Medicine Pathways, Guidelines And Position Statements

Cardiovascular system (inc. DOACs)

Direct Oral Anticoagulants (DOACs)

The documents below have been agreed by the stakeholders working in North Central London and have been approved by the NCL Joint Formulary Committee (NCL JFC). They should be used to refer appropriate patients to his/her local anticoagulation clinic for initiation of anticoagulation.
Where appropriate, local anticoagulation clinics should add their own contact details on the relevant paperwork (i.e. referral proformas, notification and transfer of care forms)
Please note that these documents may be updated intermittently. Users are also reminded that the prescribing guidance is not definitive and that other sources such as the electronic medicines compendium (SPCs) should be used for the most recent drug information. This can be found at the following link: http://www.medicines.org.uk/emc/default.aspx

Other

Summary of Antiplatelet Options in Cardiovascular Disease
Sacubitril valsartan for heart failure position statement (NEL and NCL joint positioning)
Statin prescribing & lipid modification guideline
Stable angina prescribing guideline
Omega-3 Fatty Acids Position Statement
Guidance for the review of Omega-3 fatty acids
Guidance for the management of hypertriglyceridaemia

Respiratory system

Asthma adult inhaler choice

 

The following COPD guideline has been produced by the Camden, Haringey and Islington Responsible Respiratory Prescribing Group and applies to organisations that are constituent members. It has not been ratified by the NCL Joint Formulary Committee and does not apply to all organisations in NCL.

Stable COPD Treatment Guideline

Infections

NICE and Public Health England (PHE) have brought together their information on managing common infections into a summary table.

The North Central London Medicines Optimisation Committee (NCL MOC) agreed to remove their localised ‘Management and treatment of common infection’ guidance and support the use of the NICE Managing Common Infections summary table.

 

Fluoroquinolones safe prescribing Position Statement

Endocrine system

Type 2 diabetes

Antihyperglycaemic agents for Type 2 diabetes
Insulin for Type 2 diabetes

 

Diabetes meters (finger-prick testing)

Blood glucose and Ketone monitoring

 

Diabetes meters (flash glucose monitoring)

See ‘Flash glucose monitoring‘ page

 

Other

Liothyronine position statement

Endocrine system – Flash glucose monitoring

Use of Flash Glucose Monitoring in North Central London
Forms – for use by diabetes specialists
Information sheets – for patients and primary care
Training materials
Competencies

 

Out of region implementation advice

Different CCGs across London and Hertfordshire have implemented Libre differently; to identify which CCG is responsible for a given patient, enter the patient’s registered GP practice name or postcode into https://openprescribing.net/practice/

RegionEligibilityBlueteq formHospital prescribingLibre reimbursement for TrustsSupporting paperwork
North Central London
(Camden, Barnet, Enfield, Haringey, Islington CCGs)
LDCN/LPP criteria (v2)Yes (initiation and continuation)First 2 months onlyYesPatient-prescriber agreement
North West London
(Brent, Central [Westminster], Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, West [London Borough of Kensington and Chelsea and Queen’s Park and Paddington])
NHS England criteriaYes (initiation [inc. existing self-funders])First 2 months onlyNoPatient-prescriber agreement

GP request for acute prescribing (2-4 months)

GP request for repeat prescribing (long-term)
North East London
(Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering, Redbridge, City and Hackney)
N,TH,WF: LDCN/LPP criteria

B&D,H,R: LDCN/LPP criteria

C&H: LDCN/LPP criteria
WF only: In progress

Others: No
First 2 months onlyNoPatient-prescriber agreement

Request for short term prescribing

Request for long-term prescribing
South East London
(Bexley, Bromley, Greenwich, Lambeth, Lewisham, Southwark CCGs)
LDCN/LPP criteria (v2)NoFirst 6 weeks onlyYesGP request for short-term prescribing (6-9 months)

GP request for long-term prescribing
South West London
(Croydon, Kingston, Wandsworth, Richmond, Sutton, Merton)
LDCN/LPP criteriaNoFirst 2 months onlyNoPatient-prescriber agreement

Request for short term prescribing

Request for long-term prescribing
Hertfordshire
(Herts Valleys, East & North Herts CCGs)
NHS England criteriaYes
(initiation and continuation at 6 months)
First 6 months onlyYesPatient-prescriber agreement (adults)

Patient-prescriber agreement (paeds)

GP notification of initiation (not a request to supply)

GP request for long-term prescribing

GP notification of discontinuation