Current News
Lincolnshire Position Statement on the ongoing supply of Pancreatic Enzyme Replacement Therapy (PERT)
22nd August 2024 (Updated 28/8/24)
The ongoing supply issues surrounding pancreatic enzyme replacement therapy (PERT) has progressed. These intermittent supply issues mean some people are running out of PERT or experiencing difficulties or delays in accessing PERT. Therefore, there is a need for clinical and symptom management advice that is different to normal clinical practice. For the full statement please see here.
Please also see below wording and statement intended for patients.
Patient letter: Supply issues associated with Pancreatic Enzyme Replacement Therapy (PERT)
The ICB is working with United Lincolnshire Hospital Trust (ULHT) and community pharmacies to put in place a process to manage the current very severe shortage of pancreatic enzyme replacement therapy (PERT)
Advice has already been sent out to all clinicians on the management of patients affected by the supply problems. The ICB and ULHT have also jointly produced this letter, which is intended to provide further information and advice to patients. Please read this here.
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.
The below information is archived for recording purposes, all information was correct at the time of publishing.
2024
Diabetes Continuous Glucose Monitoring Updated Statement (CGM)
31st July 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