NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Community Pharmacy

PostScript Community Pharmacy (November 2011)

In this edition:

  • Flu Vaccination
  • Change to Abbott sip feeds
  • Sanofi Insulin Products
  • Unscheduled Care PGD

If you wish to download a PDF version, please click here.


Flu Vaccination


The recent CMO letter 28th September 2011 issued guidance about the use of some brands of seasonal influenza vaccine in children because of an increased risk of fever. The revised age indication of the vaccines available for administration under the NHS GGC PGD is detailed on the link.


It should be noted that although the licensed age indication for Enzira® and CSL Biotherapies generic influenza Ph. Eur. is 5 years and for Viroflu® 6 months for simplicity the PGD excludes the use of these vaccines in children under 9 years of age. Please bear this in mind when supplying practices with influenza vaccine.


Clinicians administering Enzira® vaccine or CSL Biotherapies generic influenza Ph. Eur. vaccine to children in the age group five to less than nine years are being asked to ensure that advice is given to parents on the management of vaccine-induced fever. Viroflu® vaccine marketed by Crucell UK Ltd should not be given to children under 5 years but if used, parents should be advised to monitor for fever for 2 - 3 days following vaccination.


While appropriate doses of paracetamol or ibuprofen may be used to treat symptoms of fever, it is not recommended that these drugs are used routinely following vaccination as there is some evidence that prophylactic administration of antipyretic drugs around the time of vaccination may lower antibody responses to some vaccines. The ‘Green Book’ gives appropriate advice for the management of adverse events post vaccination.


Change to Abbott sip feeds


As you are aware the sip feed contract across NHSGGC has changed to the Abbott Ensure® range of sip feeds e.g. Ensure Plus Milkshake Style, Ensure Plus Juice. The new range of sip feeds come in 220ml bottles for the standard sip feeds but are also available as Parallel Imports of 200ml tetra packs. Prescribers have been advised to be clear with their prescribing and specify the 220ml bottles as these provide 10% more calories per unit. In addition to the higher nutrient content, the bottles are easier for patients to hold; the lids can be replaced should a patient be unable to consume all the sip feed at one time and they are less likely to be damaged than the tetra packs.


Please be aware that patients and prescribers are expecting this new range of sip feeds to be provided in the plastic bottles therefore if tetra packs are provided this may cause confusion for the patients. The new range bottle pack sizes are:

  • Ensure Plus Milkshake Style (220ml),
  • Ensure Plus Juice (220ml), Ensure Plus
  • Yoghurt Style (220ml),
  • Ensure Plus Savoury (250ml cans changing to 220ml bottles),
  • Ensure Plus Fibre(200ml bottle)
  • Ensure Twocal (200ml bottle)


Sanofi Insulin Products


Sanofi have advised of an interruption to the supply of a number of Apidra (insulin glulisine) preparations. Pharmacists will be able to source supply for individual prescriptions from the manufacturer however if they are unable to obtain a supply the patient will require to be reviewed for an alternative. In this instance practices should refer patients to the local diabetes team.


The affected products are:

  • Apidra Optiset prefilled pens – limited supplies - due to be withdrawn at the end of 2011
  • Apidra Solostar prefilled pens – limited supplies - normal supply due to resume Dec 2011
  • Apidra Clikstar cartridges- limited supplies - normal supply due to resume Dec 2011


Unscheduled Care PGD


The next version of the Unscheduled Care Patient Group Direction is expected shortly and will be sent to all community pharmacies, along with copies of the declaration form and referral forms for patients who visit a community pharmacy but require to be seen by the GEMS out of hour service. Community pharmacists are asked to note the following points regarding the use of the PGD.


Signing of PGD

Each pharmacist who wishes to make a supply using the CPUS forms for Unscheduled Care (as opposed to PHS services) must read, sign and return the declaration contained at the rear of the PGD pack. Spare copies will be provided. Please note that for those working in different health boards, a copy must be returned by fax or post to each of those health boards in which they work.


Using the PGD

Patients are not required to provide evidence of medication when accessing the service but the pharmacist must be satisfied that they get the prescription on repeat. If the patient is unsure of their medication, the pharmacist could contact NHS24 and request a check against the patient’s emergency care summary. However, NHS24 call handler must seek consent from the patient themselves – this cannot be granted through a third party eg carer or pharmacist. The ECS is not a validation tool and should not be used for confirmation purposes, but is used to check strength or dose. The ECS is linked to CHI and so can only be used for patients registered with a GP in Scotland.

Referring to GEMS

If the pharmacist assesses that the patient requires medical help, the patient is referred to the GEMS centres located across the Board area. Pharmacists must provide the patient with a written referral form. Spare copies of the referral forms are available from this link or from the Unscheduled Care folder.

Professional to Professional Number

In NHS GGC, this number is used if the pharmacist wishes to speak to a medic about a patient for clarification or advice. It is not to make appointments (as in other Board areas).

CPUS Forms

Copies of any CPUS forms written using the PGD must be faxed to the patient’s GP as soon as possible. The Health Board recommend that it is good practice to do so within 1 day of the supply. Details of GP practice fax numbers are available on the secure part of the website.


NES Pharmacy programme 2011/12

The upcoming winter events are now available to all registered pharmacists and technicians. All those wishing to attend the events must register using the NES portal system. It is self explanatory, with booking procedure listed within the 2011/12NES programme. Similarly, all cancellations must be done using this mechanism.


In light of cost savings which all Health Boards are experiencing, NES will be not be providing catering at the events (with exception of tea/coffee and biscuits) nor will anyone be able to claim for travel expenses, with the exception of facilitators or speakers.