List of Current JPC Recommendations...151 6.1.2 Exenatide Once Weekly Injection for Type 2 Diabetes ... 197 Dapoxetine for Premature Ejaculation April 2014 See JPC Advice and Guidance

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kBEDFORDSHIRE & LUTON JOINT PRESCRIBING COMMITTEE

List of Current JPC Recommendations

This list contains all the current approved JPC Bulletins, Shared Care Guidelines and other Miscellaneous documents. (NB: Older bulletins that have been archived are available from Medicine Management team on request).

Copies of all current Individual Bulletins, shared care guidelines and miscellaneous documents are available on the GP Ref website (http://www.gpref.bedfordshire.nhs.uk/). (To access all documents, click on the Bedfordshire & Luton Joint Prescribing Committee (JPC) tab on the left hand side of the GP Ref homepage. Please note documents issued prior to Sept 12 are password protected. All documents issued after Sept 12 are freely available on the website and do not require a log-in password.)

How to use this document The information contained in this document is presented in JPC approved date order. Use control + F keys and enter your search word to quickly find the relevant document.

KEY Prescribing not recommended

Consultant only prescription

Must be initiated by Specialist but may be continued by GPs Prescribe with shared care

May be initiated and continued by GPs

Miscellanous item

Bulletin Guidance No

BNF Category

Title Date approved by JPC

Additional Information

96

3.4.2 Grass Pollen Allergan Extract (Grazax®)

Sept. 07 Update Feb. 2010

See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

http://www.gpref.bedfordshire.nhs.uk/

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx


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BNF Category



116 7.4.5 Tadalafil (Cialis Once-A-day ®) April 09 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

144 2.6.3 Ivabradine for heart failure Updated June 2012 (post license recommendations)

Jan. 2011 Updated June 2012

Superseded by NICE TAG 267 www.nice.org.uk/ta267

The JPC noted that the NICE Guidance had stated that :-

‘Ivabradine should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be carried out by either a GP with a special interest in heart failure or a heart failure specialist nurse.’

The JPC confirmed that following the dose titration phase, GPs could continue prescribing.

151 6.1.2 Exenatide Once Weekly Injection for Type 2 Diabetes (Updated Sept 2011)

(June 2011) Updated Sept. 2011

Superseded by NICE TA248 www.nice.org.uk/TA248 Additional JPC Recommendation regarding prescribing (from original bulletin):

Once-weekly exenatide should be initiated by a Specialist and may be continued by a GP under shared care arrangements.

Shared care guideline available on GP Ref website.

155 Buccal Midazolam - Bulletin Updated

Original Dec. 2011 Last Updated Sept 17

See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescibig-committee-(jpc)/jpc-advice-and-guidance.aspx

167 Sequential use of biologics in patients with psoriasis

Sept 12, updated April 13

Superseded by NICE CG153 with some JPC additional recommendations See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx



http://www.nice.org.uk/ta267

http://www.nice.org.uk/TA248

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescibig-committee-(jpc)/jpc-advice-and-guidance.aspx

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescibig-committee-(jpc)/jpc-advice-and-guidance.aspx



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BNF Category



181 Linaclotide for Irritable Bowel Disease with constipation

April 13 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

190

Sodium Oxybate for the treatment of narcolepsy and cataplexy

Feb. 2014 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

197 Dapoxetine for Premature Ejaculation


204 Brimonidine tartrate gel (Mirvaso®) for the treatment of facial erythema of rosacea in adult patients

September 14 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

205 Household Salt for the Treatment of Umbilical Granuloma

September 14 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

209 Bone Morphogenetic Proteins Policy (EoE PAC policy, ratified by JPC)

Feb 2015 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

211 Ranibizumab or Bevacizumab for the treatment of Juxtafoveal Telangiecstasia


212 Domperidone – Use as a galactagogue to support Breastfeeding


















4


BNF Category



213 Eltrombopag (Revolade®) for the treatment of thrombocytopenia in adult patients with chronic hepatitis C virus infection, where degree of thrombocytopenia is the main factor preventing the initiation or limiting the ability to maintain optimal interferon-based therapy. (EoE PAC policy, ratified by JPC)


215

10.2.2 Cannabis-Based Medicinal Extract (Sativex®) for Spasticity and neuropathic pain in MS.

April 2015 Bulletin archived Feb 2020 due to publication of NICE guideline 144

217 Somatostatin Analogues – Approved Indications and Commissioning Responsibilities. (NB: Some indications are the commissioning responsibility of CCGs and others are NHSE)


I `

221 Rituximab (MabThera®) for the treatment of adults with idiopathic (immune) thrombocytopenic purpura (ITP)

Sept 2015 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

224 Choice of Non-Vitamin K Antagonist Anticoagulants (NOACs)

Original Dec 2015 Updated Feb 2019

See JPC Advice and Guidance page – Atrial Fibrillation Resources http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/atrial-fibrillation-anticoagulation-resources.aspx

225 Botulinum Toxin Type B for cervical dystonia








http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/atrial-fibrillation-anticoagulation-resources.aspx




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BNF Category




227 EXOGEN® ultrasound bone healing system used for the management of long bone fractures


229 Rifaximin (Targaxan®) for preventing episodes of overt hepatic encephalopathy (HE): Full evidence review

Sept 2015 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx For Specialist initiation and GPs to continue.

231

Liraglutide (Saxendo® for Obesity


233 Growth Hormone Devices in Children

Feb 16 Updated Nov 18


234 Botulinum Toxin A for the treatment of Focal Limb Dystonia


235 Botulinum Toxin A for the treatment of pain associated with Masseteric Hypertrophy


236 Electronic cigarettes (e-cigarettes) and other novel nicotine containing products for tobacco dependence

April 16 Archived - Repaced by Bulletin 287 (Feb 2020

237 Use of bevacizumab (Avastin®) to treat wet age-related macular degeneration (EoE PAC Briefing


















6


BNF Category



statement)

239 Rifaximin for the management of chronic diarrhoea associated with gastro intestinal disorders

April 16 Updated July 2016


240 High strength, fixed combination and biosimilar insulin products: minimising the risk of medication error - Safety Reminder : Bulletin 240

June 16 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

241 Guidelines on self-monitoring of blood glucose (SMBG) in non-insulin treated Type 2 diabetic patients for maintaining glycaemic control

June 2016 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx (This bulletin replaces Bulletin 124)

242 Low Molecular Weight Heparins (LMWHs) and Fondaparinux – Prescribing Guidance

July 16 See JPC Advice and Guidance page Currently being updated Feb 2020

243 Guanfacine for ADHD – East London Foundation Trust (ELFT) New Medicines Review

Nov 16 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

244 Botulinum toxin A – Its use in: 1) Acute setting i.e. in corneal

patients to induce temporary ptosis to prevent corneal












7


BNF Category



perforations 2) Chronic setting.e in ectropion

patients who are not suitable for surgery due to other comorbidities and who fit a specific set of patient criteria.

245 Glucagon-like peptide 1 (GLP1) receptor agonist review

Updated July 19 to include semaglutide


246 Superseded by Beds and Herts priorities Forum statement

Heavy Menstrual Bleeding (includining ulipristal use) – Beds & Herts Priorities Forum interim statement

Original Feb 17 Updated March 18

Dec 17 Update This guidance has been superseded by the updated Beds and Herts Priorities Forum statement http://www.fundingrequests.cscsu.nhs.uk/policies-bedfordshire/

To access the Beds and Herts priorities statement in full, type in “heavy menstrual bleeding” into the search box on the policy page of the csu website (see link above)

247 Bazedoxifene plus conjugated oetsrogens (Duavive®) for post-menopausal symptoms in women with a uterus


248 PCSK9 inhibitors Evolocumab and Alirocumab for the treatment of primary hyypercholesterlaemia and mixed dyslidiaemia




http://www.fundingrequests.cscsu.nhs.uk/policies-bedfordshire/





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BNF Category



249 Medical Devices –Drop-List (NB: This bulletin contains the PrescQIPP Recommendations plus locally agreed JPC Modifications)

April 17 Updated Feb 19 – Recommendations on 4 new devices added


251 Management of Hyperhidrosis June 17 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

252 Oxygen for Cluster Headaches June17 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

254 Photodynamic therapy (PDT) with verteporfin (Visudyne®) for chronic central serous retinopathy


257 Brivaracetam for Epilepsy September 17 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

258 Adrenaline Autoinjectors September 17 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx Replaces Bulletin 223 which has been archived.

260 Yellow code for LCCG

Addition of adjuvant bisphosphonate therapy to the management of early breast cancer for post-menopausal women to improve breast cancer survival.

June 2017 Uodated April 2019


Pink code for BCCG















9


BNF Category



261 Tolvaptan (Samsca®) for the treatment of hyponatraemia secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) (East of England Prescribing Advisory Committee (PAC) Guidance Statement Tolvaptan (Samsca®)

March 2018 The JPC agreed to ratify the EoE PAC policy with the locally agreed additional caveat that ‘secondary care’ (refered to in the EoEPAC recommendations) includes hospices. See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

262 Opicapone in Parkinson’s Disease December 2017 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

263 Insulin Degludec for the treatment of Diabetes Mellitus

April 2018 Updated Nov 18


264 Liothyronine Guidance Statement June 2018 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

265 FreeStyle Libre® Flash Glucose Scanning (FGS) for Children and Young People with Type 1 Diabetes (Age 4 upto age 19 years) Bulletin Archived and replace with a Flash glucose monitoring resource pack – aavailable on Gp Ref

June 2018 Updated Oct 18

Flash Glucose Monitoring resources avaialle on GP Ref Click link below: http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribinittee-(jpc)/flash-glucose-monitoring-system.aspx

266 FreeStyle Libre® Flash Glucose Scanning (FGS) for Adults with Type 1 Diabetes

June 2018 Updated Oct 18

Flash Glucose Monitoring resources avaialle on GP Ref Click link below: http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/flash-glucose-monitoring-system.aspx









http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribinittee-(jpc)/flash-glucose-monitoring-system.aspx


http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/flash-glucose-monitoring-system.aspx

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/flash-glucose-monitoring-system.aspx

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BNF Category



267 Insulin Glargine (Toujeo®) June 2018 Updated Nov 18


268 Cannabis-based products for medicinal use


269 Faster acting insulin aspart (Fiasp®) : New formulation


270 Humalog 200 units/ml Kwikpen


271 Eflornithine 11.5% cream for the treatment of Hirsutism

Feb 19 JPC position statement issued See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

272 Gender Identity Services –Primary Care Prescribing Responsibilities for Hormonal Treatment (including eflornithine for the treatment of hirsutism in this setting)

Feb 19 JPC position statement issued See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

273 Camouflage Creams - JPC Guidance Statement

April 19 JPC position statement issued See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx













http://www.gpref.bedfordshire.nhs.uk/media/219729/camouflagecreamsmay2019.pdf

http://www.gpref.bedfordshire.nhs.uk/media/219729/camouflagecreamsmay2019.pdf



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BNF Category



274 Semaglutide for the Treatment of Diabetes Mellitus Archived as incorporated into bulletin 245


274 (a) Continuous glucose monitoring (CGM) in children and young people up to the age of 19 (EoEPAC guidance)


274 (b) Continuous glucose monitoring (CGM) in adults age 19 and older (EoEPAC guidance)


275 Position Statement – High Cost Drugs Excluded from the National Tariff – Idarucizumab Injection and Liothyronine Injection

June 19 https://www.gpref.bedfordshire.nhs.uk/media/224302/bulletin275_hcd_idarucizumabandliothyronineinjection.pdf

276 Iron Chelators for the treatment of Myelodysplastic Syndrome (MDS)


277 Safinamide for Parkinson’s Disease Sept 19 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

278 Umeclidinium bromide (Incruse®Ellipta®) for the treatment of COPD

Sept 19 See JPC Advice and Guidance page https://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/new-formulary-additions/copd-inhaler-choices-(new-formulary-additions).aspx







https://www.gpref.bedfordshire.nhs.uk/media/224302/bulletin275_hcd_idarucizumabandliothyronineinjection.pdf

https://www.gpref.bedfordshire.nhs.uk/media/224302/bulletin275_hcd_idarucizumabandliothyronineinjection.pdf





https://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/new-formulary-additions/copd-inhaler-choices-(new-formulary-additions).aspx



12


BNF Category



279 Umeclidinium / Vilanterol (Anora®Ellipta®) for the treatment of COPD

See JPC Advice and Guidance page https://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/new-formulary-additions/copd-inhaler-choices-(new-formulary-additions).aspx

280 Fluticasone/vilanterol 92/22 micrograms inhalation powder (Relvar® Ellipta®) for the treatment of COPD


281 Fluticasone furoate/ umeclidinium/ vilanterol 92/55/22 micrograms inhalation powder (Trelegy® Ellipta®) for the treatment of COPD


282 Fluticasone furoate/ Vilanterol (Relvar®Ellipta®) for the treatment of Asthma (select group of patients)


283 Doxylamine succinate and pyridoxine for nausea and vomiting in pregnancy


284 Aviptadil / phentolamine Intracavernosal Injection (Invicorp) for Erectile Dysfunction

Dec 19 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

285 Rasagiline for Parkinson’s Disease Dec 19 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx



















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BNF Category



286 Infliximab for the management of diarrhoea or colitis associated with Immune Checkpoint Inhibitor (ICPI) therapy (East of England Priorities Advisory Committee (EoEPAC)* bulletin)

Dec 19 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

287 Novel Nicotine containing Devices Feb 2020 Replaces bulletin 236

JPC Shared Care Guidelines

Available on GP Ref website (to access click Bedfordshire & Luton Joint Prescribing Committee (JPC) tab on left hand side of home page and go to shared care guidelines section.

Document Title Issue Date Additional Information

Riluzole Sept. 2001 Updated Sept. 2013 Updated Dec17

Shared care guideline available on GP Ref http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx

Drug monitoring for Aminosalicylates in inflammatory bowel disease in primary care

December 2008 Updated Dec 2013 Updated Sept 19

Available on GP Ref – JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx Contains information regarding sulfasalazine and mesalazine

Lithium Shared Care Guidelines Feb.2010 Updated Dec. 2011 NEW shared care guidelines issued June 14




http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx









14


Updated April 16 Addition of Lithium app information to the shared care guideline

Apomorphine Shared Care Guidelines Dec. 2009 Updated April 2015

Updated June 2016 Updated June 19

Update : April 15 The apomorphine guidelines were reviewed and a revised set of shared care guidelines agreed. Due to a change in the way that infusion lines are provided, the JPC agreed that GP’s are now asked to prescribe the relevant infusion line on a FP10. {Exact details of which line to prescribe will be advised by the Parkinson Disease Nurse

Specialist (PDNS)} . June 2016 Shared care guideline currently being amended following an MHRA drug safety alert - contact medicine management team for further information Currently being updated to include new product choice- contact medicine management team

Inflammatory Bowel Disease Shared care guidelines (incorporating azathioprine and 6-mercaptopurine drug fact sheets)

Dec. 2013 U[dated Dec 19

Shared care guideline available on GP Ref

Low molecular weight heparin (LMWH) use in obstetric venous thromboembolism prophylaxis - intermediate risk patients treated at Bedford hospital only

Updated June 18


Lanthanum & Sevelamar Shared Care Guidelines Updated Feb 2015 Updated Sept 19

The JPC agreed to approve the Updated Shared Care Guidelines (produced by East & North Herts NHS Trust. NB These Updated guidelines now include patients not receiving renal dialysis. Shared care guideline available on GP Ref




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Alemtuzumab for treating relapsing – remitting multiple sclerosis Shared care guidelines Currently being upodate to include referenceto the MHRA Drug Safety Update issued (February 2020)

April 2015 Update June 2015 Updated Dec 17 Updated March 2020

The JPC agreed to support the alemtuzumab shared care guidelines produced by Cambridgeshire Joint Prescribing Group. Shared care guideline available on GP Ref http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx

Rheumatology Shared care guidelines for DMARDs plus individual drug prescribing sheets

Nov 16 Updated Nov 18

Shared care guideline available on GP Ref with individual drug prescribing sheets incorporated into the main document and also listed separately. http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx (Dec 17 Update The JPC agreed to continue to support the current

position regarding Methotrexate use in paediatrics and therefore, no GP prescribing of methotrexate for paediatric patients is recommended locally.) March 18 – Update to mycophenolate fact sheet to incoporporate MHRA advice Updated Nov 18 – change to frequency of blood test monitoring










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Discharge Medication for Enhanced Recovery Patients Following Primary Hip and Knee Arthroplasty – Information for GPs (L&D patients only)

Nov 16 Shared care guideline available on GP Ref http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx

Glucagon-like peptide 1 (GLP 1) agonists - Overarching share care guidelines (Information sheets listed separately)

Glucagon-like peptide 1 (GLP 1) agonists - share care guidelines – Appendix 3 Individual drug information sheets for GPs

Updated Sept 19 Shared care guideline available on GP Ref http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx

Treatment of Gender Dysphoria in Transmen (Female to Male Transsexuals) - West London Mental Health NHS Trust Shared care guideline are attached for Resource Information Purposes

Patient Information Leaflet (published by West London Mental health NHS Trust) - attached for Resource Information Purposes

June17 Updated Feb 19

Shared care guideline available on GP Ref http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx Feb 19 Update These guidelines have now been formally endorsed by the JPC (Feb 2019)

Treatment of Gender Dysphoria in Transwomen (Male to Female Transsexuals) - West London Mental Health NHS Trust Shared care guideline are attached for Resource Information Purposes Patient Information Leaflet (published by West London Mental health NHS Trust) - attached for Resource Information Purposes

June 17 Shared care guideline available on GP Ref http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx Feb 19 Update These guidelines have now been formally endorsed by the JPC (Feb 2019)

Melatonin for the treatment of Insomnia and Sleep Disorders in Children and Adolescents - Shared care guideline (New)

Dec 17 Shared care guideline available on GP Ref http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx




http://www.gpref.bedfordshire.nhs.uk/media/157419/sharedcare_glp1_agonistdraftfeb2017.pdf






http://www.gpref.bedfordshire.nhs.uk/media/160185/Treatment_of_Gender_Dysphoria_in_Transmen_(Female_to_Male_Transsexuals).pdf



http://www.gpref.bedfordshire.nhs.uk/media/160188/Patient_Information_FtM_2016_new_v1.pdf

http://www.gpref.bedfordshire.nhs.uk/media/160188/Patient_Information_FtM_2016_new_v1.pdf




http://www.gpref.bedfordshire.nhs.uk/media/160288/Treatment%20of%20Gender_Dysphoria_in_Transwomen_(Male_to_Female_Transsexuals).pdf





http://www.gpref.bedfordshire.nhs.uk/media/160285/Patient_information_MtF_2016_v2.pdf








http://www.gpref.bedfordshire.nhs.uk/media/165058/sharedcare_melatoninsc8_final.pdf

http://www.gpref.bedfordshire.nhs.uk/media/165058/sharedcare_melatoninsc8_final.pdf




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Guanfacine for the management of ADHD (Children and young people (5-17 years)


Alzheimer's disease - Shared (and Transfer of ) Care Guideline for the management of Alzheimer's disease (BCCG patients only) (Updated April 19

Replaced with a Dementia Shared (and Transfer of ) care guideline (see below)

Apil 19 Shared care guideline available on GP Ref http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx

Attention-deficit hyperactivity disorder (ADHD) - Shared care guideline for the management in Adults

June 18 Shared care guideline available on GP Ref http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-shared-care-guidelines.aspx

Attention-deficit hyperactivity disorder (ADHD) - Shared care guideline for the management in Children and adolescents (covers Methylphenidate , Atomoxetine , Dexamfetamine and Lisdexamfetamine)


Dementia Shared (and Transfer of ) care guideline Dec 19

https://www.gpref.bedfordshire.nhs.uk/media/231237/dementa_sch_

dec19.pdf

Amiodaonre Shared Care Guidelines Dec 19

Currently being updated




http://www.gpref.bedfordshire.nhs.uk/media/219878/alzheimersscg_transferofcare.pdf












https://www.gpref.bedfordshire.nhs.uk/media/231237/dementa_sch_dec19.pdf

https://www.gpref.bedfordshire.nhs.uk/media/231237/dementa_sch_dec19.pdf

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JPC Miscellaneous Approved Papers/Recommendations

Available on GP Ref website (to access click Bedfordshire & Luton Joint Prescribing Committee (JPC) tab on left hand side of home page and go to Advice and Guidance section.


JPC Terms of Reference Sept.2013 Updated June 2018

See GP Ref http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-miscellaneous-items.aspx

Bedfordshire Wound Management Formulary June 2010 Update July 2015

New formulary launched July 2015 Electronic formulary now available on smart phones and via the internet. http://cms.horizonsp.co.uk/viewer/sept/woundformulary Link to the formulary is also available on GP Ref website.

Botulinum Toxin A policy Sept. 09 Updated Sept. 12, Dec.12Sept13,Feb 15 Updated Feb 2016 ,

Feb 2015 Update: Botulinum Toxin A policy modified to incorporate the updated advice on the Management of Hyperhidrosis (see EoE PAC policy). Updated Feb 2016: The EoE PAC have issued an updated Guidance statement entitled “Botulinum toxin type A

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-miscellaneous-items.aspx

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-miscellaneous-items.aspx

http://cms.horizonsp.co.uk/viewer/sept/woundformulary

19


April 16, Feb 2017, June 17

(BTA): Evidence review and commissioning recommendations”. (Dec 2015). The new EoE PAC guidelines (with the exception of the Negative statement for treatment of Masseteric Hypertrophy) were approved, with the necessary local adaptations as specified on the front page of the JPC Botulinum policy. Updated April 16 Local policies agreed for the use of botulinum toxib A for the treatenent of focal limb dystonia (upper and lower limb) and pain associated with Masseteric hypertrophy Re: Masseteric Hypertrophy (Bulletins 234 and 235 respectively) Available under “advice and guidance, post Sept 2012” of the JPC section on GP Ref website. Updated Feb 17 Local policy agreed for the use of botulinium toxin A for the treatment of ptosis Updated June 17 – latest update Available on GP Ref – JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

Osteoporosis Guidelines for Primary Care

Original Sept. 2011 Last pdated April 19

Available on the JPC Guidelines page Click below http://www.gpref.bedfordshire.nhs.uk/media/221152/osteoporosisguidelines.pdf

Primary Care Guidelines for the Management of Chronic Non Cancer Pain in Adults

Feb. 2012

New guidelines issued Sept 18 (BCCG use only) Update April 19 – Aadpted by both BCCG and LCCG Available on the JPC Guidelines page Click below http://www.gpref.bedfordshire.nhs.uk/media/219780/guidelinesmanagementchronicnoncancerpain.pdf



http://www.gpref.bedfordshire.nhs.uk/media/221152/osteoporosisguidelines.pdf

http://www.gpref.bedfordshire.nhs.uk/media/219780/guidelinesmanagementchronicnoncancerpain.pdf

http://www.gpref.bedfordshire.nhs.uk/media/219780/guidelinesmanagementchronicnoncancerpain.pdf

20


Previous document history

Original document written Feb 2012, updated Dec 13 , April 15

Rheumatoid Arthritis - Drug treatment Options for severe Rheumatoid arthritis ( Algorithm A) (Updated March 18)

Rheumatoid Arthritis - Drug treatment Options for severe Rheumatoid arthritis ( Algorithm B: applicable for a select group of patients with certain co-morbidities - Update Sept 17)

Original June 2012 Last updated March 18

Available on the JPC Treatment pathway page Click below http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-treatment-pathways.aspx Updated March 2018 Addition of JAK inhibitors and sarilumab to the pathway.

Blood Glucose Meters : Formulary Choice of Blood Glucose Testing Strips and Meters - Updated April 19, Dec 19 (Palmdoc added )

Original June 2012, Last updated Dec 19 :Choice of meters

See JPC Advice and Guidance page https://www.gpref.bedfordshire.nhs.uk/media/233326/bccg_lccg_bgm_stripreviewupdatejan20.docx.pdf

Denosumab (Osteoporosis indication) – Information sheet and Advice for GPs

Original Dec. 12, Rewritten Sept 17

See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx Sept 17 Information sheet rewritten Sept 17 – includes recent MHRA safety updates on osteonecrosis of the external auditory canal

Denosumab for Treatment of Osteoporosis - Blood test monitoring & Dental Check-up Requirements – Patient Information Leaflet

June 15 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx (NB: To print off as a leaflet , select the “flip along the short edge “ option.)

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-treatment-pathways.aspx


https://www.gpref.bedfordshire.nhs.uk/media/233326/bccg_lccg_bgm_stripreviewupdatejan20.docx.pdf

https://www.gpref.bedfordshire.nhs.uk/media/233326/bccg_lccg_bgm_stripreviewupdatejan20.docx.pdf





21


Choice of Statin for Primary and Secondary Prevention of Cardiovascular Disease

Feb. 13, updated April 2013 Sept 2014 Update

Following the publication of NICE CG 181 Lipid modification; cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease, the following JPC recommendations were agreed (September 2014):

The pharmacological treatment recommended within NICE Clinical Guideline 181 : Lipid

Modification: cardiovascular risk assessment and the modification of blood lipids for the

primary and secondary prevention of cardiovascular disease (issued July 2014) is

supported. (www.nice.org.uk/Guidance/CG181)

The recommendations supersede those contained with the JPC document “Choice of

Statin for Primary and Secondary Prevention of Cardiovascular Disease , issued April

2013.

COPD and ACOS (Asthma - COPD Overlap Syndrome)

Original June 2013 Last updated Sept 19 Dec 19

See JPC Guidelines http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-guidelines/copd-and-aco-(asthma-copd-overlap)-guidelines.aspx June 19 update – New document added

Inhaled Corticosteroid (ICS) Step-down Protocol for Adults with COPD (June 19) Sept 19 – Inhaler choices review

Dec 19 Agreed to remove Seebri® Breezhaler® and Ultibro® Breezhaler® from the Formulary based on further analysis of inhaler use across the ICS over the last three years and that the formulary change would apply to new patients only.

Bedfordshire Community Antimicrobial Prescribing Guidelines

Original Version No 7 2013 - Last Updated

This is regularly updated every 2 months taking into account NICE recommendations. See Gp ref for the most upto date version

http://www.nice.org.uk/Guidance/CG181

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-guidelines/copd-and-aco-(asthma-copd-overlap)-guidelines.aspx

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-guidelines/copd-and-aco-(asthma-copd-overlap)-guidelines.aspx

http://www.gpref.bedfordshire.nhs.uk/media/220578/bccglccg_inhaledsteroidstepdownprotocolcopd.pdf

22


Feb 2020 http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-guidelines/antimicrobial-guidelines.aspx

Guidelines for the Prescribing of Specialist infant Formula in Primary Care (Bedfordshire & Luton)

Feb 2015 Updated Sept 17 Updated December 19

Infant Formula Guidelines - Updated December 2019

Asthma Guidelines (Adults and paediatrics)

Feb 2016 Updated March 2018 Updated Dec 19

See GP Ref for current Guidleines

Asthma Inhaler Choices(New Formulary additions)

Asthma Guidelines (Paediatrics)- Paediatric Wheeze and Asthma Guidelines (Children

Age 16 and under)

BCCG LCCG Primary Care Asthma Guidelines

NB: low carbon inhalers (Salbutamol Easyhaler®; Pulmicort® [budesonide] Turbohaler; and

Beclometasone Easyhaler®) were added to the Joint Formulary

Bevacizumab – EoE PAC statement Feb 2016 EoE PAC statement noted by the JPC See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

Transfer of care of patients administered LMWH April 2016 A transfer of care document was approved by the JPC IN April 2016. This document is designed for internal use only - for further information, please contact the JPC pharmacist , Medicine management team.

Low Molecular Weight Heparins (LMWHs) and Fondaparinux – Prescribing Guidance

July 2016 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

Gabapentin and Pregabalin - Medication Alert Feb 2017 See JPC Advice and Guidance page

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-guidelines/antimicrobial-guidelines.aspx

http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-guidelines/antimicrobial-guidelines.aspx

https://www.gpref.bedfordshire.nhs.uk/media/229653/bedscountywideprescguidelinesspecialistinfantformuladec19.pdf

https://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/new-formulary-additions/asthma-inhaler-choices-(new-formulary-additions).aspx

https://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-guidelines/paediatric-wheeze-and-asthma-guidelines-(children-age-16-and-under).aspx

https://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-guidelines/paediatric-wheeze-and-asthma-guidelines-(children-age-16-and-under).aspx

https://www.gpref.bedfordshire.nhs.uk/media/233087/bccg_lccg_asthmaprimarycareguidelinesadultsdec2019.pdf





23



Psoriasis Treatment Pathway (Severe Disease) (Feb 17)

Feb 2017 Updated April 19 , Sept 19

See JPC Treatment pathways http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-treatment-pathways.aspx

Melatonin Cost Effectiveness Choices Bulletin Feb 2017 See JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-advice-and-guidance.aspx

Psoriatic Arthritis – Treatment pathway Sept 17 Updated June 2018 Updated Nov 18

See JPC Treatment pathways http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-treatment-pathways.aspx

Ophthalmology – Intravitreal Injection Pathway .

March 2018 Update feb 2020

See JPC Treatment pathways The pathwayis currently being updated to reflect the inclusion of NICE TA 590 Fluocinolone for the treatment of recurrent non-infectious uveitis.

Ankylosing Spondylitis / Non-radiographic Axial Spondyloarthritis Treatment Pathway

March 2018 See JPC Treatment pathways http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-treatment-pathways.aspx

Dermatology Treatment Pathways

Acne

Atopic Eczema

Psoriasis

May 2018 See JPC Treatment pathways http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/jpc-treatment-pathways.aspx













24


Atrial Fibrillation Resouces Feb 2019 Updated June 19

See Atrial Firbrillation Resources on JPC Advice and Guidance page http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribing-committee-(jpc)/atrial-fibrillation-anticoagulation-resources.aspx The following documents are available :

Choice of Non-vitamin K antagonist Oral Anticoagulants (NOACs)- Bulletin 224 (Updated Feb / March

2019)

Atrial Fibrillation Anticoagulant Clinical Decision Aid and supporting resources (Ref: Source - EoEPAC)

Atrial Fibrillation Anticoagulation Patient Information and Decision Aid Booklet (Ref: Source -

PRESQIPP)

Drug Interactions with NOACs (Ref: source - PRESQIPP)

NOAC Patient Information (Ref: source - PRESQIPP)

Table of NOAC comparisons (Ref: source - PRESQIPP)

Calculating Renal Function (Cockroft-Gault Formula) using SystmONE when Prescribing (NOACs)

Flash Glucose Monitoring resources April 19 Available on GP Ref Click link below: http://www.gpref.bedfordshire.nhs.uk/referrals/bedfordshire-and-luton-joint-prescribinittee-(jpc)/flash-glucose-monitoring-system.aspx

Primary Headache Pathway June 19 https://www.gpref.bedfordshire.nhs.uk/media/224831/alternativeheadachepathway.pdf

Vitamin D Patient information leaflet June 19

Vitamin D Guidelines (Adults and Paeds)

Simple Vitamin D Deficiency Paeds Guideline for Panbeds use

Vitamin D guidelines (Adults) :- Management of Simple Vitamin D Deficiency in adults > 18 years with eGFR >30ml/min



http://www.gpref.bedfordshire.nhs.uk/media/221732/atrialfibrillationbulletin224.pdf

http://www.gpref.bedfordshire.nhs.uk/media/221732/atrialfibrillationbulletin224.pdf

http://www.gpref.bedfordshire.nhs.uk/media/222420/af_anticoagulant_clindecisionaid.pdf

http://www.gpref.bedfordshire.nhs.uk/media/221729/atrialfibrilationanticoagpresqipp.pdf

http://www.gpref.bedfordshire.nhs.uk/media/221729/atrialfibrilationanticoagpresqipp.pdf

http://www.gpref.bedfordshire.nhs.uk/media/221735/druginteractionsnoacs.pdf

http://www.gpref.bedfordshire.nhs.uk/media/221738/noac_patientinfo.pdf

http://www.gpref.bedfordshire.nhs.uk/media/221741/tablenoac_comparisons.pdf

http://www.gpref.bedfordshire.nhs.uk/media/222535/calccreatinineclearancenoacssytmone.pdf



https://www.gpref.bedfordshire.nhs.uk/media/224831/alternativeheadachepathway.pdf

https://www.gpref.bedfordshire.nhs.uk/media/233430/simplevitd_deficiencypaedsguidelinepanbedsuse.pdf

https://www.gpref.bedfordshire.nhs.uk/media/209202/bedslutonguidelinemgmntsimplevitd_deficiencyadults.pdf

https://www.gpref.bedfordshire.nhs.uk/media/209202/bedslutonguidelinemgmntsimplevitd_deficiencyadults.pdf

25


Inflammatory Bowel Disease Biologic Pathways for Crohn’s Disease and Ulcerative Colitis

Sept 19 Crohn's Disease Biologic Treatment Pathway

Ulcerative Colitis (Moderate to severe) Biologic Treatment Pathway

Linezolid GP Fact sheet Dec 19

https://www.gpref.bedfordshire.nhs.uk/media/231647/linezolidfactsheet.pdf

Continence Appliance Prescribing Guidelines Dec 19 Continence Appliance Prescribing Guidelines

Dry Eye Prescribing Guideline Dec 19 Dry Eye - Prescribing Guideline for Dry Eye Management in Adults

Oral Nutritional Supplements in adults Dec 19 Oral Nutritional Supplements (ONS) in Adults Prescribing Guidelines - NEW (December 2019)

Growth Hormone – Information Sheet for GPs Feb 2020 Currently being finalised

Updated Feb 2020 By S McGroarty, Medicine Management JPC Pharmacist

https://www.gpref.bedfordshire.nhs.uk/media/225800/crohnsdiseasebiologictreatmentpathway.pdf

https://www.gpref.bedfordshire.nhs.uk/media/225806/modsevereulcerativecolitisbiologictreatmentpathway.pdf

https://www.gpref.bedfordshire.nhs.uk/media/231647/linezolidfactsheet.pdf

https://www.gpref.bedfordshire.nhs.uk/media/231641/continenceapplianceprescguidelines.pdf

https://www.gpref.bedfordshire.nhs.uk/media/231231/bedsprescguidelinesdyeeyemgmntadultsdec19.pdf

https://www.gpref.bedfordshire.nhs.uk/media/229656/lutonbedsonsprescguidelines2019.pdf

https://www.gpref.bedfordshire.nhs.uk/media/229656/lutonbedsonsprescguidelines2019.pdf

Documents

List of Current JPC Recommendations...151 6.1.2 Exenatide Once Weekly Injection for Type 2 Diabetes ... 197 Dapoxetine for Premature Ejaculation April 2014 See JPC Advice and Guidance