Frequently Asked Questions (FAQ)

  • In order to answer your query, please provide:
    • Your name and profession
    • Place of work and contact details
    • Include relevant GP details if applicable
  • For specialist, hospital or out of area prescribing queries, in addition, please provide the following:
    • The specialists name and profession / speciality
    • Indication for treatment
    • Place of work
    • Patient’s GP (further patient details maybe requested if necessary)

To allow your query to be answered efficiently, please provide a brief summary of your query and all relevant detail relating to it, such as other medicines that have been tried if looking for an alternative. If this is in relation to a paediatric patient, include the age.

We may request further information if required.

Which drugs can be prescribed in Lincolnshire?

Any drug listed in the drug tariff is available to prescribe on the NHS. However, the government mandate that each CCG needs to have their own local formulary. Most drugs in the formulary have been assessed by the Lincolnshire Joint Formulary Group and ratified by PACEF for their inclusion. The formulary classifications take into account NICE guidance, local guidance, quality & safety, and cost.

The formulary, Lincolnshire Formulary (lincolnshirejointformulary.nhs.uk) is divided into a “traffic light” system.

GREEN Drugs – are medicines approved for use in both primary and secondary care within the licensed indications. Specialist initiation and shared care guidelines are not considered necessary. 

AMBER 2 Drugs – are medicines suitable to be prescribed in primary care after specialist recommendation or initiation.

AMBER 1 Drugs - are medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. 

RED Drugs – are medicines approved for use in secondary and tertiary care and should not be prescribed in primary care.

RED RED Drugs – are medicines not recommended for prescribing in either primary or secondary care. NB, any drug awaiting assessment by PACEF is classified as RED RED.

GREY Drugs – are medicines which are restricted for use in those patients under the care of external trusts i.e - Peterborough and Stamford Hospitals NHS Foundation Trust or the Northern Lincolnshire and Goole NHS Foundation Trust and can be continued if initiated by them.

What do I do if the drug is not in the formulary?

Occasionally you might find an area, or a particular drug or appliance, where there is no guidance in the formulary or in PACEF bulletins. The formulary is continuously being updated and this particular area or drug may never have been requested for review. Please contact the LIMPS team (licb.limps@nhs.net) if any further clarification is required or ask the prescriber to complete a New Drug Request form and forward to the LIMPS inbox.

I have been asked to prescribe a RED drug, what should I do?

RED drugs should be referred back to the hospital consultant to prescribe and supply.

A new patient has joined my practice and their prescription includes a RED RED drug on the Lincolnshire formulary, what should I do?

  1. First look in the patient’s records to see if the formulary alternatives have been tried. If not, please consider switching to a formulary medication.
  2. If other formulary alternatives are not suitable, ie tried in the past and not worked or not been tolerated, then in the best interests of the patient the drug may continue to be prescribed. Please document this in the patient’s record.
  3. If the drug is pending assessment, or no reason given, please contact the LIMPS team.

I have been asked to prescribe a RED RED drug by a Lincolnshire hospital specialist, what should I do?

The practice should decline to prescribe and refer back to the hospital.

If the drug is RED RED pending assessment or not included in the formulary, please contact the LIMPS team (licb.limps@nhs.net) providing the name, form & strength of the medication, indication for use and the requesting physician’s name and specialitnew drug request form will be sent to the consultant.

Can a drug be prescribed if it has been initiated by an out of area specialist?

Yes, it can be prescribed if it fulfils one of the following criteria:

  • it is listed as GREEN in the Lincolnshire formulary
  • it is listed as AMBER 1 in the Lincolnshire formulary, a shared care agreement has been signed by the GP and appropriate specialist, and this is saved in the patient’s records.
  • it is AMBER 2 in the Lincolnshire formulary and has been initiated by the appropriate specialist.

Contact Lincolnshire IMPS team (licb.limps@nhs.netfor further advice:

  • For requests for items listed as RED or RED RED in the Lincolnshire formulary. The drug may have a different classification in the out of area formulary. Please provide the name, form & strength of the medication, indication for use and the requesting physician’s name, speciality and hospital.

If the product is non-formulary in both Lincolnshire and the specialist’s ICB, this should be referred back to the out of area specialist.

For privately practicing specialists, GPs should be satisfied these are from genuine prescribers in their relevant field.

What is a shared care agreement?

A shared care agreement is a written agreement, signed by both the initiating specialist and the patient’s GP, to allow the prescribing of amber 1 drugs on Lincolnshire formulary. It states who is responsible for which part of the patient’s care and includes baseline & further monitoring, blood tests, doses of medications, side effects and what to do if the patient’s condition deteriorates. Prescribing of medication is only taken over by the GP when the patient is stable on treatment. Often the consultant will continue annual review and assessment of the patient’s condition.  Both specialist and GP sign and date the protocol if they are in agreement. A copy of this should be saved by the practice in the patient’s records.

Do I need a new shared care agreement if the dose has been changed after initial titration and stabilisation?

A new shared care agreement is not needed for dose changes, but the GP should contact the consultant to inform him/her of any deterioration in the patient’s condition and doses should only be adjusted as per specialist advice or agreed plan.

See the following link for further details: https://lincolnshire-pacef.nhs.uk/shared-care-agreements.

Which providers are commissioned to provide ADHD service to adult patients?

Lincolnshire ICB does not have a fully commissioned service for adults with ADHD however it uses the services of:

The ADHD 360 clinic

Dr Natasha Gopee

Dr Jajawi

Patients may be referred for NHS treatment through the OATS referral form to one of these providers.

Should I sign a shared care agreement from a private company?

There are no shared care agreements written by Lincolnshire ICB for adult ADHD medicines. In the absence of adult services in Lincolnshire patients have looked for private providers. It is the GP’s decision whether to take over prescribing of ADHD drugs from the private provider and should only sign the shared care agreement if happy with the conditions within it.

Who should I contact regarding any queries about ADHD services?

There is a generic inbox for all ADHD queries:

licb.mhldateam@nhs.net

What Gluten Free products can I prescribe?

Lincolnshire follows the national guidance for England. The only gluten free products which are allowed on prescription are bread, bread mixes and flour mixes.

The drug tariff, section XV borderline substances under gluten free, has been updated to reflect this and so if a product is listed in the drug tariff our guidance allows it to be prescribed.

The list from Coeliac UK lists more types of food than are available on prescription eg crispbreads, crackers and pizza bases. These are available to buy.

How many units of Gluten Free food should be prescribed?

The number of units that can be prescribed per month varies depends on the individual patient eg age, gender, pregnancy, breast feeding. The following the link provides Coeliac UK recommended units www.coeliac.org.uk, please follow this unless a dietician has advised otherwise.

For information:

400g bread    = 1 unit

500g flour     = 2 units

Due to the ongoing challenges around HRT, the ICB team are recommending the use of Special Pharmacy Services 'prescribing available HRT products' webpage here. Along with a 'HRT preparations and equivalent alternatives' guide issued by The British Menopause Society here.

These resources are updated frequently and will be the most accurate source of information for prescibers.

Please note this is for health professionals only and does require clinicians to register for an account (free to nhs.net email addresses).

Does Lincolnshire have guidelines on the use of Melatonin?

Before recommending medication to adults, there is a lot of guidance on the NHS website re sleep aid apps. Also consider giving sleep hygiene advice see Scenario: Managing short-term insomnia (< 3 months) | Management | Insomnia | CKS | NICE or for patients with long term insomnia check the following guidance Scenario: Managing long-term insomnia (> 3 months) | Management | Insomnia | CKS | NICE

Circadin® MR 2mg tablets are approved for use on the formulary within their licensed indication; monotherapy for short term treatment (13 weeks) of primary insomnia, characterised by poor quality of sleep in patients who are aged 55 or over.

Guidance for children can be found in our PACE Bulletin Vol 13 No 8 Aug 19 Melatonin

There is a shared care agreement in place to support the use of melatonin in children and adolescents up to the age of 18 years, but no shared care guidance to support use in adults.

Can Melatonin be used for jetlag?

No, Melatonin is not recommended for use in jet lag on the NHS in Lincolnshire.

What licensed melatonin products are included in the formulary?

Currently there are two licensed products listed in the Lincolnshire Joint Formulary:

Circadin® MR 2mg tablets licensed for the short term treatment (13 weeks) of primary insomnia, in adults aged 55 or over.

Slenyto® MR 1mg and 5mg tablets licensed for the treatment of insomnia in children and adolescents aged 2 to 18 years with Autism Spectrum Disorder (ASD) and/or Smith-Magenis syndrome, where sleep hygiene measures have been insufficient.

What formulations of melatonin can be prescribed for children/adolescents that have difficulty swallowing tablets?

See copy of the shared care agreement for sleep disorders in children here.

  1. At the discretion of the clinician Circadin® can be crushed and dispersed in water if an immediate release profile is desired, (halving it with a tablet cutter will preserve some of it modified release properties). The use of this is “off-label” in children.
  2. Prescribe unlicensed “Melatonin 10mg/5ml oral suspension (Alcohol and Sugar Free)” if the indication does not meet Slenyto® licensed indication and dose or the patient cannot take tablets. Please add “Alcohol and Sugar Free” to the dose (e.g. 2.5ml ON, alcohol and sugar free). This is an unlicensed use.

Also see a leaflet regarding information for parents and carers on helping children to swallow tablets should this be an issue.

Can we prescribe the Colonis® brand of melatonin?

No, Colonis® is RED RED on the formulary.

While Colonis® 1mg/1ml oral solution might seem to be an unlicensed alternative for children, it is not recommended as safety and efficacy has not been established. This is due to the product containing 150.50mg of propylene glycol and 140mg of sorbitol in each ml which is above the daily quantity recommended for children.

Liraglutide (Saxenda) for weight management is classed as RED-RED in Lincolnshire. This is because ULHT is not a tier 3 centre. See Lincolnshire formulary for information here.

Lincolnshire patients are managed through the regional Derbyshire Tier 3 centre as an NHS service. We understand that GPs can make a direct referral.

Where prescription forms are lost (whether or not theft is suspected), this must be reported immediately to the practice manager.

The practice manager should immediately inform:

1. The police

2. The controlled drugs accountable officer 0113 8249614 /8248678 or England.centralmidlands-cd@nhs.net

3. The NHS England Contracting Team at Lincoln 0113 8248642 or england.eastmidlandspharmacy@nhs.net

Please refer to the Safe and Secure Handling of Medicines Policy (page 30).

Any report of loss of prescription forms should as a minimum include: date and time of loss / place where loss occurred / type and quantity of prescription stationery / serial numbers / details of to whom the incident has been reported.

Practice staff must complete an incident reporting form in accordance with their own incident reporting policy.

For all non-medical prescribers working within a GP practice, registration is completed by the Lincolnshire Integrated Medicines and Prescribing Service following the process outlined below:

On joining a GP Practice(s) the non-medical prescriber is required to complete a database form. This form should be printed, filled in, scanned and emailed to the Lincolnshire Integrated Medicines and Prescribing Service (LIMPS) generic inbox licb.limps@nhs.net. It is a requirement that this form is signed by the prescriber as the ICB has to keep a record of all non-medical prescriber’s signatures.

As part of the registration process, LIMPS will confirm the non-medical prescriber’s eligibility to prescribe with their relevant professional registration body and then consequently fill in the necessary paperwork to send to NHS BSA to complete the registration. This information is stored on an ICB database. The NMP will be copied into the application emailed to the NHS BSA to let them know this has been done.

The NHS BSA do not usually acknowledge the registration and only get in contact with LIMPS if there is a problem. The NHS BSA complete applications quite quickly and if there has been no contact it can be assumed that registration has been completed after 2-3 working days.

If starting at a GP practice, having changed jobs from another organisation eg LCHS or another Trust, it is important that the NMP informs the organisation they have left so they can be de-registered from those services.

If prescription pads are required, these are obtained through Primary Care Services England by the Practice. If working across multiple practices, NMPs can use one prescription pad but must add the relevant practice code number for each patient for whom they prescribe.

When a NMP leaves a practice any remaining prescription pads must be destroyed at this point e.g., by shredding and access to practice computer systems removed.

Any prescriber who works for more than one employer or in more than one setting must have a separate prescription pad for each organisation.

No, the Lincolnshire IMPS team are not responsible for registering GPs.

The registration is done by Primary Care Services England, and can be found here.

New GPs can register for their PPA number and existing GPs can amend their practice location details. Practice managers will also have access to this site.

More coming soon...