Current News
Lincolnshire Hybrid Closed Loop Position Statement
3rd April 2025
Lincolnshire ICB have approved this statement on implementation of NICE guidance for Hybrid closed loop.
Lincolnshire Blood Glucose and Testing Strips Clinical Guidance
3rd April 2025
Formulary Updated from NHSE recommendations.
This replaces the previous edition with no major changes. Only changes included are around section 6 which were meters not on NHSE recommended list but to be retained for use with named insulin pumps). The majority of these have now been discontinued and now removed from the guidance.
Lincolnshire Blood Glucose and Testing Strips (BGKT) Clinical Guidance
Lincolnshire Position Statement on the ongoing supply of Pancreatic Enzyme Replacement Therapy (PERT)
Updated 31st January 2025
Following the release of an updated National Patient Safety Alert in December 2024, the Lincolnshire Health Care system PERT working group has reviewed local guidance that was previously produced.
The priority patient group has been revised and now includes post-transplant patients requiring PERT therapy and patients with a faecal elastase level <200.
The ICB position statement has been updated to include the agreed list of priority patient groups where supplies of PERT should be maintained. For the full statement please see here.
At the request of clinicians, we have also produced a resource document which brings together all of the latest information on the supplies of PERT, including links on how to obtain stocks of unlicensed supplies. This can be found here.
These documents have also been updated to include links to updated resources hosted on the Pancreatic Society of Great Britain and Ireland website https://www.psgbi.org/
The patient letter template has also been updated and cirulated to all practices via the Primary Care Bulletin on 30th January.
Lincolnshire wound management product system-wide guidance on contact with commercial representatives
30th January 2025
The Lincolnshire wound management product system-wide guidance on contact with commercial representatives is a system wide collective adoption to direct all commercial representatives (also known as pharmaceutical representatives) contact for new, or products not included, in the Lincolnshire wound management formulary to the ULTH procurement team. Contact method is detailed in the guidance, via www.ulh.nhs.uk/about/trust/procurement/. ULTH procurement team will collate and pass requests on to the Clinical Procurement team. The outcomes of the Clinical Procurement team meeting will then be fed back to the Wound Management Formulary working group. This has been developed to help alleviate the frequent, and duplicated, commercial representative requests received across the system. To note - Commercial representatives and companies that support Trusts/Practices with training for products that are already included on the formulary/procured by the Trusts/Practices are still invited to contact Trusts/Practices through the usual channels. However, we ask that in this instance, the promotion of new products solely be undertaken through ULTH procurement.
Statement as below:
As a system we recognise the role that commercial representatives and companies play in assisting health practitioners to provide safe, effective, and economic products and services to the patients in their care. To ensure the relationship between commercial representatives, companies and the Trusts are transparent and well managed we have set out to mandate the use of a system wide approach. Commercial representatives will no longer be able to make ad-hoc contact or visits that have not been approved, or to ‘drop in’ on members of staff following a visit which they have been invited. The Procurement Governance lead and Procurement team at the ULTH Trust are now responsible for the operational management of all commercial representative and company contact for wound management products. The Procurement team at the ULTH Trust will forward all appropriate requests to the Clinical team who are responsible for standardisation and rationalisation of system-wide wound management products. Please direct all contact via the website - Procurement - United Lincolnshire Hospitals.
Commercial representatives and companies that support Trusts with training for products that are already included on the formulary/procured by the Trusts are still invited to contact Trusts through the usual channels. However, we ask that in this instance, the promotion of new products solely be undertaken through the above contact method.
Medicine Safety Update: New advice for men taking valproate
3rd October 2024
In a new Drug Safety Update Published on the 5th September 2024, the Medicines and Healthcare products Regulatory Agency (MHRA) advise men taking valproate and their partners to use effective contraception as a precaution.
The new update is as a result of a retrospective observational study which indicated a potential small increased risk of neurodevelopmental disorders to children associated with paternal exposure to valproate at conception. The study suggested that compared to children whose fathers took other antiseizure medications - lamotrigine or levetiracetam, children whose fathers took valproate during the 3 month period before they were conceived had a small increased risk of neurodevelopmental disorders. This potential risk is much lower than the risk of neurodevelopmental disorder in children born to mothers taking valproate during pregnancy.
The new Drug Safety Update includes information and advice for healthcare professionals and patients. It also contains information about the study findings and information on reporting suspected adverse drug reactions to the Yellow Card Scheme. Healthcare professionals, patients, and caregivers are asked to provide as much information as possible, including information about batch numbers, medical history, any concomitant medication, onset timing, treatment dates, and product brand name when reporting.
Advice of the Commission on Human Medicines:
- There should be a clear recommendation for the male patient and their female partner to use effective contraceptive birth control during treatment and for 3 months after stopping.
- Male patients should be advised to avoid sperm donation during treatment for 3 months after stopping valproate treatment.
- Male patients should have their treatment reviewed regularly and those planning to conceive should discuss alternative treatments with their prescriber.
- Healthcare professionals should inform male patients of reproductive potential of the possible risk at initiation of valproate or at their next medication review.
Advice for healthcare professionals:
- Inform male patients (of any age) who may father children of the possible risk at initiation of valproate or at their next regular treatment review – this counselling should be given irrespective of the indication for valproate and also after intravenous use of valproate.
- As a precaution, recommend that male patients use effective contraception (condoms, plus contraception used by the female sexual partner) throughout the valproate treatment period and for 3 months after stopping valproate, to allow for one completed sperm cycle not exposed to valproate.
- At the next regular treatment review, discuss with men on oral valproate treatment whether they are planning a family in the next year and if they are, refer to a specialist to discuss alternative treatment options.
- If a female patient reports they are pregnant or planning a pregnancy with a man on valproate (including those undergoing IVF), refer for prenatal counselling.
- Advise men not to donate sperm during valproate treatment and for 3 months after stopping valproate.
- Report any suspected adverse drug reactions associated with valproate on a Yellow Card.
Advice for healthcare professionals to provide to male patients:
- It is recommended that you and your female sexual partner should both use effective birth control (condoms and another form of female contraception) as a precaution while you are taking valproate and for at least 3 months after stopping valproate.
- Allow at least 3 months to pass after stopping valproate before trying to father a child.
- You should not donate sperm whilst taking valproate and for 3 months after stopping.
- Do not stop taking valproate unless you are advised to do so by a healthcare professional.
- If your partner is pregnant or you are undergoing IVF treatment, talk to a healthcare professional who can counsel you further if you have any concerns.
- At your next regular treatment review, you will be offered a discussion on the risks and other treatments available, if you have concerns or are planning a family you will get an appointment sooner.
- If you father a child while you are taking valproate or in the 3 months after stopping valproate, there is a potential small increased risk of the child being diagnosed with a mental or movement related developmental disorder (neurodevelopmental disorder)
- Advice will be added to the valproate patient guide; in the meantime see MHRA’s Advice for male patients on valproate to use contraception and Visual risk communication diagram
- Report any suspected adverse drug reactions associated with valproate on a Yellow Card
Useful resources
MHRA Drug Safety Update volume 18, issue 2: September 2024 https://www.gov.uk/drug-safety-update/valproate-use-in-men-as-a-precaution-men-and-their-partners-should-use-effective-contraception
Emc (medicines.org.uk): Epilim 200 mg Gastro-resistant tablets - Risk Management Materials https://www.medicines.org.uk/emc/product/519/rmms#about-medicine
MHRA Collection Valproate safety measures https://www.gov.uk/government/collections/valproate-safety-measures
FutureNHS: Valproate (Background) https://future.nhs.uk/MedicinesSafetyImprovement/view?objectId=47573808
FutureNHS: Valproate Q&A January 2024 v0.1 https://future.nhs.uk/MedicinesSafetyImprovement/view?objectId=195803557
Specialist Pharmacy Service: MSATS – Safe use of valproate event February 2024. https://www.sps.nhs.uk/articles/msats-safe-use-of-valproate/#:~:text=valproate
The below information is archived for recording purposes, all information was correct at the time of publishing.
2024
Dermatology Prescribing in Primary Care
5th September 2024
Emollients have a key role in treating a multitude of dry skin conditions, including eczema and psoriasis, and can be bought over the counter as well as being prescribed. Despite this, emollients are often underutilised in the treatment of these conditions, as it can be considered time consuming to apply them and they are often needed long-term for maximum effect. Continuous use is necessary to receive full clinical benefit, which means persisting with the treatment regimen even when the eczema or psoriasis is in remission.
How can we improve adherence?
Informed, shared decision making, based on a range of emollients is thought to be key in encouraging adherence and optimising emollient treatment for conditions such as eczema.
Information (including written information) about treatment should be provided to the patient and they should be signposted to other useful resources as appropriate. The rationale for continued emollient treatment should be explained to the patient, and the importance of regular application preventing further flares should be stressed.
Patients should be given easy access to self-care advice and application information (such as technique, quantity to apply and frequency). A range of information sources for the public can be found at the end of the article.
How much emollient should be prescribed?
For patients who have long term chronic skin conditions, prescribing an appropriate quantity of suitable emollient can prevent A&E attendance and admission, which has benefits for the whole system, as it is cost efficient, as well as increasing health and wellbeing and reducing stress for patients and their families. It is important to provide patients with enough emollient to enable them to use it regularly and adhere to their regimen, therefore preventing flare-ups in their condition.
Prescribing may involve trialling different emollients (in small quantities) until a suitable preparation that is acceptable to the individual is found. The Lincolnshire emollient guidance contains all the preparations which can be used in Lincolnshire. These have been agreed by dermatology specialists, and it should not be necessary to prescribe outside of this.
Interpreting the NHSE over-the-counter guidance
Emollients are products which can be bought over the counter, and if the patient has a minor self-limiting condition rather than a chronic long-term diagnosis, such as mild irritant dermatitis or mild dry skin, then it may be appropriate to recommend that the patient buy the product and self-treat.
There are some chronic long-term conditions such as any of the following, which should not have to be treated solely by the patient purchasing over the counter products. These conditions are:
- Eczema, dermatitis or psoriasis
- Ichthyosis
- Or those who need emollients to compliment another treatment, such as phototherapy.
If the patient has one of the above conditions, then it is likely that they will need regular access to these medications, and it is appropriate to issue them on prescription. As with any medication, it is important to ask about usage at medication reviews, and to adjust quantities as dictated by patient need, to reduce wastage and increase efficacy. It is also important to ensure that there are appropriate indications recorded for emollients, and the indication is a documented dermatological condition. Prescribing of emollients for non-clinical, cosmetic purposes is not recommended and should be reviewed.
Bath and shower emollients and soap substitutes
The use of bath and shower emollients is controversial and, until recently, evidence to inform practice was lacking. It is generally accepted that soap is drying and potentially irritating to skin and is best avoided by those with dry skin conditions. There is therefore clinical consensus that soap substitutes are necessary for people with dry skin conditions to wash with, and a guide on how to use these emollients as soap substitutes is available here: Bathing, showering and washing clothes | ECO (eczemacareonline.org.uk)
The recently published BATHE study aimed to address some of the uncertainty regarding emollient bath additives (i.e. those that are poured into bath water). This pragmatic randomised controlled trial (n=483) in children with eczema (aged one to eleven years) found no evidence of a clinically meaningful benefit from emollient bath additives, when used in addition to standard eczema management. This study indicated that efforts and resources should be targeted at effective use of leave-on emollients and soap substitutes in children with eczema, rather than the use of bath emollients. A full summary of the clinical evidence is available here.
Proprietary wash products (such as soap substitute shower gels) can be expensive, and evidence to justify their use over lower-cost alternatives is lacking. People with eczema should therefore be advised to wash with a regular leave-on emollient that is suitable for use as a soap substitute. Bath and Shower emollients are available to purchase over the counter if the patient wishes to use them.
Bath and shower emollients are therefore included in the NHS England » Items which should not be routinely prescribed in primary care. Lincolnshire is prescribing less of these items than other ICBs – well done and keep it up!
Bandaging for dermatological conditions
Bandaging can sometimes be a useful adjuvant to eczema treatments. Covering the eczema with bandages can help with the itch–scratch cycle and flare ups. It prevents damage to the skin from scratching, aids healing and enhances the absorption of topical therapies (emollients, and topical corticosteroids used with caution). There are two types commonly used:
- Impregnated paste bandages can be useful for treating eczema of the limbs, especially chronic and/or lichenified eczema. Examples are zipzoc and icthopaste.
- Wet wraps are ideal for treating extensive eczema that is not controlled by conventional treatments. These should be initiated by healthcare professionals with experience in wet-wrapping eczema, and support may be required in primary care (to supply replacements on average 3 monthly). In Lincolnshire we commonly use the skinnies viscose brand. We don’t use silk versions in atopic eczema.
Silk Garments
Silk garments are also included in the NHS England » Items which should not be routinely prescribed in primary care guidance. Lincolnshire does still have some prescribing of these items; the items listed below are the ones identified by EPACT2 as falling into the category, as should not be being prescribed.
Silk garments have primarily been used in the past for patients with atopic eczema although they have also been used for a variety of other conditions including vulvar conditions, epidermolysis bullosa and burns. A range of garments are available including eye masks, socks, gloves, vests, pyjamas, and body suits.
Silk garments are classified as medical devices. Currently, manufacturers need to ensure that their devices are safe and fit for their intended purpose to gain the CE mark; there is no requirement for clinical trials of efficacy. NHS England has designated silk garments as having low clinical effectiveness, and a lack of robust evidence of clinical efficacy. A summary of the available evidence is available here, but the small sample sizes in the available trials limit any conclusions which can be drawn.
Due in part to the limited evidence available, the NIHR HTA programme commissioned the CLOTHES trial to look at whether silk garments had a role in reducing eczema severity. This concluded that silk garments are unlikely to be cost effective to the NHS.
It is important when reviewing silk garment prescribing not to confuse all Skinnies brand prescribing with silk garments. Very, very rarely a tertiary referral centre may recommend a silk garment for one of the rarer dermatological diseases and potentially burn injuries. These recommendations should come from very specialist clinics, and the GP should expect to see evidence of MDT consultation and seek advice on duration of treatment, so that they are aware of how best to approach prescribing.
Resources for patients
Eczema NHS Choices – Atopic eczema https://www.nhs.uk/conditions/atopic-eczema/
The National Eczema Society produces several factsheets, including one on emollients. Access via Information & Advice | National Eczema Society
The Nottingham Support Group for Carers of Children with Eczema produces information leaflets. Subjects include ‘Skin moisturisers in atopic eczema’ and ‘Bathing and showering’. Access via http://www.nottinghameczema.org.uk/information/index.aspx#Treatments
The British Association of Dermatologists has a Patient Information Leaflet about Atopic eczema and psoriasis. Access via http://www.bad.org.uk/for-the-public/patient-information-leaflets
Psoriasis NHS Choices – Psoriasis https://www.nhs.uk/conditions/psoriasis/
The Psoriasis and Psoriatic Arthritis Alliance have a number of resources, including one about ‘Emollients and psoriasis’. Access via Psoriasis and Psoriatic Arthritis Alliance (PAPAA)
General NHS Choices – Emollients https://www.nhs.uk/conditions/Emollients
Eczema Care Online has lots of useful resources: Intro | ECO (eczemacareonline.org.uk)
References
Lincolnshire Emollient Guidance accaessed via PACEF :: Lincolnshire Prescribing and Clinical Effectiveness (lincolnshire-pacef.nhs.uk) on 14/8/2024
Atopic eczema in primary care: evidence update and implications for practice (bjgp.org) accessed online on 14/8/2024
PrescQIPP Bulletin 239: Emollients; June 2020 accessed online on 14/8/2024 at 239. Emollients 2.0 (prescqipp.info)
NICE Guideline CG57; June 2023 accessed online on 14/8/2023 available at CG57 Atopic eczema in under 12s: diagnosis and management (update): Evidence review A 07/06/2023 (nice.org.uk)
EPACT2 accessed online at Oracle Analytics Interactive Dashboards - Items not for Routine Prescribing (nhsbsa.nhs.uk) on 23/8/2024
NHS England » Items which should not routinely be prescribed in primary care: policy guidance accessed online on 23/8/2024
NHS England » Guidance on conditions for which over the counter items should not routinely be prescribed in primary care accessed online on 23/8/2024
Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness accessed online on 23/8/2024 at BMJ 2018;361:k1332
Specialist Pharmacy Service “Clinical evidence for emollient bath and shower preparations” accessed online on 23/8/2024
Specialist Pharmacy Service “Clinical evidence for silk garments” accessed online on 23/8/2024
The Drug Tariff accessed online on 2/9/2024 Drug Tariff Part IX | NHSBSA
Updated Lincolnshire Emollient Formulary Guidance
8th August 2024
The Lincolnshire Emollient Formulary Guidance has been updated in line with the recent Epimax Ointment and Epimax Paraffin-Free Ointment drug safety update. The drug safety update was issued following reports of ocular surface toxicity and ocular chemical injury.
The following changes have been made:
- ‘Do NOT use on the face, to avoid contact with the eyes’ added to Epimax Ointment and Epimax Paraffin-Free Ointment.
- Links to the drug safety update added to guidance for reference.
Please find the guidance here.
Please find the drug safety update here.
Diabetes Continuous Glucose Monitoring Updated Statement (CGM)
31st July 2024 (Updated 14th November 2024)
In March 2022, the National Institute for Health and Care Excellence (NICE) reviewed the evidence and updated recommendations on continuous glucose monitoring (CGM) for both Type 1 and 2 diabetes management.
The Lincolnshire position statement regarding the use of continuous glucose monitoring (CGM) system for the management of diabetes had been updated in line with NICE recommendations NG17, NG18 and NG28. Please note that the initiation of CGM devices is currently only permitted within the specialist diabetes service teams in ULHT and LCHS for continuation in primary care.
The Lincolnshire Integrated Care Board Interim Position Statement on CGM updated for 2024 can be found here.
Lincolnshire Gabapentinoid Tapering Guidance
19th June 2024
Gabapentinoids (gabapentin and pregabalin) have been increasingly prescribed for chronic non-cancer pain despite a lack of evidence in this area. They are recommended by NICE (CG173) for neuropathic pain but commonly used off-label for other types of chronic pain. In 2019, gabapentinoids were reclassified in the UK as Class C drugs due to increased deaths from misuse. Side effects are common, and tolerance often develops. This guidance was developed to support clinicians who review gabapentinoid prescriptions in chronic (persistent) non-cancer pain patients, and to provide a careful, collaborative approach to tapering.
Please find the Lincolnshire Guidance here:
NHS_Lincolnshire_Gabapentinoid_Tapering_Guidance_V4_FINAL.pdf (lincolnshire-pacef.nhs.uk)
Updated Lincolnshire Guidance for the use of anticoagulants in the management of Non-Valvular Atrial Fibrillation (NVAF)
24th April 2024
Attached below is the updated Lincolnshire Guidance for the use of Direct Oral Anticoagulants (DOACs) in Non-Valvular Atrial Fibrillation.
The following changes have been made:
- Apixaban is now the most cost effective DOAC, and the guidance has been amended to reflect this. Generic apixaban (twice a day treatment) is to be used 1st line for patients with NVAF unless there is a specific clinical reason not to do so, Edoxaban is the next preferred option (once a day) currently if apixaban is not suitable.
- Page 10 which provides a table summarising the differences between the different DOACs now includes links to new resources on the Specialist Pharmacy Services (SPS) website.
- Appendix 5 which covers the calculation of Creatinine Clearance (CrCL) now includes additional details of the SystmOne renal calculator.
Please find the guidance here.
Updated GLP 1 RA Shortage Document
8th April 2024
This updated document was produced by the Association of British Clinical Diabetologists in support of ongoing national shortage of glucagon like peptide-1 receptor agonists (GLP1 RA agents) used in the management of type 2 diabetes. The situation is not expected to resolve until late 2024. Therefore, this document is aimed to support primary care teams in selecting appropriate antidiabetic agent alternatives if a GLP1 RA a type 2 diabetes patient is taking becomes unavailable. This document is outside the scope of use of GLP1 Ras for the management of obesity.
Please find the new document here.
Improving access and capacity using community pharmacy
22nd January 2024
Please see enclosed document around improving access and capacity using community pharmacy.
New virtual pain cafe
3rd January 2024
As part of our ongoing work to support people in Lincolnshire experiencing long term persistent pain, Lincolnshire’s NHS has launched a new virtual pain café.
There will be 10 virtual events throughout the year that people can join from the comfort of their own home and join others experiencing similar persistent pain, to learn new techniques, share experiences and look at alternatives to medication.
The sessions take place once a month on a Wednesday, over the course of 12months and will be around 20mins of teaching. There will also be some face-to-face sessions hosted in various locations across the county and more details will follow once confirmed.
The sessions will follow the 10 steps of the nationally recognised Live Well with Pain programme, with time to ask questions and share experiences where people feel comfortable.
These are open to anyone experiencing persistent pain and people can be an active participant, or sit with camera off and just listen, whatever they prefer.
Whilst the sessions have already started people can join at any time. email licb.patientmo@nhs.net for more information and dates.
Empowered Relief – Free patient pain workshops
3rd January 2024
We are pleased to have been able to now extend our free pain workshops for people living in Lincolnshire, following a successful pilot in 2023.
These workshops are part of Lincolnshire’s NHS work to provide alternatives to medications for people living with chronic non-cancer pain.
There is substantial evidence that non-pharmacological support for non-cancer chronic pain is safer and often more effective for managing symptoms and should be explored as a first step before prescribing.
Empowered Relief™ is an evidence-based, 2-hour virtual workshop on pain that rapidly equips people with the skills to effectively manage their pain. The session covers:
- How pain is processed in the brain and how to best manage it
- Simple skills that people can use everyday
- Creating a personalised plan for long-term relief
Workshops take place periodically throughout the year. The sessions are virtual and take place over Microsoft Teams. Patients can attend either workshop, which will be delivered by Dr Graham Dunthorne a Specialist Pain Management GP in the county, from the comfort of their own home.
People should register their interest by emailing licb.patientmo@nhs.net
Management of Winter Illness
2nd February 2024
Winter illnesses are not always serious, but they can make patients feel very unwell, and this results in a greater burden of appointments on GP practices, and potentially pressure from patients to prescribe antibiotics.
We know that a lot of respiratory conditions such as flus and colds should not necessarily be treated with antibiotics, and that these conditions will often resolve themselves over time, but often the patients don’t know how long they should wait before seeking advice, or how to find this out. Patients are also often unaware of the side effects which can result from taking antibiotics, and there is a lot of education which needs to be done by healthcare professionals regarding this.
Please click here to view the full article.
Guidance for the management of the National Patient Safety Alert Methylphenidate, Lisdexamfetamine & Guanfacine
6th October 2023
Here is the ICS guidance on how to manage the recent NatPSA alert regarding the shortage of methylphenidate prolonged-release capsules and tablets, lisdexamfetamine capsules, and guanfacine prolonged-release tablets.
Self Care and Prescriptions During Winter
7/12/2023
This winter, the ICB is promoting self care and staying warm during the colder months.
You can find the latest updates from the ICB from our X account (formerly Twitter):
https://twitter.com/nhslincsicb?lang=en-GB
You can order prescriptions online through the following site to avoid delays and save time:
https://www.nhs.uk/nhs-services/online-services/how-to-order-a-repeat-prescription/
We are also encouraging both patients and staff to get their winter vaccines, more information can be found here:
https://www.nhs.uk/live-well/seasonal-health/keep-warm-keep-well/
2023
Wegovy® (Semaglutide)
5th September 2023
ICB Statement
Wegovy® (Semaglutide) has been launched in the UK on 4th September 2023. It is available to patients on the NHS only via NHS specialist weight management services. To obtain Wegovy® on the NHS those patients eligible for treatment under NICE TA 875 will need to be referred to/or currently under the care of NHS specialist tier 3 or 4 weight management services.
Novo Nordisk have confirmed that supplies will be sent direct to those centres providing this treatment. Wegovy® is licensed as an adjunct to a reduced-calorie diet and increased physical activity for weight management and should not be prescribed within primary care.
Diabetes Continuous Glucose Monitoring (CGM)
The Lincolnshire Integrated Care Board Interim Position Statement on CGM can be found here.
GLP-1 receptor agonist supply disruption
There is an ongoing national shortage of glucagon like peptide-1 receptor agonists (GLP-1 RAs) licensed in the management of Type 2 Diabetes Mellitus (T2DM). Information available indicates that there are very limited, intermittent supplies of all GLP-1 RAs. The supply issues have been caused by an increase in demand for these products for licensed and off-label indications and is not expected to return to normal until at least mid-2024.
This guidance aims to support clinicians in choosing suitable alternative glucose lowering therapies to GLP-1 RAs during this period of national shortage.
Clinicians are recommended to refer to the SPS Tool for Medicines Shortages for an up-to-date supply stock situation and clinical guidance on alternative treatment options; see links below:
Background information
Approach to weight loss management for obesity is multifactorial and should include dietary advice, weight loss targets, physical activity programmes, behavioural interventions and psychological support and pharmacological therapy such as semaglutide, a GLP-1 receptor agonists.
The National Institute for Health and Care Excellence (NICE) Technology appraisal guidance [TA875] Published: 08 March 2023 recommended the use of semaglutide (Wegovy®) alongside a reduced-calorie diet and increased physical activity to adults who have at least one weight-related comorbidity and a body mass index (BMI) of at least 30kg/m2 and over for managing overweight and obesity in an NHS specialist weight management service.
At present the product semaglutide (Wegovy®) has not been launched in the UK and currently there is no information regarding the product such as price or who will be able to prescribe. No date has been confirmed by the company Novo Nordisk as to when the product or information will be available. Semaglutide (Wegovy®) for weight loss will only be available to patients that meet the eligibility criteria outlined by NICE through a specialist weight management service. semaglutide (Wegovy®) was added to the formulary as a NICE TA875, but not given a traffic light classification until it becomes available in the UK and there is clarification how it will be used.
However, given the ongoing national shortage of GLP-1 receptor agonists caused by an increase in demand for these products for licensed and off-label indications, a National Patient Safety Alert – DHSC issued on 18-Jul-2023 requests that the off-label use of these agents for the management of obesity is strongly discouraged. All existing stock must be conserved for use in patients with diabetes because of the serious clinical implications in the management of patients with type 2 diabetes that these shortages pose.
The ICB DOES NOT support the use of GLP-1 receptor agonists for weight loss until there is clear guidance from NHS England and we are over the supply issue. In addition, we will put in place a clinically led pathway BEFORE this is authorised for use. Eligible people with T2DM who would like support with weight management should be signposted to available locally and nationally available weight management programmes.
Useful Resources
NICE Technology Appraisal Guidance [TA875] https://www.nice.org.uk/guidance/ta875
MHRA Central Alerting System: National Patient Safety Alert (NatPSA)
https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103235
Primary Care Diabetes Society PCDS_ABCD-GLP-1-RA-shortage_20230628.pdf (diabetesonthenet.com)
Healthier You. NHS Diabetes Prevention Programme – clinicians to complete the referral form embedded in your clinical system and send via email to scwcsu.lincolnshire@nhs.net
Other useful resources to support clinicians in choosing suitable alternative glucose lowering therapies to GLP-1 RAs during this period of national shortage
Type 2 diabetes in adults: management | Guidance | NICE
NG28 Visual summary on choosing medicines for type 2 diabetes in adults (nice.org.uk)
Shared decision making | Guidance | NICE
https://www.medicines.org.uk/emc#gref
PCDS_ABCD-GLP-1-RA-shortage_20230628.pdf (diabetesonthenet.com)
Patient useful resource/information
FAQs – GLP-1 RA shortages | Diabetes UK