Current News

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.

2024

Spring Bank Holiday Pharmacy Opening Times

15th April 2024

 

Please find the updated Spring May Bank Holiday 2024 rota for 27th May:

ODS Pharmacy Name Address 1 Address 2 City/Town Postcode Spring Bank Holiday  - Monday 27th May 2024
FCX81 Asda Pharmacy Newark Road North Hykeham Lincoln LN6 8JY 10:00-16:00 
FK029 Asda Pharmacy Sleaford Road   Boston PE21 8EQ 10:00-16:00 
FRJ49 Asda Pharmacy Union Street   Grantham NG31 6NZ 10:00-16:00 
FKF52 Ask Chemist 13 Forbes Road   Boston PE21 0PD 14:00-16:00
FFR51 BOOTS 58-64 Lumley Road   Skegness PE25 3NG 10:00 - 17:00
FGR00 BOOTS 11-14 Hall Place   Spalding PE11 1SA 10:00-16:00
FHY65 BOOTS 41-45 Southgate   Sleaford NG34 7SY 10:00 - 16:00
FNR78 BOOTS 66/67 High Street   Stamford PE9 2AW 10:00-16:00
FER87 Boots Pharmacy Beacon Park Health Centre Churchill Avenue Skegness  PE25 2RN 14:00-16:00
FMQ05 Boots, 29 High Street   Mablethorpe LN12 1AF 10:00-12:00
FWH94 Hawthorn Pharmacy Hawthorn Health Centre Scotton Road Gainsborough DN21 3SB 10:00 - 12:00 
FWA76 Knight Street Pharmacy 22 Knight Street Pinchbeck Spalding  PE11 3RB 14:00-16:00
FGR53 Lincoln Co-Op Chemist 121 Monks Road   Lincoln LN2 5HT 14:00-16:00
FPX47 Lincoln Co-Op Chemist 2 Jerusalem Road Skellingthorpe Lincoln LN6 5TW 10:00-12:00
FJN65 Lincoln Co-Op Chemist Vanessa Drive   Gainsborough DN21 2UQ 14:00-16:00
FP637 Lincoln Co-Op Chemist 176 Winchester Road   Grantham NG31 8RX 10:00-12:00
FX130 Lincoln Co-Op Chemist 52 Eastgate   Louth LN11 9PG 09:00-17:30
FHC57 Riverside Pharmacy 47 Boston Road   Sleaford NG34 7HD 14:00-16:00
FGA80 Stamford Pharmacy 6 St Mary's Hill   Stamford PE9 2DP 10:00-12:00
FC096 Tesco Pharmacy In-Store Tesco 65 Northgate Sleaford NG34 7BB 10:00-16:00
FF878 Tesco Pharmacy In-Store Tesco South Road Bourne PE10 9LS 10:00-16:00
FNH76 Tesco Pharmacy Wragby Road   Lincoln LN2 4QQ 10:00-16:00

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 

 

Medicines Supply Issues & Shortages

To support the management of supply shortages, The Medicines Optimisation team recommends to access the Medicine Supply tool available on the Specialist Pharmacy Service website. Registering via NHS email is required through https://www.sps.nhs.uk.

Please see our Medicines Supply Issues and Shortages document to support you with the increasing number of reported stock issues.

This leaflet is designed to support primary care teams to care for patients with diabetes during the period of Ramadan fasting.

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.

Nutrition and Hydration Week 2024

8/3/2024

 

11th- 17th March 24 is Nutrition and Hydration Week. There has never been a more important time to raise awareness of the importance of eating and drinking well in later life.

With around 3 million people at risk of malnutrition in the UK we need to engage opportunities to raise the awareness of the risks and promote the good practices that can help prevent malnutrition and dehydration. Preventing malnutrition and dehydration improves health and well-being and helps to reduce the burden on the health and social care services in treating and supporting those suffering from under nutrition and dehydration.

Nutrition and Hydration Week is an annual event to educate people on the value of food and drink in maintaining health and wellbeing. and raise awareness of the work the speech and language therapists (SLTs) do to help people living with eating, drinking, and swallowing difficulties.

The week is also continuing focus on the following aims:
• Promoting the 10 Key Characteristics for Good Nutritional Care
• Promoting Mealtimes Matter and Protected mealtimes
• Encouraging the introduction of Nutrition Advocates /Champions to each health and Social Care Setting
• The introduction of minimum standards for good nutrition in all settings
• Sharing Good nutrition and hydration practice
• Promoting Continued Education and Professional Development especially in the health and social care sector for catering staff.
• Improve staff awareness of their own hydration and nutritional requirements.

Poor nutrition and hydration not only harms people’s health and wellbeing, but it can also reduce their ability to recover and leads to increased admissions to hospitals and care homes. Around 1 in 3 patients admitted to hospital or who are in care homes are malnourished or at risk of becoming so.

Malnutrition can be difficult to recognise and can happen very gradually, which can make it very difficult to spot in the early stages. Signs to watch out for include loss of appetite, weight loss, tiredness, altered mood and poor concentration.

The Malnutrition Universal Screening Tool (MUST) is a five-step screening tool that identifies adults who are underweight and at risk of malnutrition.

Eating, drinking, and swallowing problems (known a dysphagia) can affect up to 10% of older people in hospital and 75% of care home residents. 1 in 17 people will develop dysphagia at some point in their lifetime.

If dysphagia is not treated appropriately, it can result in choking, dehydration, malnutrition, weight loss, pneumonia, and chest infections. Early identification reduces medical complications and improves nutrition, hydration, and overall physical and mental wellbeing.

Learn more about Nutrition and Hydration Week.

We all have a role to play in helping people to notice if they have started to lose weight without meaning to or if they are not drinking enough. It is everyone’s responsibility to encourage good nutrition and hydration intake and to raise awareness of simple tips to better nutrition and hydration intake.

Tresiba NPSA Update

15/12/23

In response to the medicines supply notification on 24th May 2023 regrading a shortage of Tresiba® (insulin degludec) FlexTouch® 100units/ml solution for injection 3ml pre-filled pens.

Some patients may have been switched to Tresiba® (insulin degludec) FlexTouch® 200units/ml solution for injection 3ml pre-filled pens. However the Medication Safety Officer (MSO) Network have now highlighted five reports of prescribing, dispensing and administration errors where some patients have been incorrectly advised to reduce the number of units of insulin to be administered. This document is to support clinicians on how to ensure patient safety when using Tresiba.

Please see the updated guidelines here: https://lincolnshire-pacef.nhs.uk/application/files/1917/0265/0967/NPSA_Tresiba_Summary.pdf

 

Additional information regarding supply: Tresiba® FlexTouch® 100units/ml pre-filled pens are out of stock until December 2024. Prescribers are advised to adhere to the recommendations

In the MSN supply tool https://www.sps.nhs.uk/shortages/shortage-of-tresiba-insulin-degludec-flextouch-100units-ml-solution-for-injection-3ml-pre-filled-pens/ and the National Patient

Safety Alert https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103242

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.

Lincolnshire Blood Glucose and Ketone test strips Formulary

5th October 2023

This guidance is an updated formulary for blood glucose and ketone test strips. It was produced by the Lincolnshire Diabetes Specialist Clinicians and Lincolnshire ICB Medicines Optimisation Team, and approved at PACEF September 2023. It is based on the NHS England Commissioning National Recommendations produced April 2023.

It provides guidance on appropriate, cost effective blood glucose meters, test strips and ketone test strips.

Full Guidance can be found here

NHS England have announced Changes to their Commissioning recommendations for blood glucose and ketone meters, testing strips (BGKT) and lancets Version 2, 12 October 2023.

•            It has removed the AgaMatrix Agile and On Call Extra Mobile for first line treatment of gestational diabetes requiring a GDm-Health™ application due to technical issues with the software. (Page 7)

•            They have also corrected their recommendation for type 2 diabetes - paediatrics to “On Call Extra” and not “On Call Extra Mobile”. (page 7)

•            They have also advised that the launch date the Aga-Matrix Agile has now been delayed until December 2023. ( pages 6 & 9)

We have now updated our Lincolnshire joint formulary in line with the changes. The formulary and PACEF websites will be updated accordingly.

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/

Cervical Cancer Awareness Week

22/01/2024

Cervical screening is one of the best ways to protect yourself from cervical cancer. It's not a test for cancer, it's a test to help prevent cancer. Protect yourself — attend your cervical screening when invited.

https://www.nhs.uk/conditions/cervical-screening/

For any services in the Boston area, please see the enclosed poster shared by the Boston GP Practices.

PrescQIPP Clinical Masterclass - Acute and preventative treatment of migraine

22/1/2024

Please see below message from PrescQIPP about their upcoming webinar:

"On 24th January 1-2pm, we welcome Dr Callum Duncan to talk about Acute and preventative treatment of migraine.

Dr Duncan is a Consultant Neurologist at Aberdeen Royal Infirmary where he has run a headache clinic, along with Dr David Watson (GPwSI Headache), since 2008. He obtained his MBChB from Aberdeen University in 1999, during which he also obtained an intercalated PhD. He trained in General Medicine in Aberdeen, Neurology in Aberdeen and Edinburgh, and Headache in Aberdeen, Edinburgh, Glasgow and the NHNN Queen Square London.

He is chair of the SIGN 155 guideline group which updated guidance on pharmacological management of migraine in 2022 and 2023. He is a past secretary of the British Association for the Study of Headache (2016-2022) and chair of the development group for the Scottish National Headache Pathway (part of Scottish Government Modernising Patient Pathways initiative). He is currently undertaking a pharmacy project on migraine management in pharmacy with the Migraine Trust."

Wednesday 24th January 13.00 - 14.00
Clinical Masterclass Registration

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.

Pharmacy Holiday Opening Times

21/12/2023

 

Please find below opening times for local pharmacies over the holiday period.

Christmas Day

ODS Pharmacy Name Address 1 Address 2 City/Town Postcode Christmas Day 2023  - Monday 25th December 2023
FAM17 BOOTS Unit 1, The Carlton Centre Outer Circle Road Lincoln LN2 4WA 15:00-17:00 
FER87 BOOTS Beacon Park Health Centre Churchill Avenue Skegness PE25 2RN 14:00-16:00 
FGR00 BOOTS 11-14 Hall Place   Spalding PE11 1SA 10:00-1200 
FP635 BOOTS St Johns Vicarage 62 London Road Grantham NG31 6HR 14:00-16:00 
FMK59 Clover House pharmacy  Clover House Boston Road Sleaford NG34 7HD 10:00-12:00 
FWH94 Hawthorn Pharmacy Hawthorn Health Centre Scotton Road Gainsborough DN21 3SB 10:00-12:00 
FEC14 Lincoln Co-op Chemists Ltd 90 Jasmin Road Birchwood Lincoln LN6 0QQ 13:00-15:00 
FNG12 Lincoln Co-op Chemists Ltd Newland Health Centre 34 Newland Lincoln LN1 1XP 10:00-12:00 
FN019 Newmarket Pharmacy 155 NewMarket   Louth LN11 9EH 11:00-13:00
FP299 Parkside Pharmacy Tawney Street   Boston PE21 6PA 10:00-12:00
FGA80 Stamford Pharmacy 6 St Mary's Hill   Stamford PE9 2DP 14:00-16:00 
FKN04 Pharmacy Wise 23 High Street   Mablethorpe LN12 2EY 10:00-12:00 

 

Boxing Day

ODS Pharmacy Name Address 1 Address 2 City/Town Postcode Boxing Day 2023  -  Tuesday 26th December 2023
FCX81 Asda Pharmacy Newark Road North Hykeham Lincoln LN6 8JY 10:00-16:00 
FK029 Asda Pharmacy Sleaford Road   Boston PE21 8EQ 10:00-16:00
FRJ49 Asda Pharmacy Union Street   Grantham NG31 6NZ 10:00-16:00
FH064 BOOTS 11 High Street Sutton-on-Sea Mablethorpe LN12 2EY 10:00-12:00 
FNR78 BOOTS 66/67 High Street   Stamford PE9 2AW 10:00-16:00 
FW570 Grantham Pharmacy 17 High Street   Grantham NG31 6PN 10:00-12:00 
FWA76 Knight Street Pharmacy 22 Knight Street Pinchbeck Spalding PE11 3RB 14:00-16:00 
FD243 Lincoln Co-op Chemists Ltd High Street Ruskington Sleaford NG34 9DY 14:00-16:00
FJN65 Lincoln Co-op Chemists Ltd Vanessa Drive   Gainsborough DN21 2UQ 14:00-16:00 
FAQ04 Lloyds Pharmacy South Square   Boston PE21 6JU 14:00-16:00 
FN019 Newmarket Pharmacy 155 NewMarket   Louth LN11 9EH  12:00-13:00 
FK184 SIT FPW (Chemists) High Street Ingoldmells Skegness PE25 1NS 14:00-16:00 
FCV46 Lincoln Co-op Chemists Ltd 107 High Street Saxilby Lincoln LN1 2HG 14:00-16:00 
FAM17 Boots Unit1, The Carlton Centre Outer Circle Road Lincoln LN2 4WA 10:30-16:30

 

New Years Day

ODS Pharmacy Name Address 1 Address 2 City/Town Postcode New Years Day 2024 -  Monday 1st January 
FA306 Rowlands Pharmacy Hawthorn Road Skegness Lincolnshire PE25 3TD 14:00-16:00 
FCX81 Asda Pharmacy Newark Road North Hykeham Lincoln LN6 8JY 10:00-16:00
FK029 Asda Pharmacy Sleaford Road   Boston PE21 8EQ 10:00-16:00
FRJ49 Asda Pharmacy Union Street   Grantham NG31 6NZ 10:00-16:00
FM543 Beacon Pharmacy Skegness Road Ingoldmells Skegness PE25 1JL 14:00-16:00 
FEH98 Lincoln Co-op Chemists Ltd 226 Rookery Lane   Lincoln LN6 7PH 10:00-12:00 
FQ149 Lincoln Co-op Chemists Ltd 15 Market Street   Gainsborough DN21 2BL 14:00-16:00 
FX130 Lincoln Co-op Chemists Ltd 52 Eastgate   Louth LN11 9PG 12:00-13:00 
FMP75 Lloyds Pharmacy Boston West Business Park Sleaford Road Boston PE21 8EG 14:00-16:00 
FNJ59 Lloyds Pharmacy 171 New Beacon Road   Grantham NG31 9LJ 10:00-12:00 
FGJ83 Marisco Pharmacy   Stanley Avenue   Mablethorpe LN12 1DP 10:00-12:00 
FC922 Nene Pharmacy Ltd 184 Bridge Road Sutton Bridge Spalding PE12 9SF 14:00-16:00 
FC096 Tesco Pharmacy In-Store Tesco 65 Northgate Sleaford NG34 7BB 14:00-16:00 
FKH66 Well Pharmacy Sheep Market Surgery Ryhall Road Stamford PE9 1YA 10:00-12:00 
FAM17 Boots Unit1, The Carlton Centre Outer Circle Road Lincoln LN2 4WA 10:30-16:30
FLD47 Jhoots Brayford Quays Newland Lincoln LN1 1YA 14:00-16:00

PrescQIPP Clinical Masterclass - Eczema management in primary care

15/12/23

Please see below message from PrescQIPP about their upcoming webinar:

"On 19th December we welcome Dianne Sanderson to talk about Eczema management in primary care.
Dianne worked in Community pharmacy for 24 years and then had a complete career change and spent some time in a Rheumatology department before moving into primary care. Dianne has been a practice pharmacist for 8 years and the lead pharmacist at Macclesfield PCN for the past 3 years, leading a team of pharmacists and pharmacy technicians. For the past 4 years, she has spent one day a week in the local NHS dermatology service where she oversees topical and oral treatments of acne, eczema and psoriasis. Dianne became an independent prescriber in 2016 and also does some academic teaching."

World Antimicrobial Awareness Week

31/10/23

World AMR Awareness Week (18th – 24th November 2023) is a global annual campaign aimed at improving awareness and understanding of antimicrobial resistance. Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.

The theme for WAAW 2023 is "Preventing antimicrobial resistance together". AMR is a threat to humans, animals, plants, and the environment. It affects us all.

The infographic below shows the number of predicted deaths caused by antimicrobial resistance in 2050 if we are unable to change the current trajectory. Experts predict that in just under 30 years, antimicrobial resistance will kill more people worldwide than cancer and diabetes combined. People will be dying of infections that were previously treatable.

 

Antimicrobial resistance currently adds over £1 billion to hospital treatment and societal costs in the EU, this is a continually increasing figure, and with an ageing population we will continue to use an increasing volume of antimicrobials, driving the problem further. From the 1930s to the 1960s, 14 classes of antimicrobial were introduced, but since 1968 there have been only five new drug classes developed. Since 1984, no new registered classes of antimicrobials for human treatment have been developed, so it is even more important that we protect the antibiotics that we do have, to ensure that they remain effective.

Antibiotics are wonderful life saving treatments, but we must only use them when we really need them, and it is everyone’s responsibility to protect them for the future.

Antibiotics in Lincolnshire

Unfortunately, in Lincolnshire we use more antibiotics than average, and we know that high use of antibiotics drives resistance. The good news is that this means that we are all capable of helping to improve the current situation and protect the world from future infections.

The graph below shows all ICB’s prescribing of antibacterial items per STAR-PU. The orange line depicts the national target. Lincolnshire ICB is in red at the right-hand side of the graph. We are the worst ICB in the country on this measure and prescribe more antibacterial items than anywhere else.

Optimising Antibiotic Course Length – Shorter is Better

We all need to work together on improving our use of antibiotics, and one of the areas that Lincolnshire ICB is going to focus on over the next twelve months is optimising antibiotic course length. Antibiotics should be prescribed for the shortest duration needed, and often, although seven-day courses have been historically prescribed, this is a longer course than is necessary for some conditions.   

Unnecessarily long courses of antimicrobials are one of the factors driving antimicrobial resistance and an increased risk of C.Difficile infection in at-risk populations. Reducing course length is not only a good thing in terms of antimicrobial resistance, but also is potentially safer for the patient, as it reduces the incidence of adverse effects. Each additional day of antibiotic therapy is associated with a 4% increase in risk of side effects and a 3% increase in risk of resistance.

Looking purely at amoxicillin courses, we know that Lincolnshire prescribes roughly 32% of amoxicillin as 5-day courses and 63% of this as 7-day courses (the remainder is made up of other miscellaneous course lengths). The national average is 45% of 5-day courses, but some ICBs have reached up to 75% of amoxicillin being prescribed as 5 day courses, so we know there are massive gains which can be made on this in Lincolnshire. Data on this is free to access right down to practice level here: Optimising Antimicrobial Use Dashboard | PrescQIPP C.I.C

Antibiotic Research UK

Antibiotic Research UK (ANTRUK) is charity, founded in 2014, which aims to tackle antibiotic resistance by raising sufficient funds over the next five years to bring at least one new antibiotic treatment to market by the early 2020’s. The charity also aims to provide public and professional education and information for patients. It has lots of good information and support networks for patients who have been affected by antimicrobial resistance and provides a place for GPs to signpost these patients to. Support Antibiotic Research | Fight Antibiotic Resistance | ANTRUK

Get involved….

 

References

  1. The Maxwell Finland Lecture: for the duration-rational antibiotic administration in an era of antimicrobial resistance and clostridium difficile - PubMed (nih.gov)
  2. The New Antibiotic Mantra — “Shorter Is Better” - PMC (nih.gov)
  3. Antibiotic resistance as big a threat as climate change – chief medic | Antibiotics | The Guardian
  4. Antimicrobial resistance: a global threat | UNEP - UN Environment Programme
  5. Antibiotic Guardian – Pledge to be an Antibiotic Guardian
  6. World AMR Awareness Week 2023 (who.int)
  7. Antibiotic Research UK | Fighting Antibiotic Resistance
  8. Course: TARGET antibiotics toolkit hub (rcgp.org.uk)
  9. World Antimicrobial Resistance Awareness Week (WAAW) and European Antibiotic Awareness Day (EAAD) - GOV.UK (www.gov.uk)
  10. O'Neill Review into Antibiotic Resistance (parliament.uk)

PrescQIPP - Clinical Masterclass - Pharmacogenomics

8/11/23

Please see the following from PrescQIPP:

Tuesday 14th November 13.00 - 14.00

On 14th November we welcome Professor Sir Munir Pirmohamed to talk about Pharmacogenetics.
Munir is David Weatherall Chair of Medicine at the University of Liverpool, and a Consultant Physician at the Liverpool University Hospital Foundation NHS Trust.
He is Director of the Centre for Drug Safety Sciences, Director of the Wolfson Centre for Personalised Medicine and Director of HDR North.

Register to attend the webinar here

Medication Safety Week

31/10/23

6th to 12th November 2023

This year’s campaign will focus on WHO CAN REPORT.

All healthcare professionals have a key role to play in the cycle of medicines safety. The MHRA want to explore the different perspectives that come from the various healthcare professional groups and how the information that they can provide will help make medicines safer.

How can you open the lines of communication around reporting adverse reactions to medicines and vaccines via the Yellow Card Reporting?

Have you used the Yellow Card Reporting?

What methods can you use to promote the use of the reporting tool within your work area?

Please support the campaign and talk to your patients and colleagues about side effects and how they can report suspected problems to the MHRA Yellow Card Scheme. https://yellowcard.mhra.gov.uk/

If using social media follow the hashtag #MedSafetyWeek and #MHRAYellowCard to help extend and magnify the message.

There are various promotional tools on the Yellow Card website - https://yellowcard.mhra.gov.uk/MedSafetyWeek

You can view case studies to see where yellow card reporting has made a difference - https://yellowcard.mhra.gov.uk/casestudies

If you fancy completing some CPD there are e-learning modules which can be found here - https://yellowcard.mhra.gov.uk/resources/elearning

Upcoming PrescQIPP Webinars

11th October 2023

 

Please see the below message from PrescQIPP regarding their upcoming webinars later this month:

Clinical Masterclass - Stoma management in primary care

Tuesday 17th October 13.00 - 14.00

In our Clinical Masterclass on 17th October 2023 1-2pm, we welcome Heather Ilett who will talk about Stoma management in primary care.
Heather has been a registered nurse for over 30 years, specialising in stoma care. Having worked in an Acute NHS Trust for 15 years and run a busy stoma community service, she has taken her experience in a different direction, working as Lead Stoma Nurse for Hertfordshire and West Essex Integrated Care Board (ICB). 
Heather works with GPs and Pharmacists (ICB, practice and primary care network) as well as other health care professionals, providing stoma education sessions and supporting practices with reviewing their stoma prescribing. She is also integral in local stoma formulary and guideline development, as well as being an active interface between primary and secondary stoma care.

Register to attend the webinar here

 

Practice Plus Monthly Webinar

Wednesday 18th October 12.45 - 13.45

Medication Safety Research into Primary Care Practice

Dr Richard Keers ,Senior Clinical Lecturer in Pharmacy at the University of Manchester will bring us all up to date about medication safety research relevant to general practice , in particular the future of clinical decision support systems such as PINCER and improving the safety of mental health prescribing.

Register to attend the webinar here

 

Lincolnshire Prescribing Forums

Your next Lincolnshire prescribing forum is Wednesday 18th October 2023.

For more information please click here.

Diabetes Continuous Glucose Monitoring (CGM)

The Lincolnshire Integrated Care Board Interim Position Statement on CGM can be found here.

TARGET - Train The Trainer Session

 

What is the TARGET antibiotics toolkit?

TARGET stands for “Treat Antibiotics Responsibly; Guidance, Education and Tools”. Developed by the UK Health Security Agency (UKHSA), the Royal College of General Practitioners (RCGP) and the Antimicrobial Stewardship in Primary Care (ASPIC) Group, TARGET is the central resource to help primary care healthcare professionals and commissioning organisations improve antibiotic prescribing. Using the TARGET Antibiotics Toolkit resources will also enable primary care organisations to demonstrate compliance with the Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance.

Details

Lincolnshire ICB will be hosting a virtual TARGET train-the-trainer session with the aim being to improve antimicrobial prescribing across the system. This half-day event will be run in collaboration with our regional antimicrobial stewardship lead and the national TARGET team. We will also have one of our consultant microbiologists Dr Reena Rambani attending to help deliver the material and present it from a Lincolnshire perspective.

This training will not only upskill your personal knowledge on infections and AMR but will also train you to deliver TARGET antibiotic workshops locally, so that you can cascade training to others.

There will be two clinical scenarios covered in the session, as well as the training on how to be a trainer. This training should help to reduce inappropriate antibiotic prescribing within Lincolnshire and make a big difference to the quality of care for our patients; it is an excellent opportunity to proactively help improve prescribing and reduce antimicrobial resistance.

This training session is open to all healthcare professionals who work with primary care prescribers and who could deliver training sessions to their colleagues (GPs, practice nurses, pharmacists, paramedics, care home nurses, ICB or PCN staff etc). The session is also free and will count towards your CPD (you will need to complete the pre- and post-event survey to be accredited as a trainer and get your CPD certificate).

We would like it if we could get at least one member of staff from each PCN, so that they can then cascade this training down, but we would love to see as many people as possible. The training will be via Teams and will run from 09:30 – 13:00 on 27th September. Further information about the event will be sent out to those who register.

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:

Shortage of GLP-1 receptor agonists used in the management of type 2 diabetes (semaglutide, dulaglutide, liraglutide, exenatide) – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice

Prescribing available GLP-1 receptor agonists – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice

Prescribing available insulins – SPS - Specialist Pharmacy Service – The first stop for professional medicines advice

 

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

 

Click here to download the document regarding these issues

World Sepsis Day - 13th September 2023

There are up to fifty million cases of sepsis annually and it causes at least eleven million deaths per year. One in five deaths worldwide is associated with sepsis.

What is Sepsis?

Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. It occurs when the body’s immune system (which normally helps to protect us and fight infection) goes into overdrive. It can lead to shock, multiple organ failure and sometimes death, especially if not caught early and treated promptly.

Sepsis mainly affects very young children and the elderly, and it is also more common in people with underlying health conditions or a weakened immune system; however, it can happen to anyone, including those who are otherwise fit and healthy.

Sepsis always starts with an infection, but no-one knows why sepsis goes on to occur in some patients but not others. Five people an hour die of sepsis in the UK, and it can be triggered by any infection, such as chest infections and UTIs. The infographic below shows common causes of sepsis.