NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Primary Care

PostScript Primary Care - February 2014

Dapoxetine

Dapoxetine (Priligy®) is a new medicine licensed for the treatment of premature ejaculation in men aged 18 to 64 years. It has not been evaluated by the Scottish Medicines Consortium and thus is non-Formulary.

Gluten-Free Food Formulary

The NHSGGC Gluten-free Food Formulary has now been approved by the Area Drugs and Therapeutics Committee and is available on the prescribing website.

Hypertension Guideline Error

The new Hypertension Guideline which was sent to practices and available on staffnet contains an error.  The threshold for commencing treatment should state a Cardiovascular Risk greater than 20% and NOT 10%.

Prescribing Local Enhanced Services for 2014/15

The general practice local enhanced service (LES) activities offered for 2014/15 (starting 10th March 2014) are summarised below:

Polypharmacy LES

  • Review and feedback of compliance against Medicines Reconciliation ‘care bundle’ (10 patients per month)
  • Completion of a medicines reconciliation reflection template at baseline and at contract end
  • Polypharmacy review
    • Supporting an enhanced review of ACP patients and an additional 1% of patients outwith ACP
    • Priority patients include:
      • High risk drugs / combinations
      • Patients aged 75+ and on oral antipsychotic
      • Combination of step 2 opioids

 Repeat Prescribing LES

  • Completion of three Repeat Prescribing Significant Event Analyses
  • Quarterly installation of electronic preferred list formulary and synonyms (where appropriate)
  • Preferred list prescribing target of 78% or 1% baseline increase
  • Level 1 Medication Review of:
    • 80% of active repeat patients (within previous two years at contract end)
    • 90% of Monitored Dosage System and Care Home patients (within one year at contract end)
  • Inactivation of selected obsolete repeat drugs if not ordered within previous 6 months (appliances, dressings, elastic hosiery, gluten free products, incontinence appliances, oral nutrition supplements and stoma appliances)
  • Identifying patients not attending for asthma review then annotating pharmacy text to encourage review by Community Pharmacist (tied in with Community Pharmacy Asthma LES)

 Related Community Pharmacy LES

  • Identification and feedback to GP Practices of:
    • Monitored Dosage System patients
    • CMS registered patients that the Community Pharmacist considers suitable for serial prescribing
  • Review of Asthma patients identified by the Practice as not attending for annual review
  • Oral bisphosphonates – support patients to obtain maximum benefit from these medicines

Prescribing of Hepatitis B Virus treatments in General Practice

Following initiation by a specialist, adefovir, entecavir, lamivudine and tenofovir can be used in the treatment of Hepatitis B in primary care with prescribing by a GP as part of a shared care protocol. These protocols have recently been updated to reflect a change in supplier for the drugs.

The number of patients being treated in the community with these drugs is relatively small but difficulties continue to arise with the supply to patients. Any patient being initiated on treatment will be transferred to GP care. They will be given a letter explaining how to obtain further prescriptions and letters will also be sent to the patient’s GP and nominated community pharmacy for information.

Alerts will shortly be added to Scriptswitch® for these drugs to help prescribers.

Macmillan Pharmacy Facilitators

Following the successful evaluation of the Macmillan Pharmacy Facilitator Project (2009-2012) involving four CHCPs within NHSGGC, the Board and Macmillan Cancer have jointly agreed to fund the transition of the project from pilot phase to board-wide roll out. The roll out began in October 2013 and sees the establishment of a new Macmillan Pharmacy Service, the first of its kind in Britain.
The Macmillan Pharmacy Service team includes both pharmacist and pharmacy technician facilitators who are based within CHCPs:
West/East Dunbartonshire: Jane Stuart, Raina Morris
Inverclyde/Renfrewshire: Sandra Reynolds, Anne McGowan
Glasgow South /East Renfrewshire: Alex McMillan, Carol Pettigrew
Glasgow North West: Pauline Brown, Raina Morris
Glasgow North East: Nadia Afzal, Leighanne Bee

The vision and mission of the service is to help patients to live and die well at home by improving palliative care services within the community. The Macmillan pharmacy facilitators will achieve this by driving a quality improvement programme which engages community pharmacies and the wider multi-disciplinary primary care team. Key service objectives include: increase awareness of palliative care services provided by network pharmacies; facilitate timely access out of hours to palliative care medication; deliver palliative care training to pharmacy support staff and GP practice managers and receptionists; develop palliative care information resources for patients; facilitate appropriate prescribing and dispensing of palliative medicines.

For more information, please visit: http://www.palliativecareggc.org.uk/index.php?action=cms.comm_pharm
Email: Service Lead, Kate McCusker, catherine.mccusker@nhs.net

Ensure® Plus

Ensure® Plus* is available in bottles of 220 ml produced for the UK market  but also in 200 ml Tetra Pak® cartons (parallel import) and we are aware that both presentations are being dispensed across NHSGGC.

Our dietitians recommend that this product should be prescribed in multiples of 220 ml. If 200ml Tetra Pak® cartons are dispensed, a patient will need to open more than one carton in order to take the prescribed dose. Open cartons should not be left at room temperature. If opened and refrigerated, they should be discarded after 12 hours.

A patient may have to open two cartons at breakfast time to complete a prescribed 220 ml dose. Even if refrigerated, it may be more than 12 hours before the next dose and would therefore have to be discarded. As 200ml cartons can be wasteful and could become contaminated, we recommend that only the 220ml bottles of Ensure® Plus are supplied.

 * Milkshake Style, Yogurt Style, Juce and Savoury varieties

Glasgow Addiction Services

From Monday 24th February, Glasgow Addiction services contact details will be as follows:


Glasgow Addiction Service
2nd Floor, Possilpark Health and Care Centre
99 Saracen Street
Glasgow
G22 5AP
Telephone: 0141 800 0660