist who is treating the patient.

The Surrey Heartlands ICS Area Prescribing Committee have agreed the use of an ORBIT-bleed risk scoring tool when considering or reviewing anticoagulant treatment in Atrial Fibrillation (AF).

The Surrey Heartlands ICS Area Prescribing Committee have agreed the use of an ORBIT-bleed risk scoring tool when considering or reviewing anticoagulant treatment in Atrial Fibrillation (AF).

The Surrey Heartlands ICS Area Prescribing Committee have agreed the use of an ORBIT-bleed risk scoring tool when considering or reviewing anticoagulant treatment in Atrial Fibrillation (AF).

The Surrey Heartlands ICS Area Prescribing Committee have agreed the use of an ORBIT-bleed risk scoring tool when considering or reviewing anticoagulant treatment in Atrial Fibrillation (AF).

The Surrey Heartlands ICS Area Prescribing Committee have agreed the use of an ORBIT-bleed risk scoring tool when considering or reviewing anticoagulant treatment in Atrial Fibrillation (AF).

The Surrey Heartlands ICS Area Prescribing Committee have agreed the use of an ORBIT-bleed risk scoring tool when considering or reviewing anticoagulant treatment in Atrial Fibrillation (AF).

The Surrey Heartlands ICS Area Prescribing Committee agree that Sativex for the treatment of spasticity in Multiple Sclerosis patients should be given a BLUE (no information sheet) traffic light status. 

The specialist team will prescribe the first 12 weeks of treatment using the payment by responder scheme (3 vials free of charge), and will determine response to Sativex in line with the information in the licence [https://www.medicines.org.uk/emc/product/602], before transfer of care is requested.

This drug / device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug / device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug / device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission.
 

This drug / device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug / device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug / device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission.
 

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends the use of cenobamate in the treatments of focal onset seizures in epilepsy, in line with NICE guidance  (TA753).

A RED traffic light status will be applied to cenobamate for this indication.

The Surrey Heartlands APC does not recommend the use of Liraglutide (Saxenda) for managing obesity in people aged 12 to 17 years.

This decision follows the termination of the NICE appraisal (TA749): Liraglutide for managing obesity in people aged 12 to 17 years.

The Surrey Heartlands Integrated Care System Area Prescribing Committee recommends Upadacatinib as a treatment option for the treatment of moderate  Rheumatoid Arthritis in line with NICE TA744

Upadacatinib will be considered RED on the traffic light system. Prescribing will be by hospital specialists only, in line with NICE TA744.

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

Inhaled budesonide is no longer recommended as a treatment option in patients with Covid-19.

See below for a Therapeutic Alert from the DHSC which supersedes previous advice

This device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence.

Clinicans can contact syheartlandsccg.APC@nhs.net if they wish to make a submission. 

The Surrey Heartlands APC have agreed a variety of resources to support the safe and effective prescribing of adrenaline auto-injectors:

• an Aide Memoire for Primary Care when prescribing adrenaline auto-injectors
• guidance for the prescribing of appropriate quantities
• a checklist / proforma for completion by secondary care when discharging adults or children following anaphylaxis
• an AccuRx template

See below for these documents

The prescribing of Jext, EpiPen and Emerade are supported and should be prescribed by BRAND to ensure the patient receives the correct device.
Patients should receive regular device training. Patient support materials are also available below.

This drug / device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug / device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug / device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 

This drug / device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug / device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug / device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 

This device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 
 

This drug / device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 
 

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission. 
 

This device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission. 
 

This device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission. 
 

This drug / device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission. 
 

Do not prescribe.

It is anticipated that this drug will be part of a central, national distribution process.

Further details will follow.

This drug / device falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.
Treatment should remain with the specialist (RED) hospital only drug.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.

The Surrey Heartlands integrated care system Area Prescribing have agreed that acetazolamide should be initiated and prescribed by specialist neurology teams. 

Acetazolamide will be given a RED traffic light status for this indication.
 

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed with NICE recommendation not to use bezlotoxumab to prevent recurrence of C. Difficile infection because it is not cost effective.

Bezlotoxumab will be given a NON-FORMULARY traffic light status for this indication.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed the use of budesonide for maintenance of Eosinophilic Oesophagitis at the lowest effective dose.

Prescribing will be initiated by the specialist and continue for an initial 3 months before a request is made to the primary care clinician.
A BLUE information sheet for prescribers can be found below.
 

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) have approved:

• the updated guidance for the Management of Obesity in Adults

• Liraglutide (Saxenda) referral criteria and pathway

See documents below

This drug/device falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Treatment should remain with the specialist as a hospital only (RED) drug.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 
 
 

This drug has not yet been assessed for formulary status.
It has not yet been evaluated by NICE or the Surrey Heartlands ICS Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug. 

Decision reviewed March 2022
The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia in line with NICE TA733

A GREEN traffic light status will be applied to inclisiran. 

Key points:

• It should be a shared decision making process between the patient and the prescribing clinician in line with NICE.
• Patient should be on maximum tolerated lipid-lowering therapy prior to initiation with inclisiran.
• Can be used in combination with statins or other lipid lowering treatments OR
• As monotherapy only if a person was unable to take any other type of lipid-lowering therapy  

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed the following: 
Patient with two conditions – use of two biologics for different conditions
Surrey Heartlands CCG will routinely commission as follows:

• Both biologics should be NICE approved
• There should be a Multi Disciplinary Team (MDT) (with both specialities) and/or a Drugs & Therapeutics Committee (DTC) agreement. Confirmation will be requested by the high cost drugs team.
• One biologic treatment should be considered (if NICE approved for both conditions) where appropriate, from a safety perspective prior to consideration of two biologic treatments.
• Blueteq forms are available for all biologic treatments that are NICE approved and these should be completed by the individual teams at initiation and at follow up.

Patient with two conditions – use of one biologic for both conditions 
Surrey Heartlands CCG will routinely commission as follows:

• Both specialities should agree a common approach to treatment
• Treatment should be NICE approved for both conditions
• Blueteq forms are available for all biologic treatments that are NICE approved and these should be completed by the individual teams at initiation and at follow up.

Patient with one condition – use of two biologics for same condition

• Surrey Heartlands CCG will NOT routinely commission and the IFR process should be followed if patient is clinically exceptional. Information on the IFR process can be provided by emailing the high cost drugs team at highcost.drugs@nhs.net or the IFR policy is available here: https://www.surreyheartlandsccg.nhs.uk/documents/documents/about-us/policy-and-guidance/clinical-policies 

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve bimekizumab as a treatment option for the treatment of severe plaque psoriasis in line with NICE TA723. The current Psoriasis high cost immunomodulator treatment pathway is available below.
Increased frequency of dosing is agreed for those patients with a body weight ≥ 120 kg who did not achieve complete skin clearance during induction.

Bimekizumab for this indication will be considered as RED on the traffic light status (treatment should be initiated and continued by specialist clinicians).

Increased frequency of dosing is agreed for those patients with a body weight ≥ 120 kg who did not achieve complete skin clearance during induction.
Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve Ixekizumab as a treatment option for the treatment of ankylosing spondylitis or active non-radiographic axial spondyloarthritis in line with NICE TA718. The current spondyloarthritis treatment pathway is attached below.

Ixekizumab for this indication will be considered as RED on the traffic light status (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve Ixekizumab as a treatment option for the treatment of ankylosing spondylitis or active non-radiographic axial spondyloarthritis in line with NICE TA718. The current spondyloarthritis treatment pathway is attached below.

Ixekizumab for this indication will be considered as RED on the traffic light status (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve secukinumab as a treatment option for the treatment of non-radiographic axial spondyloarthritis in line with NICE TA719. The current spondyloarthritis treatment pathway is attached below.

Secukinumab for this indication will be considered as RED on the traffic light status (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve infliximab for chronic pouchitis after treatment with steroids and/or antibiotics in combination.

Infliximab will be assigned a RED traffic light status on the Prescribing Advisory Database (PAD)

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve vedolizumab for the treatment of immunotherapy related colitis after steroids and infliximab (1st line) have been ineffective.

Vedolizumab will be assigned a RED traffic light status on the Prescribing Advisory Database (PAD)

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

This device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence.

Clinicans can contact syheartlandsccg.APC@nhs.net if they wish to make a submission. 

This device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 
 

This device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This device has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 
 

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 
 

This drug has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 
 

This drug / device falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Treatment should remain with the specialist (RED) hospital only drug.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.

This drug/device has not yet been assessed for formulary status. but is on the APC work-plan. 

This drug/device has not yet been evaluated by the Surrey Heartlands ICS Area Prescribing Committee (APC).  As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug / device.

This advice will be updated after consideration by the APC.

This drug/device has not yet been assessed for formulary status and is not currently on the APC work-plan for this indication

This drug/device has not yet been evaluated by the Surrey Heartlands ICS Area Prescribing Committee (APC).  As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug / device.

The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsccg.APC@nhs.net  if they wish to make a submission.

The Surrey Heartlands APC recommends the administration of depot antipsychotic injections under an AMBER shared care agreement for practices that have signed up to the agreed locally commissioned service (LCS).
The updated shared care agreement can be found below.

Surrey Heartlands CCG have developed the LCS to enable stable patients with schizophrenia to be prescribed and administered these injections through their primary care prescriber (GP). 

If a practice has not signed up to the LCS the drug remains as RED status and prescriptions will be issued by the provider.

The Surrey Heartlands APC recommends the administration of depot antipsychotic injections under an AMBER shared care agreement for practices that have signed up to the agreed locally commissioned service (LCS).
The updated shared care agreement can be found below.

Surrey Heartlands CCG have developed the LCS to enable stable patients with schizophrenia to be prescribed and administered these injections through their primary care prescriber (GP). 

If a practice has not signed up to the LCS the drug remains as RED status and prescriptions will be issued by the provider.

The Surrey Heartlands APC recommends the administration of depot antipsychotic injections under an AMBER shared care agreement for practices that have signed up to the agreed locally commissioned service (LCS).
The updated shared care agreement can be found below.

Surrey Heartlands CCG have developed the LCS to enable stable patients with schizophrenia to be prescribed and administered these injections through their primary care prescriber (GP). 

If a practice has not signed up to the LCS the drug remains as RED status and prescriptions will be issued by the provider.

The Surrey Heartlands APC recommends the administration of depot antipsychotic injections under an AMBER shared care agreement for practices that have signed up to the agreed locally commissioned service (LCS).
The updated shared care agreement can be found below.

Surrey Heartlands CCG have developed the LCS to enable stable patients with schizophrenia to be prescribed and administered these injections through their primary care prescriber (GP). 

If a practice has not signed up to the LCS the drug remains as RED status and prescriptions will be issued by the provider.

The Surrey Heartlands APC recommends the administration of depot antipsychotic injections under an AMBER shared care agreement for practices that have signed up to the agreed locally commissioned service (LCS).
The updated shared care agreement can be found below.

Surrey Heartlands CCG have developed the LCS to enable stable patients with schizophrenia to be prescribed and administered these injections through their primary care prescriber (GP). 

If a practice has not signed up to the LCS the drug remains as RED status and prescriptions will be issued by the provider.

Note: Clopixol Acuphase is an intermediate-acting formulation of zuclopenthixol acetate which should only be used on in-patient units for the short-term management of acute psychotic episodes and mania. When prescribing intramuscular zuclopenthixol, check that the prescription is clear and unambiguous in order to ensure the intended treatment is dispensed and administered

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve adalimumab, etanercept & infliximab (biosimilars only) as treatment options for treating moderately active Rheumatoid Arthritis in line with NICE TA715.  The current treatment pathway is available below.

Adalimumab, etanercept and infliximab (biosimilars only) for this indication will be considered as RED on the traffic light status (treatment should be initiated and continued by specialist clinicians).  Please prescribe biological products by brand name (as recommended by MHRA).

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve adalimumab, etanercept & infliximab (biosimilars only) as treatment options for treating moderately active Rheumatoid Arthritis in line with NICE TA715.  The current treatment pathway is available below.

Adalimumab, etanercept and infliximab (biosimilars only) for this indication will be considered as RED on the traffic light status (treatment should be initiated and continued by specialist clinicians).  Please prescribe biological products by brand name (as recommended by MHRA).

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approve adalimumab, etanercept & infliximab (biosimilars only) as treatment options for treating moderately active Rheumatoid Arthritis in line with NICE TA715.  The current treatment pathway is available below.

Adalimumab, etanercept and infliximab (biosimilars only) for this indication will be considered as RED on the traffic light status (treatment should be initiated and continued by specialist clinicians).  Please prescribe biological products by brand name (as recommended by MHRA).

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agrees with the recommendations made in NICE TA715. Abatacept for moderately active Rheumatoid Arthritis was not recommended by NICE and will be given a NON-FORMULARY traffic light status for this indication. The current treatment pathway is attached below.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agree budesonide orodispersible tablets for inducing remission in patients with eosinophilic oesophagitis in line with NICE TA708.
Budesonide orodispersible tablet for this indication will be considered as RED on the traffic light status (treatment should be initiated by gastroenterology teams).

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effected and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) have made the following recommendations for the implementation of the NICE guideline - Venous Thromboembolic Diseases: diagnosis, management and thrombophilia testing (NG158):

1. Apixaban, rivaroxaban, edoxaban and dabigatran were assigned a BLUE (no information sheet) traffic light status with:

• Apixaban or rivaroxoaban for initiation in most patients because they do not require initial treatment with 5 days of LMWH
• Edoxaban and dabigatran reserved for those few patients who are not clinically suitable for apixaban or rivaroxaban eg those with excellent renal function where dabigatran is the best choice.

2. Specialist to prescribe the first month of treatment
3. Specialist to request transfer of prescribing to primary care using the transfer of prescribing document (see below)
4. The NICE & South West London pathways for VTE diagnosis and management are available below for reference

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) have made the following recommendations for the implementation of the NICE guideline - Venous Thromboembolic Diseases: diagnosis, management and thrombophilia testing (NG158):

1. Apixaban, rivaroxaban, edoxaban and dabigatran were assigned a BLUE (no information sheet) traffic light status with:

• Apixaban or rivaroxoaban for initiation in most patients because they do not require initial treatment with 5 days of LMWH
• Edoxaban and dabigatran reserved for those few patients who are not clinically suitable for apixaban or rivaroxaban eg those with excellent renal function where dabigatran is the best choice.

2. Specialist to prescribe the first month of treatment
3. Specialist to request transfer of prescribing to primary care using the transfer of prescribing document (see below)
4. The NICE & South West London pathways for VTE diagnosis and management are available below for reference

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) have made the following recommendations for the implementation of the NICE guideline - Venous Thromboembolic Diseases: diagnosis, management and thrombophilia testing (NG158):

1. Apixaban, rivaroxaban, edoxaban and dabigatran were assigned a BLUE (no information sheet) traffic light status with:

• Apixaban or rivaroxoaban for initiation in most patients because they do not require initial treatment with 5 days of LMWH
• Edoxaban and dabigatran reserved for those few patients who are not clinically suitable for apixaban or rivaroxaban eg those with excellent renal function where dabigatran is the best choice.

2. Specialist to prescribe the first month of treatment
3. Specialist to request transfer of prescribing to primary care using the transfer of prescribing document (see below)
4. The NICE & South West London pathways for VTE diagnosis and management are available below for reference

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) have made the following recommendations for the implementation of the NICE guideline - Venous Thromboembolic Diseases: diagnosis, management and thrombophilia testing (NG158):

1. Apixaban, rivaroxaban, edoxaban and dabigatran were assigned a BLUE (no information sheet) traffic light status with:

• Apixaban or rivaroxoaban for initiation in most patients because they do not require initial treatment with 5 days of LMWH
• Edoxaban and dabigatran reserved for those few patients who are not clinically suitable for apixaban or rivaroxaban eg those with excellent renal function where dabigatran is the best choice.

2. Specialist to prescribe the first month of treatment
3. Specialist to request transfer of prescribing to primary care using the transfer of prescribing document (see below)
4. The NICE & South West London pathways for VTE diagnosis and management are available below for reference

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed the use of naltrexone and acamprosate for reducing alcohol consumption in people with alcohol dependence.

Naltrexone and acamprosate will be given a RED traffic light status, for prescribing by Drug and Alcohol teams only.

Any prescribing established in primary care prior to this decision may continue.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) agreed the use of naltrexone and acamprosate for reducing alcohol consumption in people with alcohol dependence.

Naltrexone and acamprosate will be given a RED traffic light status, for prescribing by Drug and Alcohol teams only.

Any prescribing established in primary care prior to this decision may continue.

This drug/device has not yet been assessed for formulary status and is not currently on the APC work-plan.
This drug/device has not yet been evaluated by the Surrey Heartlands ICS Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that
clinicians contact their medicines management team for further information and advice before prescribing this drug / device.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsccg.APC@nhs.net if they wish to make a submission.

This product has not yet been evaluated by the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this product.
The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicans can contact syheartlandsccg.APC@nhs.net
if they wish to make a submission. 

Note - this product is a "P" medicine and may be purchased from a pharmacy.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed andexanet alfa, as an alternative treatment option, for reversing anticoagulation from apixaban or rivaroxaban,in adults with life threatening or uncontrolled bleeding from the gastrointestinal tract in line with NICE TA697

A RED traffic light status is agreed and the decision to treat should be made by a haematology consultant.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that Ulipristal acetate is considered Non- Formulary for uterine fibroids
The Medicines and Healthcare products Regulatory Agency (MHRA) guidance for the use of ulipristal for the treatment of uterine fibroids, updated in February 2021, is available here https://www.gov.uk/drug-safety-update/ulipristal-acetate-5mg-esmya-further-restrictions-due-to-risk-of-serious-liver-injury
If a clinician or provider wishes to apply for formulary use of ulipristal for the treatment of uterine fibroids, they may submit a
request by contacting the APC sectretariat at syheartlandsccg.apc@nhs.net 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that rifaximin for the reduction in  recurrence of episodes of overt hepatic encephalopathy in patients ≥ 18 years of age, has a BLUE (with flow chart/pathway) traffic light status. See below for agreed documentation

The Surrey Heartlands Area Prescribing Committee have agreed that primary care prescribers may prescribe replacement hydrocortisone injection for the hydrocortisone rescue kits for patients at risk of adrenal crisis when:

- the patient has been provided with clear instructions
- a management plan has been provided to the GP and the patient
- the previous supply of hydrocortisone injection has been used or has expired

The current recommendations from CKS on the management of adrenal crisis in Addison's disease can be found at the link below.
Secondary care will prescribe the initial supply of the appropriate formulation of hydrocortisone 

NOTES for prescribing:
- hydrocortisone sodium phosphate is licensed for adrenal crisis and comes as a solution which does not require reconstitution.
- hydrocortisone sodium succinate is licensed for adrenal crisis but comes in a powder that does require reconstitution (may be less suitable for rescue kits)
- DO NOT USE hydrocortisone acetate injection to treat adrenal crisis

Surrey Heartlands Integrated Care System Area Prescribing Committee recommend the early use of the thrombopoietin receptor (TPO) agonists in adults patients 18 years and over, with new or relapsed immune thrombocytopenia in line with the NHS England interim commissioning policy, during the COVID pandemic response.
TPO agonist prescribing is considered RED on the traffic light system for prescribing by Haematologists in this patient cohort.
Commissioning arrangements will be in line with NHS England, and will be reviewed before April 2022.
Blueteq initiation and continuation forms will be made available for Haematologists to complete for identified adult patients.
Initiated patients should be reviewed regularly by a Haematologist to determine continued clinical need.

Surrey Heartlands Integrated Care System Area Prescribing Committee recommend the early use of the thrombopoietin receptor (TPO) agonists in adults patients 18 years and over, with new or relapsed immune thrombocytopenia in line with the NHS England interim commissioning policy, during the COVID pandemic response.
TPO agonist prescribing is considered RED on the traffic light system for prescribing by Haematologists in this patient cohort.
Commissioning arrangements will be in line with NHS England, and will be reviewed before April 2022.
Blueteq initiation and continuation forms will be made available for Haematologists to complete for identified adult patients.
Initiated patients should be reviewed regularly by a Haematologist to determine continued clinical need.

Bempedoic acid with ezetimibe is agreed for treating hypercholesterolaemia / mixed dyslipidaemia in line with NICE TA694 for patients in whom:

- statins are contraindicated or not tolerated (see Statin Intolerance pathway below)
- ezetimibe alone does not control low-density lipoprotein cholesterol well enough

Treatment should be initiated by a specilaist and the prescribing should remain with the specilaist for at least 3 months to ensure that the patient is responding to treatment before transfer of care to the patient's primary care prescriber.

NOTE: The combination preparation of bempedoic acid with ezetimibe is more cost effective than prescribing the separate components. However, it is appropriate to prescribe the bempedoic acid (single component) as an add-on in patients who have already started treatment with ezetimibe prior to the publication of this guidance.

Bempedoic acid with ezetimibe is agreed for treating hypercholesterolaemia / mixed dyslipidaemia in line with NICE TA694 for patients in whom:

- statins are contraindicated or not tolerated (see Statin Intolerance pathway below)
- ezetimibe alone does not control low-density lipoprotein cholesterol well enough

Treatment should be initiated by a specilaist and the prescribing should remain with the specilaist for at least 3 months to ensure that the patient is responding to treatment before transfer of care to the patient's primary care prescriber.

NOTE: The combination preparation of bempedoic acid with ezetimibe is more cost effective than prescribing the separate components. However, it is appropriate to prescribe the bempedoic acid (single component) as an add-on in patients who have already started treatment with ezetimibe prior to the publication of this guidance.

Mesalazine therapy is included within the locally agreed pathway for Ulcerative Colitis (see pathway document below).

Mesalazine therapy should be prescribed by BRAND. The following brands have been considered by the APC: 

• Salofalk® gastro-resistant tablets and granules - 1st line for new patients
• Octasa® MR gastro-resistant tablets - 1st line for new patients
• Pentasa® modified-release tablets and granules -  1st line for patients who require upper GI release
• Mezavant® XL tablets -  Alternative choice for patients with high pill burden

Choice is dependent on required site of release and factors that may aid adherence to therapy.  Prescribe by brand to ensure continuation of those chosen properties

Asacol® MR gastro-resistant tablets are non-formulary and least cost-effective option - can continue in existing patients with good disease control (see separate page https://surreyccg.res-systems.net/PAD/Search/DrugConditionProfile/6208).  Octasa® MR has the same release properties as Asacol® MR

The Asacol brand of mesalazine is least cost-effective and is not included within the locally agreed pathway for Ulcerative Colitis (see pathway document below). Asacol may continue to be prescribed in existing patients with good disease control.  Octasa® MR has the same release properties as Asacol® MR

Other brands of mesalazine therapy are included within the locally agreed pathway for Ulcerative Colitis and should be prescribed by BRAND. The following brands have been considered by the APC: 

• Salofalk® gastro-resistant tablets and granules - 1st line for new patients
• Octasa® MR gastro-resistant tablets - 1st line for new patients
• Pentasa® modified-release tablets and granules - 1st line for patients who require upper GI release
• Mezavant® XL tablets -   Alternative choice for patients with high pill burden

Choice is dependent on required site of release and factors that may aid adherence to therapy.  Prescribe by brand to ensure continuation of those chosen properties.

The Surrey Heartlands Integrated Care System (ICS) Area Prescribing Committee has agreed a GREEN traffic light status for propranolol (prescribed generically) for migraine prophylaxis in line with NICE Clinical Knowledge Summaries (CKS).

Information in CKS is available by following this link https://cks.nice.org.uk/topics/migraine/prescribing-information/drugs-for-the-prevention-of-migraine/

The Surrey Heartlands Integrated Care System (ICS) Area Prescribing Committee has agreed a GREEN traffic light status for topiramate (prescribed generically), for migraine prophylaxis in line with NICE Clinical Knowledge Summaries (CKS). Note that topiramate is contraindicated in pregnancy.

Topiramate tablets
If indicated for women and girls of childbearing age ensure that a pregnancy prevention plan (PPP) is in place.

Topiramate capsules
Only use in patients who cannot swallow tablets and ensure that a PPP is in place for women and girls of childbearing age.

Topiramate liquid
Only use in patients who cannot swallow tablets or capsules and ensure that a PPP is in place for women and girls of childbearing age.

Information in CKS is available by following this link https://cks.nice.org.uk/topics/migraine/prescribing-information/drugs-for-the-prevention-of-migraine/

The Surrey Heartlands Integrated Care System (ICS) Area Prescribing Committee has agreed a GREEN traffic light status for amitriptyline for migraine prophylaxis in line with NICE Clinical Knowledge Summaries (CKS). Information in CKS is available by following this link https://cks.nice.org.uk/topics/migraine/prescribing-information/drugs-for-the-prevention-of-migraine/

The Surrey Heartlands Integrated Care System (ICS) Area Prescribing Committee has agreed a NON-FORMULARY traffic light status for gabapentin, noting that NICE Clinical guideline CG150, recommends that gabapentin should not be offered for the prophylactic treatment of migraine. 

Follow link to NICE CG150 here: https://www.nice.org.uk/guidance/cg150

The Surrey Heartlands Integrated Care System (ICS) Area Prescribing Committee has agreed a NON-FORMULARY traffic light status for pregabalin, based on the fact that pregabalin has the same mode of action as gabapentin which is not recommended by NICE (CG150), to be offered to patients for the prophylactic treatment of migraine. 

Follow link to NICE CG150 here: https://www.nice.org.uk/guidance/cg150

This device is currently not on the APC workplan. The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Please contact your local CCG Medicines Management team OR formulary pharmacist at your acute trust, if you wish to make a submission. 
This device has not yet been evaluated by NICE or the Surrey Heartlands Area Prescribing Committee (APC). As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this device.