Committees : Surrey Heartlands Integrated Care System Area Prescribing Committee (APC)

The APC approved a change in Traffic Light Status from Blue to Green while reviewing drugs for inclusion on the Surrey Heartlands Joint Formulary.

It was agreed that GPs would initiate non-hormonal treatments for menopausal symptoms in accordance with CKS guidelines and NICE NG23: Menopause: identification and management

The APC approved a change in Traffic Light Status from Blue to Green while reviewing drugs for inclusion on the Surrey Heartlands Joint Formulary.

It was agreed that GPs would initiate non-hormonal treatments for menopausal symptoms in accordance with CKS guidelines and NICE NG23: Menopause: identification and management

The APC approved a change in Traffic Light Status from Blue to Green while reviewing drugs for inclusion on the Surrey Heartlands Joint Formulary.

It was agreed that GPs would initiate non-hormonal treatments for menopausal symptoms in accordance with CKS guidelines and NICE NG23: Menopause: identification and management

The APC approved a change in Traffic Light Status from Blue to Green while reviewing drugs for inclusion on the Surrey Heartlands Joint Formulary.

It was agreed that GPs would initiate non-hormonal treatments for menopausal symptoms in accordance with CKS guidelines and NICE NG23: Menopause: identification and management

The APC approved a change in Traffic Light Status from Blue to Green while reviewing drugs for inclusion on the Surrey Heartlands Joint Formulary.

It was agreed that GPs would initiate non-hormonal treatments for menopausal symptoms in accordance with CKS guidelines and NICE NG23: Menopause: identification and management

During the process of reviewing drugs for inclusion on the Surrey Heartlands Joint Formulary, it was noted that Leuprorelin had not been included within the shared care arrangements for treatment of precocious puberty.

Leuprorelin did not have a license for this indication at the point of agreeing shared care for triptorelin. 

Leuprorelin is now licensed for precocious puberty and can be used in accordance with the shared care agreement.

The shared care document will be reviewed and updated.

The APC approved the new asthma pathways for:

• Adults and Over 12 years
• Children and young people (5-11 years)

The use of High Dose Inhaled Corticosteroid (ICS) Safety Cards are recommended for use as appropriate.

Spacer devices are recommended for use with Metered Dose Inhalation (MDI) devices.

Branded prescribing of corticosteroid inhalers is recommended following the increase in the range of inhaler devices now available. Patients should be prescribed an inhaler that meets their individual needs - where there is more than one option available, the brand with the lowest acquisition cost is recommended.

Patient education videos and instruction leaflets on the correct use of their inhaler devices can be found on the PAD page for all formulary devices.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed that melatonin may be considered for for the short term (up to 13 weeks) adjunctive treatment of primary insomnia in patients aged 55 years or over, where sleep hygiene measures have failed, and insomnia is not likely to resolve soon. CBTi should be offered before melatonin (if available).

In all patients, sleep hygiene and behavioural interventions should be tried prior to considering medication for sleep disorders and should continue to be used alongside melatonin. Sleep | Healthy Surrey

Where treatment is continued beyond 2 years, patient to be advised of limited safety evidence beyond this timeframe and a discussion should be documented in clinical notes.

Melatonin is considered as GREEN status for this patient cohort.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed updated Dry eye guidelines and associated resources following the discontinuation of Evolve Preservative Free Hypromellose 0.3%.

This preparation has been replaced by AddTear® Hypromellose  0.3% PF 10ml & Ocufresh®  Hypromellose  0.3% PF 10ml

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed that melatonin may be considered to treat rapid eye movement sleep behaviour disorder (RBD) in people with Parkinson's Disease and sleep disturbance (unlicensed use), on request from a Parkinson's specialist.

In all patients, sleep hygiene and behavioural interventions should be tried prior to considering medication for sleep disorders and should continue to be used alongside melatonin. Sleep | Healthy Surrey

Where treatment is continued beyond 2 years, patient to be advised of limited safety evidence beyond this timeframe and a discussion should be documented in clinical notes.

A BLUE (on specialist recommendation) has been agreed.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a local adaptation of the methotrexate shared care.  

Specialists who make the clinical decision to change a patient from oral to subcutaneous methotrexate are responsible for ensuring safety during transition and they must provide clear communication, before the first primary care presciption is required, as follows

• Stop date for prescribing oral methotrexate
• Date of transfer of prescribing to primary care
• Confirm that the first prescription of subcutaneous methotrexate and training (injection technique) will be provided by the specialist
• Any additional monitoring required and who will do this?
• Dose of methotrexate subcutaneous to be prescribed

Other responsibilities for specialist team.

• Advise patient to take any remaining oral methotrexate to their community pharmacy for safe disposal
• Prescribe at least 4 weeks subcutaneous methotrexate before transfer of prescribing
• Signpost patient to the process for safe disposal of sharps boxes through councils. Information available here  Sharps and clinical waste disposal - Council arrangements - update

Patients should be provided with sharps bin on dispensing of 1st prescription

A new shared care document will not be required, as primary care have already accepted shared care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a local adaptation of the methotrexate shared care.  

Specialists who make the clinical decision to change a patient from oral to subcutaneous methotrexate are responsible for ensuring safety during transition and they must provide clear communication, before the first primary care presciption is required, as follows

• Stop date for prescribing oral methotrexate
• Date of transfer of prescribing to primary care
• Confirm that the first prescription of subcutaneous methotrexate and training (injection technique) will be provided by the specialist
• Any additional monitoring required and who will do this?
• Dose of methotrexate subcutaneous to be prescribed

Other responsibilities for specialist team.

• Advise patient to take any remaining oral methotrexate to their community pharmacy for safe disposal
• Prescribe at least 4 weeks subcutaneous methotrexate before transfer of prescribing
• Signpost patient to the process for safe disposal of sharps boxes through councils. Information available here  Sharps and clinical waste disposal - Council arrangements - update

Patients should be provided with sharps bin on dispensing of 1st prescription

A new shared care document will not be required, as primary care have already accepted shared care.

 The Surrey Heartlands Integrated Care System Area Prescribing Committee has a agreed a NON-FORMULARY traffic light status for melatonin to manage insomnia in people living with Alzheimer’s disease, in line with NICE guidance (NG97)

The Surrey Heartlands Integrated Care System Area Prescribing Committee has a agreed a NON-FORMULARY traffic light status for melatonin use for the treatment of Jet lag adult patients

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a local adaptation of the methotrexate shared care.  

Specialists who make the clinical decision to change a patient from oral to subcutaneous methotrexate are responsible for ensuring safety during transition and they must provide clear communication, before the first primary care presciption is required, as follows

• Stop date for prescribing oral methotrexate
• Date of transfer of prescribing to primary care
• Confirm that the first prescription of subcutaneous methotrexate and training (injection technique) will be provided by the specialist
• Any additional monitoring required and who will do this?
• Dose of methotrexate subcutaneous to be prescribed

Other responsibilities for specialist team.

• Advise patient to take any remaining oral methotrexate to their community pharmacy for safe disposal
• Prescribe at least 4 weeks subcutaneous methotrexate before transfer of prescribing
• Signpost patient to the process for safe disposal of sharps boxes through councils. Information available here  Sharps and clinical waste disposal - Council arrangements - update

Patients should be provided with sharps bin on dispensing of 1st prescription

A new shared care document will not be required, as primary care have already accepted shared care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a local adaptation of the methotrexate shared care.  

Specialists who make the clinical decision to change a patient from oral to subcutaneous methotrexate are responsible for ensuring safety during transition and they must provide clear communication, before the first primary care presciption is required, as follows

• Stop date for prescribing oral methotrexate
• Date of transfer of prescribing to primary care
• Confirm that the first prescription of subcutaneous methotrexate and training (injection technique) will be provided by the specialist
• Any additional monitoring required and who will do this?
• Dose of methotrexate subcutaneous to be prescribed

Other responsibilities for specialist team.

• Advise patient to take any remaining oral methotrexate to their community pharmacy for safe disposal
• Prescribe at least 4 weeks subcutaneous methotrexate before transfer of prescribing
• Signpost patient to the process for safe disposal of sharps boxes through councils. Information available here  Sharps and clinical waste disposal - Council arrangements - update

Patients should be provided with sharps bin on dispensing of 1st prescription

A new shared care document will not be required, as primary care have already accepted shared care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a local adaptation of the methotrexate shared care.  

Specialists who make the clinical decision to change a patient from oral to subcutaneous methotrexate are responsible for ensuring safety during transition and they must provide clear communication, before the first primary care presciption is required, as follows

• Stop date for prescribing oral methotrexate
• Date of transfer of prescribing to primary care
• Confirm that the first prescription of subcutaneous methotrexate and training (injection technique) will be provided by the specialist
• Any additional monitoring required and who will do this?
• Dose of methotrexate subcutaneous to be prescribed

Other responsibilities for specialist team.

• Advise patient to take any remaining oral methotrexate to their community pharmacy for safe disposal
• Prescribe at least 4 weeks subcutaneous methotrexate before transfer of prescribing
• Signpost patient to the process for safe disposal of sharps boxes through councils. Information available here  Sharps and clinical waste disposal - Council arrangements - update

Patients should be provided with sharps bin on dispensing of 1st prescription

A new shared care document will not be required, as primary care have already accepted shared care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have updated their recommendations for 1st line hypromellose preservative free eye drops, where these are indicated 

AddTear or Ocufresh preservate free 0.3% will replace Evolve preservative free 0.3% as these have been discontinued.

The associated resources have been updated for reference

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a local adaptation of the methotrexate shared care.  

Specialists who make the clinical decision to change a patient from oral to subcutaneous methotrexate are responsible for ensuring safety during transition and they must provide clear communication, before the first primary care presciption is required, as follows

• Stop date for prescribing oral methotrexate
• Date of transfer of prescribing to primary care
• Confirm that the first prescription of subcutaneous methotrexate and training (injection technique) will be provided by the specialist
• Any additional monitoring required and who will do this?
• Dose of methotrexate subcutaneous to be prescribed

Other responsibilities for specialist team.

• Advise patient to take any remaining oral methotrexate to their community pharmacy for safe disposal
• Prescribe at least 4 weeks subcutaneous methotrexate before transfer of prescribing
• Signpost patient to the process for safe disposal of sharps boxes through councils. Information available here  Sharps and clinical waste disposal - Council arrangements - update

Patients should be provided with sharps bin on dispensing of 1st prescription

A new shared care document will not be required, as primary care have already accepted shared care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a local adaptation of the methotrexate shared care.  

Specialists who make the clinical decision to change a patient from oral to subcutaneous methotrexate are responsible for ensuring safety during transition and they must provide clear communication, before the first primary care presciption is required, as follows

• Stop date for prescribing oral methotrexate
• Date of transfer of prescribing to primary care
• Confirm that the first prescription of subcutaneous methotrexate and training (injection technique) will be provided by the specialist
• Any additional monitoring required and who will do this?
• Dose of methotrexate subcutaneous to be prescribed

Other responsibilities for specialist team.

• Advise patient to take any remaining oral methotrexate to their community pharmacy for safe disposal
• Prescribe at least 4 weeks subcutaneous methotrexate before transfer of prescribing
• Signpost patient to the process for safe disposal of sharps boxes through councils. Information available here  Sharps and clinical waste disposal - Council arrangements - update

Patients should be provided with sharps bin on dispensing of 1st prescription

A new shared care document will not be required, as primary care have already accepted shared care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a change in traffic light status for relugolix in the treatment of Prostate Cancer.

A BLUE (with specialist initiation) traffic light status was agreed, with at least 1 month prescribing of relugolix by the specialist team prior to transfer of care.

Fluticasone is considered to be a 3rd line agent for nasal allergic rhinitis - see local guidelines below. 

If fluticasone is necessary, prescribe as Avamys (fluticasone furoate 27.5mcg/dose).

Avamys is approxiamtely 40% less expensive than generic scripts for fluticasone propionate or branded Flixonase.

Allergic rhinitis guidelines were agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed Lidocaine medicated plasters for the symptomatic relief of neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia) in adults.

The Surrey Heartlands Integated Care system Area Prescribing Committee recommends the administration of depot antipsychotic injections under an AMBER shared care agreement for practices that have signed up to the agreed locally commissioned service (LCS). The AMBER shared care includes a monthly injection schedule and a schedule for injections every 2 months.
 

Surrey Heartlands ICB have developed the LCS to enable stable patients with schizophrenia to be prescribed and administered these injections through their primary care prescriber (GP). 

If a practice has not signed up to the LCS the drug remains as RED status and prescriptions will be issued by the provider.

GENERIC Cetirizine has been considered by the APC and has been agreed as a 1st-line treatment option.
Available to purchase.

Liquids reserved for patients unable to swallow solid dose forms.
Loratadine liquid (5mg/5ml) suger free is the 1st-line choice (from 2 years)

Cetirizine liquid (1mg/ml) is 2nd-line option. Safe and effective and can be prescribed from age of 2.

Cetirizine capsules are considerably more costly and are therefore not recommended for routine use within local guidelines

GENERIC loratadine has been considered by the APC and has been agreed as a 1st line treatment option
Available to purchase

Liquids reserved for patients unable to swallow solid dose forms.
Loratadine liquid (5mg/5ml) suger free is the 1st-line choice (from 2 years)

Cetirizine liquid (1mg/ml) is 2nd-line option. Safe and effective and can be prescribed from age of 2.
 

Beclometasone 50mcg/dose (200 dose container) is recommended as a 1st line alternative treatment option. NOTE Beconase Hayfever and other container sizes (180 dose and 100 dose) are much more expensive and should not be used.

Desloratadine and levocetirizine are not recommended 1st line as there is little evidence that they confer any additional benefit over the more established non-sedating antihistamines and are more costly - see local guidelines below

Cetirizine or loratadine are the 1st line non-sedating antihistamines

Desloratadine liquid is non-formulary

Desloratadine and levocetirizine are not recommended 1st line as there is little evidence that they confer any additional benefit over the more established non-sedating antihistamines and are more costly - see local guidelines below

Cetirizine or loratadine are the 1st line non-sedating antihistamines

Levocetirizine liquid is non-formulary

Once daily Benacort (budesonide) or generic budesonide 64mcg/dose  may be considered reasonable second line options for corticosteroid nasal sprays in allergic rhinitis   

Generic mometasone furoate (once daily) nasal spray was agreed as a 1st line treatment option for intranasal corticosteroids.
Generic beclometasone or Beconase nasal spray (200 dose container) is an appropriate 1st line alternative.

Bilastine tablets for allergic rhinitis have not been recommended for use within the local guidelines.
Bilastine is considerably more expensive and is not considered a cost-effective treatment option.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the use of lidocaine plasters as BLUE (on initiation) following specialist pain team or palliative care team review and where a clinical need has been identified.

The specialist will be required to supply a 1 month minimum supply prior to transfer of care 

The specialist will be required to ensure the patient has responded to treatment and is stable before transferring care. They will be asked to provide the following information to the primary care prescriber in the clinic letter when transferring care.

o   Indication for initiation

o   MDT discussion/plan

o   Dose to be prescribed

o   Confirmation of response to initial treatment

o   Intended duration of treatment

o   Ongoing monitoring/assessment of response

Fexofenadine is recommended as a 2nd line treatment option.

Prescribe generically

NOTE - the 180mg tablets are NOT licensed for allergic rhinitis

Rupatadine tablets for allergic rhinitis have not been recommended for use within the local guidelines.
Rupatadine is considerably more expensive and is not considered a cost-effective treatment option.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approve the updated Interface Prescribing Policy 2025/2028 

Referral of patients to a smoking cessation service is the preferred management pathway.

GPs should only prescribe smoking cessation products for patients who decline referral in line with CKS guidance or through requests from the smoking cessation service (see below).

The ‘One You Surrey’ Smoking cessation service has been commissioned by Public Health (Surrey County Council) since April 2019 and provides support to clients as part of a 12 week programme.

Nicotine replacement therapy (NRT) will be provided as part of the service in pregnancy and for clients with defined long-term health conditions.

Requests to prescribe NRT will only be made to the GP in rare circumstances where the client requests further NRT beyond 12- weeks (at the discretion of the GP).

For clients requiring the following, a request form for prescribing (includes screening questions) will be sent to the client’s GP by the service:

• Bupropion (Zyban)
• Varenicline
• Cytisinicline

Clients will be monitored by ‘One You’ Surrey on a weekly basis for any side effects. At the end of treatment, patients will be issued with a letter to be given to their GP to update records and book a medication review (where appropriate).

Patients can be referred by a health care professional or can self refer: https://oneyousurrey.org.uk/stop-smoking/

Further information on the service is available at: https://oneyousurrey.org.uk/

There is a dedicated section for primary care health professionals: https://oneyousurrey.org.uk/professionals/

Bupropion, Varenicline and Cytisinicline will be given a GREEN (see narrative) traffic light status on the Joint Formulary

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

To be used  as a 3rd line alternative when monotherapy is inadequate.

Fluticasone is considered to be a 3rd line agent for nasal allergic rhinitis - see local guidelines below. 

If fluticasone is necessary, prescribe as Avamys (fluticasone furoate 27.5mcg/dose).

Avamys is approxiamtely 40% less expensive than generic scripts for fluticasone propionate or branded Flixonase.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the use of lidocaine plasters for rib fractures.

A RED traffic light status has been agreed for this indication.

Trusts must ensure that appropriate durations can be supplied without requests to primary care for further supply

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Aflibercept 8mg Intravitreal Injection

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the use of aflibercept 8mg intravitreal injection.

Aflibercept 2mg (biosimilar when available) remains a first line treatment option (alongside ranibizumab biosimilar).

Aflibercept 8mg can be used in those patients that have not responded sufficiently to the 2mg treat and extend protocols and that aflibercept 8mg will be used no more frequently than every 8 weeks in line with the licence

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed an updated Osteoporosis pathway for specialist (high cost) treatments.

Please note that algorithm 1 in the Osteoporosis Guidelines has not been updated.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the use of teriparatide for osteoporosis in postmenopausal women in line with its licence (24 months treatment length).

Teriparatide will continue to have RED traffic light status for use in this patient cohort.

The updated definitions for use and severity in the national guidance for osteoporosis treatment from the NOGG/ROC (2024 recommendations) was agreed to enable access to teriparatide, romosozumab and abaloparatide at patients at high risk. National Osteoporosis Guidelines Group UK

Aflibercept 8mg Intravitreal Injection

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the use of aflibercept 8mg intravitreal injection.

Aflibercept 2mg (biosimilar when available) remains a first line treatment option (alongside ranibizumab biosimilar).

Aflibercept 8mg can be used in those patients that have not responded sufficiently to the 2mg treat and extend protocols and that aflibercept 8mg will be used no more frequently than every 8 weeks in line with the licence

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees the following place in therapy for glucocorticoids in line with NG243 (Adrenal insufficiency: identification and management)

• Hydrocortisone immediate release is the first choice glucocorticoid.
• Prednisolone is an alternative first line if multiple daily doses are not appropriate.
• Hydrocortisone modified-release is a 2nd line option
• Fludrocortisone for mineralocorticoid replacement if needed (to normalise serum electrolytes and plasma renin, and reduce postural symptoms and salt craving)

See Formulary status and restrictions for individual formulations.

Dosing of glucocorticoids during acute illness - It is important for people with adrenal insufficiency to increase their corticosteroid doses at times of illness in order to reduce the risk of adrenal crisis. As a guide, for any moderate intercurrent illness (such as illness with fever, requiring bedrest, or requiring antibiotics), they should double their usual doses of Hydrocortisone until recovered, or if on Prednisolone, they should increase to a minimum dose of 10 mg daily (or follow specific advice as recommended by their specialist).

In order to allow patients to promptly increase their corticosteroid dose at times of need, and to avoid any risk from unexpected supply shortages, patients should ideally retain 2 months reserve supply at all times and should be reminded to renew their prescription in good time.

The Surrey Heartlands Area Prescribing Committee agreed to adopt the updated South West London (SWL) migraine prophylaxis high cost drug pathway for chronic and episodic migraine.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed tirzepatide for obesity and weight management in line with NICE TA1026.

A RED traffic light status has been agreed, and access will be through the specialist weight management service (SWMS) at Ashford & St Peters NHS Foundation Trust ONLY.

Tirzepatide will be added to the existing SWMS medical pathway alongside semaglutide and in line with the Guidance issued by the Society for Endocrinology and Obesity Management Collaborative UK.  Initially patients who meet the eligibility criteria listed in phase 1 of the guidance will be prioritised for referral to the specialist weight management service to allow those with the combination of highest and most urgent clinical need to be assessed ).

In line with NICE TA1026 further work is in progress around the establishment of our weight management programme, including establishing a service delivering care in the primary care setting.  A further paper will be considered by the Area Prescribing Committee in June or July 2025  

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees the following place in therapy for glucocorticoids in line with NG243 (Adrenal insufficiency: identification and management)

• Hydrocortidsone immediate release is the first choice glucocorticoid.
• Prednisolone is an alternative first line if multiple daily doses are not appropriate.
• Hydrocortisone modified-release is a 2nd line option
• Dexamethasone is a 2nd line option
• Fludrocortisone for mineralocorticoid replacement if needed (to normalise serum electrolytes and plasma renin, and reduce postural symptoms and salt craving)

See Formulary status and restrictions for individual formulations.

Dosing of glucocorticoids during acute illness - It is important for people with adrenal insufficiency to increase their corticosteroid doses at times of illness in order to reduce the risk of adrenal crisis. As a guide, for any moderate intercurrent illness (such as illness with fever, requiring bedrest, or requiring antibiotics), they should double their usual doses of Hydrocortisone until recovered, or if on Prednisolone, they should increase to a minimum dose of 10 mg daily (or follow specific advice as recommended by their specialist).

In order to allow patients to promptly increase their corticosteroid dose at times of need, and to avoid any risk from unexpected supply shortages, patients should ideally retain 2 months reserve supply at all times and should be reminded to renew their prescription in good time.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees the following place in therapy for glucocorticoids in line with NG243 (Adrenal insufficiency: identification and management)

• Hydrocortidsone immediate release is the first choice glucocorticoid.
• Prednisolone is an alternative first line if multiple daily doses are not appropriate.
• Hydrocortisone modified-release is a 2nd line option
• Fludrocortisone for mineralocorticoid replacement if needed (to normalise serum electrolytes and plasma renin, and reduce postural symptoms and salt craving)

See Formulary status and restrictions for individual formulations.

Dosing of glucocorticoids during acute illness - It is important for people with adrenal insufficiency to increase their corticosteroid doses at times of illness in order to reduce the risk of adrenal crisis. As a guide, for any moderate intercurrent illness (such as illness with fever, requiring bedrest, or requiring antibiotics), they should double their usual doses of Hydrocortisone until recovered, or if on Prednisolone, they should increase to a minimum dose of 10 mg daily (or follow specific advice as recommended by their specialist).

In order to allow patients to promptly increase their corticosteroid dose at times of need, and to avoid any risk from unexpected supply shortages, patients should ideally retain 2 months reserve supply at all times and should be reminded to renew their prescription in good time.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees the following place in therapy for glucocorticoids in line with NG243 (Adrenal insufficiency: identification and management)

• Hydrocortidsone immediate release is the first choice glucocorticoid.
• Prednisolone is an alternative first line if multiple daily doses are not appropriate.
• Hydrocortisone modified-release is a 2nd line option
• Dexamethasone is a 2nd line option
• Fludrocortisone for mineralocorticoid replacement if needed (to normalise serum electrolytes and plasma renin, and reduce postural symptoms and salt craving)

See Formulary status and restrictions for individual formulations.

Dosing of glucocorticoids during acute illness - It is important for people with adrenal insufficiency to increase their corticosteroid doses at times of illness in order to reduce the risk of adrenal crisis. As a guide, for any moderate intercurrent illness (such as illness with fever, requiring bedrest, or requiring antibiotics), they should double their usual doses of Hydrocortisone until recovered, or if on Prednisolone, they should increase to a minimum dose of 10 mg daily (or follow specific advice as recommended by their specialist).

In order to allow patients to promptly increase their corticosteroid dose at times of need, and to avoid any risk from unexpected supply shortages, patients should ideally retain 2 months reserve supply at all times and should be reminded to renew their prescription in good time.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees the following place in therapy for glucocorticoids in line with NG243 (Adrenal insufficiency: identification and management)

• Hydrocortidsone immediate release is the first choice glucocorticoid.
• Prednisolone is an alternative first line if multiple daily doses are not appropriate.
• Hydrocortisone modified-release is a 2nd line option
• Fludrocortisone for mineralocorticoid replacement if needed (to normalise serum electrolytes and plasma renin, and reduce postural symptoms and salt craving)

See Formulary status and restrictions for individual formulations.

Dosing of glucocorticoids during acute illness - It is important for people with adrenal insufficiency to increase their corticosteroid doses at times of illness in order to reduce the risk of adrenal crisis. As a guide, for any moderate intercurrent illness (such as illness with fever, requiring bedrest, or requiring antibiotics), they should double their usual doses of Hydrocortisone until recovered, or if on Prednisolone, they should increase to a minimum dose of 10 mg daily (or follow specific advice as recommended by their specialist).

In order to allow patients to promptly increase their corticosteroid dose at times of need, and to avoid any risk from unexpected supply shortages, patients should ideally retain 2 months reserve supply at all times and should be reminded to renew their prescription in good time.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees the following place in therapy for glucocorticoids in line with NG243 (Adrenal insufficiency: identification and management)

• Hydrocortidsone immediate release is the first choice glucocorticoid.
• Prednisolone is an alternative first line if multiple daily doses are not appropriate.
• Hydrocortisone modified-release is a 2nd line option
• Dexamethasone is a 2nd line option
• Fludrocortisone for mineralocorticoid replacement if needed (to normalise serum electrolytes and plasma renin, and reduce postural symptoms and salt craving)

See Formulary status and restrictions for individual formulations.

Dosing of glucocorticoids during acute illness - It is important for people with adrenal insufficiency to increase their corticosteroid doses at times of illness in order to reduce the risk of adrenal crisis. As a guide, for any moderate intercurrent illness (such as illness with fever, requiring bedrest, or requiring antibiotics), they should double their usual doses of Hydrocortisone until recovered, or if on Prednisolone, they should increase to a minimum dose of 10 mg daily (or follow specific advice as recommended by their specialist).

In order to allow patients to promptly increase their corticosteroid dose at times of need, and to avoid any risk from unexpected supply shortages, patients should ideally retain 2 months reserve supply at all times and should be reminded to renew their prescription in good time.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees the following place in therapy for glucocorticoids in line with NG243 (Adrenal insufficiency: identification and management)

• Hydrocortidsone immediate release is the first choice glucocorticoid.
• Prednisolone is an alternative first line if multiple daily doses are not appropriate.
• Hydrocortisone modified-release is a 2nd line option
• Dexamethasone is a 2nd line option
• Fludrocortisone for mineralocorticoid replacement if needed (to normalise serum electrolytes and plasma renin, and reduce postural symptoms and salt craving)

See Formulary status and restrictions for individual formulations.

Dosing of glucocorticoids during acute illness - It is important for people with adrenal insufficiency to increase their corticosteroid doses at times of illness in order to reduce the risk of adrenal crisis. As a guide, for any moderate intercurrent illness (such as illness with fever, requiring bedrest, or requiring antibiotics), they should double their usual doses of Hydrocortisone until recovered, or if on Prednisolone, they should increase to a minimum dose of 10 mg daily (or follow specific advice as recommended by their specialist).

In order to allow patients to promptly increase their corticosteroid dose at times of need, and to avoid any risk from unexpected supply shortages, patients should ideally retain 2 months reserve supply at all times and should be reminded to renew their prescription in good time.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agree to adopt the South West London position statement for wound drainage bags.

Wound management – Wound drainage bags are for chronic non-healing and highly exuding wounds, which are unmanageable with standard formulary dressings, only on recommendation from Tissue Viability nurse (TVN). The preferred product is the ‘Eakin wound drainage bag with fold and tuck closure, small.’

Renal dialysis – Primary care prescribers are asked not to prescribe any wound drainage bag shower protection pouches and auxiliary products for dialysis patients. E.g. Cath Dry Dressing, Independence easy access / wound protection /collection pouches, LINC catheter shower pouches or independence No Sting Barrier Film wipes.

Ensure that new and further prescriptions are not issued on a dispensing appliance company’s (DAC) recommendation on behalf of a patient. If required, patients can be asked to seek further advice from their dialysis clinician or dialysis nurse at their regular appointments.

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves bimekizumab as a treatment option in line with the recommendations made in NICE TA918, for treating axial spondyloarthritis.

Bimekizumab for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

Treatment pathway is available on separate guidelines page.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Surrey Heartlands ICB has agreed the local adoption of the SERMOG policy recommendations for compact oral nutritional supplements for adults. The local ONS traffic light document has been updated accordingly

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

Treatment pathway is available on separate guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the updated Community Prescribing Guidelines for Specialist Infant Formula. SMA Soya has been discontinued for both prescription and purchase as of October 2024 and the guidelines have been updated to reflect this change

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

Treatment pathway is available on separate guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

Treatment pathway is available on separate guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

Treatment pathway is available on separate guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees that new patients in Surrey Heartlands who require insulin glargine to be initiated as a pre-filled pen should be initiated on Semglee ® (insulin glargine) 100units/ml solution for injection 3ml pre-filled pen. 

Semglee® insulin glargine for diabetes mellitus will be considered as GREEN on the traffic light system

 Note: Semglee® insulin is not available as cartridges for use in re-usable insulin pens

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

Treatment pathway is available on separate guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has confirmed a NON-FORMULARY traffic light status for esketamine for treating major depressive disorder in adults at imminent risk of suicide.

This decision is in view of the NICE terminated Technology Appraisal for esketamine for this indication

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed a GREEN traffic light status for:

 Estriol (Blissel®) topical gel

in women who do not tolerate topical oestrogen creams or vaginal pessaries.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

Treatment pathway is available on separate guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

Treatment pathway is available on separate guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated axial spondyloarthritis pathway.

Treatment pathway is available on separate guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated spondyloarthritis treatment pathway.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed an updated guide to prescribing thickeners in adults. A reference source for safe eating, drinking and swallowing techniques was also agreed to support patients prior to speech and language therapist assessment.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed an updated guide to prescribing thickeners in adults. A reference source for safe eating, drinking and swallowing techniques was also agreed to support patients prior to speech and language therapist assessment.

Fusidic acid (Fucidin) 250mg tablets and 250mg/5ml oral suspension are being discontinued in Jan 2025 and Jun 2025 respectively.
The Specialist Pharmacy Service (SPS) have issued advice on appropriate actions and alternative, unlicensed preparations: https://www.sps.nhs.uk/shortages/discontinuation-of-sodium-fusidate-fucidin-250mg-tablets-and-fusidic-acid-fucidin-250mg-5ml-oral-suspension/

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated spondyloarthritis treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed a NON-FORMULARY status for 

 Drospirenone (Slynd®) for HRT

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves a NON-FORMULARY traffic light status for phenindione for Atrial Fibrillation

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Please note; these are availableto purchase from a pharmacy.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Please note; these are available to purchase from a pharmacy.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Please note; these are available to purchase in a pharmacy.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Please note; these are available to purchase in a pharmacy.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Please note; these are available for purchase in a pharmacy.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed a Green traffic light status (with restrictions) for drospirenone (Slynd®) for contraception

Restricted use as a second line treatment option, after desogestrel, in women requiring progestogen-only contraception who do not have risk factors for potassium elevation (renal impairment, hypoadrenalism, concomitant use of potassium-elevating medicines)
 

Caution: May have different drug interactions to other progestogen only pills (POP)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves relugolix for treating hormone-sensitive prostate cancer in line with NICE TA995).

Relugolix for this indication will be considered as RED on the traffic light system.

Prescribing should be initiated and continued by a specialist clinician. If the patient has already been initiated on this medicine by a specialist clinician, please ensure this is recorded as a ‘Hospital Only Drug’ in the patient’s medication list, in order to be alert to potential side-effects and interactions with other medicines prescribed in primary care.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

This drug has been included on the joint formulary having been agreed by the DTC of at least one Surrey Heartlands Acute Trust.

See “Formulary Status” to identify where this drug has been agreed for use.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees that new patients in Surrey Heartlands who require insulin glargine to be initiated as a pre-filled pen should be initiated on Semglee ® (insulin glargine) 100units/ml solution for injection 3ml pre-filled pen. 

Semglee® insulin glargine for diabetes mellitus will be considered as GREEN on the traffic light system

 Note: Semglee® insulin is not available as cartridges for use in re-usable insulin pens

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agrees that new patients in Surrey Heartlands who require insulin glargine to be initiated as a pre-filled pen should be initiated on Semglee ® (insulin glargine) 100units/ml solution for injection 3ml pre-filled pen. 

Semglee® insulin glargine for diabetes mellitus will be considered as GREEN on the traffic light system

 Note: Semglee® insulin is not available as cartridges for use in re-usable insulin pens

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed an updated guide to prescribing thickeners in adults. A reference source for safe eating, drinking and swallowing techniques was also agreed to support patients prior to speech and language therapist assessment.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves latanoprost with netarsudil for previously treated primary open-angle glaucoma or ocular hypertension as recommended by NICE TA1009

Latanoprost -netasurdil for this indication will be considered as BLUE on the traffic light system, treatment should be initiated by specialist clinicians, and at least 1 month supply should be provided at initiation before transfer of care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves bevacizumab gamma as a treatment option for the treatment of wet age-related macular degeneration as recommended by NICE TA1022

Bevacizumab gamma for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Prescribing should be initiated and continued by a specialist clinician. If the patient has already been initiated on this medicine by a specialist clinician, please ensure this is recorded as a ‘Hospital Only Drug’ in the patient’s medication list, in order to be alert to potential side-effects and interactions with other medicines prescribed in primary care

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a GREEN traffic light status for bempedoic Acid with ezetimibe in line with NICE guidance (TA694).

 Please follow the guidance in the SPC and the National Lipid Management pathway for advice on initial and onward monitoring requirements.

 Note: Anaemia is a common side-effect of bempedoic acid. For patients where a reduction in haemoglobin (Hb) may be of concern, consider a full blood count (FBC) at 3 months and annually thereafter. 

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a GREEN traffic light status for bempedoic Acid with ezetimibe in line with NICE guidance (TA694).

 Please follow the guidance in the SPC and the National Lipid Management pathway for advice on initial and onward monitoring requirements.

 Note: Anaemia is a common side-effect of bempedoic acid. For patients where a reduction in haemoglobin (Hb) may be of concern, consider a full blood count (FBC) at 3 months and annually thereafter. 

The Surrey Heartlands Integrated Care System Area Prescribing Committee noted the ongoing shortages of pancreatic enzyme replacement therapies.

Local guidance has been produced to summarise current issues and information and actions for prescribers, community pharmacies and patients.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a RED traffic light status for the use of paraldehyde Olive Oil Enemas to treat seizures or status epilepticus.

Patients currently being prescribed paraldehyde olive oil enemas in primary care may continue if, following discussions with the patient / carer, the prescriber is satisfied that the treatment is appropriate and there are no safety concerns.

For all new patients prescribing should remain with the specialist team that initiated the treatment.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands ICS Respiratory programme have developed a pathway, based on NICE guidelines, for the primary care assessment of patients with community acquired pneumonia. 

The pathway has been agreed by the ICS respiratory network

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Traffic light status agreed / updated at the Surrey Heartlands APC as part of the Joint Formulary review.

The Royal College of Ophthalmologists issued monitoring guidelines in 2020 that recommend annual retinopathy monitoring to begin after 1 year of drug therapy for patients with additional risk factors for retinal toxicity: 

• Concomitant tamoxifen use
• Impaired renal function (eGFR <60ml/min/1.73m2)
• Dose of hydroxychloroquine greater than 5mg per kg per day
• Chloroquine use

For all other patients, monitoring begins after 5 years of drug therapy.

The current arrangements for opthalmology monitoring are:

East Surrey Place: see narrative below from Feb 2020

Guildford & Waverley Place: A retinopathy screening service is provided by Frimley Health NHS Foundation Trust. A self-populating referral form is available on EMIS.

North West Surrey Place: A retinopathy screening service is provided by Frimley Health NHS Foundation Trust. A self-populating referral form is available on EMIS.

Guidelines from the Royal College of Ophthalmologists: Hydroxychloroquine-and-Chloroquine-Retinopathy-Monitoring-Guideline.pdf (rcophth.ac.uk)

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The place in therapy of theophylline MR is under review. The role of theophylline in the management of asthma and COPD has changed and become much more limited now that more effective, and safer treatments are available.  Therapeutic drug monitoring is required in patients on theophylline, which further limits its usefulness. Recent national guidance emphasises the need for organisations to ensure they have management systems in place to support the safe use of this medicine.  It is not recommended that GPs initiate theophylline in primary care without seeking specialist advice.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Nabilone is not on any local Trust formulary and has been awarded a non-formulary status for this indication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves

GREEN Traffic light classification for.

• Esomeprazole granules as branded product, Nexium® as an option in children and infants under the age of 1 with a NG tube >6 French (FR) in situ.(off-label use)
• Generic esomeprazole granules may be prescribed (3rd line) for infants and children under the age of 1 without an NG tube in situ where the parents or carers are having difficulties in giving part-dose using orodispersible tablets.

This will need to be reviewed every 3 months as the child grows, to either discontinue treatment or change to the much less expensive orodispersible tablets described in the ‘PPIs for Children Prescribing Algorithm’ on the PAD

The APC note that the previous decisions made in December 2022 still stand:

• omeprazole suspension in children under the age of 1 with a NG tube in situ, continues to have BLUE traffic light status
• omeprazole suspension in children and infants under the age of 1 without an NG tube in situ, continues to have a NON-FORMULARY traffic light status

The Royal College of Ophthalmologists issued monitoring guidelines in 2020 that recommend annual retinopathy monitoring to begin after 1 year of drug therapy for patients with additional risk factors for retinal toxicity: 

• Concomitant tamoxifen use
• Impaired renal function (eGFR <60ml/min/1.73m2)
• Dose of hydroxychloroquine greater than 5mg per kg per day
• Chloroquine use

For all other patients, monitoring begins after 5 years of drug therapy.

The current arrangements for opthalmology monitoring are:

East Surrey Place: see narrative below from Feb 2020

Guildford & Waverley Place: A retinopathy screening service is provided by Frimley Health NHS Foundation Trust. A self-populating referral form is available on EMIS.

North West Surrey Place: A retinopathy screening service is provided by Frimley Health NHS Foundation Trust. A self-populating referral form is available on EMIS.

Guidelines from the Royal College of Ophthalmologists: Hydroxychloroquine-and-Chloroquine-Retinopathy-Monitoring-Guideline.pdf (rcophth.ac.uk)

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves linzagolix for the treatment of moderate to severe symptoms of uterine fibroids as recommended by NICE TA996

Linzagolix for this indication will be considered as BLUE (following specialist initiation) on the traffic light system. Specialist will be expected to prescribe a minimum of 1 month of linzagolix before requesting transfer of care to the primary care prescriber.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the following traffic light status for treating menorrhagia associated with fibroids:

 GREEN traffic light status

• Tranexamic acid tablets
• Norethisterone
• Combined Hormonal Contraception
• Levonorgestrel intrauterine system (LNG-IUS) - Benilexa, levosert & Mirena

RED traffic light status

GnRH/LHRH analogues

• Triptorelin (Decapeptyl SR® 3.75mg)
• Leuprorelin (Prostap SR DCS®) 3.75mg
• Gosereline acetate (Zoladex® 3.6mg)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the following traffic light status for treating menorrhagia associated with fibroids:

 GREEN traffic light status

• Tranexamic acid tablets
• Norethisterone
• Combined Hormonal Contraception
• Levonorgestrel intrauterine system (LNG-IUS) - Benilexa, levosert & Mirena

RED traffic light status

GnRH/LHRH analogues

• Triptorelin (Decapeptyl SR® 3.75mg)
• Leuprorelin (Prostap SR DCS®) 3.75mg
• Gosereline acetate (Zoladex® 3.6mg)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the following traffic light status for treating menorrhagia associated with fibroids:

 GREEN traffic light status

• Tranexamic acid tablets
• Norethisterone
• Combined Hormonal Contraception
• Levonorgestrel intrauterine system (LNG-IUS) - Benilexa, levosert & Mirena

RED traffic light status

GnRH/LHRH analogues

• Triptorelin (Decapeptyl SR® 3mg)
• Leuprorelin (Prostap SR DCS®) 3.75mg
• Gosereline acetate (Zoladex® 3.6mg)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the following traffic light status for treating menorrhagia associated with fibroids:

 GREEN traffic light status

• Tranexamic acid tablets
• Norethisterone
• Combined Hormonal Contraception
• Levonorgestrel intrauterine system (LNG-IUS) - Benilexa, levosert & Mirena

RED traffic light status

GnRH/LHRH analogues

• Triptorelin (Decapeptyl SR® 3mg)
• Leuprorelin (Prostap SR DCS®) 3.75mg
• Gosereline acetate (Zoladex® 3.6mg)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed the following traffic light status for treating menorrhagia associated with fibroids:

 GREEN traffic light status

• Tranexamic acid tablets
• Norethisterone
• Combined Hormonal Contraception
• Levonorgestrel intrauterine system (LNG-IUS) - Benilexa, levosert & Mirena

RED traffic light status

GnRH/LHRH analogues

• Triptorelin (Decapeptyl SR® 3mg)
• Leuprorelin (Prostap SR DCS®) 3.75mg
• Gosereline acetate (Zoladex® 3.6mg)

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves vibegron as an option for treating the symptoms of overactive bladder (OAB) syndrome in adults.

Vibegron is only recommended if antimuscarinic medicines are not suitable, do not work well enough or have unacceptable side effects, as recommended by NICE in TA999.

Vibegron for this indication will be considered as GREEN on the traffic light system. Vibegron will be placed alongside mirabegron in the OAB pathway but mirabegron will be the preferred 1st line where both these two treatments may be suitable.

Vibegron does not have an identified place in therapy in preference to mirabegron.

 It was noted that vibegron has a BLACK triangle status with no evidence of advantages over Mirabegron, a well-established treatment, and it is therefore expected to have a very limited place in therapy in Surrey Heartlands ICB until more evidence becomes available

Wegovy® should only be prescribed within Ashford & St Peters pilot site clinics for children and young people(12 to 16 years) from Surrey Heartlands with severe complications of excess weight. Wegovy®, is only a small component of the service, and will only be considered for a sub-section of the CYP in this pilot.

Referrals to the service need to be made by Paediatricians

Do NOT prescribe Wegovy ®, or semaglutide for the treatment of obesity in primary care.

Alternatively, for all children or teenagers aged 5-17 years with concerns about their weight, can be referred to the Be your Best service by their primary care team, or can self-refer for better health.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves faricimab for the treatment of visual impairment caused by macular oedema after retinal vein occlusion as recommended by NICE TA1004

Faricimab for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Prescribing should be initiated and continued by a specialist clinician. If the patient has already been initiated on this medicine by a specialist clinician, please ensure this is recorded as a ‘Hospital Only Drug’ in the patient’s medication list, in order to be alert to potential side-effects and interactions with other medicines prescribed in primary care.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves abaloparatide for the treatment of osteoporosis as recommended by NICE TA991.

Abaloparatide for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Terbutaline nebules:

The Respiratory Care Team will ensure that the patient has undergone a suitable trial and training re use of equipment, response and safety.  After this trial GPs may prescribe following a request from the respiratory care team. The advice will include frequency and duration of treatment, and whether additional support is required for the patients, e.g. wrap around frequent or long-term steroids.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Respiratory Care Team will ensure that the patient has undergone a suitable trial and training re use of equipment, response and safety.  After this trial GPs may prescribe following a request from the respiratory care team. The advice will include frequency and duration of treatment, and whether additional support is required for the patients, e.g. wrap around frequent or long-term steroids.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Initiation and stabilisation by specialist team before transfer of prescribing to primary care.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed to add Simplera Sync™ to the available Continuous Glucose Monitoring (CGM), used as part of the Medtronic 780g Hybrid Closed Loop System for people living with Type 1 diabetes.

The Respiratory Care Team will ensure that the patient has undergone a suitable trial and training re use of equipment, response and safety.  After this trial GPs may prescribe following a request from the respiratory care team. The advice will include frequency and duration of treatment, and whether additional support is required for the patients, e.g. wrap around frequent or long-term steroids.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

Terbutaline nebules:

The Respiratory Care Team will ensure that the patient has undergone a suitable trial and training re use of equipment, response and safety.  After this trial GPs may prescribe following a request from the respiratory care team. The advice will include frequency and duration of treatment, and whether additional support is required for the patients, e.g. wrap around frequent or long-term steroids.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found on the IBD guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found on the IBD guidelines page.

UPON SPECIALIST RECOMMENDATION ONLY

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found on the IBD guidelines page.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

It is recommended that slow-release and longer-acting nifedipine products are prescribed by brand.

The preferred brands for use in primary care have been updated following the discontinuation of Adipine MR in August 2024. 

The recommendations are now:

TWICE DAILY

• Coracten SR capsules OR
• Tensipine MR for patients preferring a tablet

ONCE DAILY

• Coracten XL capsules OR
• Adipine XL for patients preferring a tablet

It is recommended that slow-release and longer-acting nifedipine products are prescribed by brand.

The preferred brands for use in primary care have been updated following the discontinuation of Adipine MR in August 2024. 

The recommendations are now:

TWICE DAILY

• Coracten SR capsules OR
• Tensipine MR for patients preferring a tablet

ONCE DAILY

• Coracten XL capsules OR
• Adipine XL for patients preferring a tablet

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found here - https://surreyccg.res-systems.net/PADFormularyV1Admin/Profile/Detail/7986 

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found here - https://surreyccg.res-systems.net/PADFormularyV1Admin/Profile/Detail/7986 

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found here - https://surreyccg.res-systems.net/PADFormularyV1Admin/Profile/Detail/7986 

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found on the IBD guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found on the IBD guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found here - https://surreyccg.res-systems.net/PADFormularyV1Admin/Profile/Detail/7986 

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found on the IBD guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves risankizumab as a treatment option in line with the recommendations made in NICE TA998, for treating moderately to severely active ulcerative colitis. Risankizumab for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians). Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found in the IBD guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves lebrikizumab as a treatment option in line with the recommendations made in NICE TA986, for treating moderate to severe atopic dermatitis.

Lebrikizumab for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated IBD immunomodulator pathway, which is to be found in the IBD guidelines page.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed the reviewed and updated Atopic Dermatitis immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated ITP pathway.

The Surrey Heartlands preferred list of oral nutritonal supplements (ONS) for Primary Care has been updated.
The APC have also approved the list of ONS with defined Traffic Light Status to aid identification of preferred, non-preferred and non-formulary products.

In addition, there are a variety of other locally approved resources to support prescribers, patients and carers - see additional documentation

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated ITP pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated ITP pathway.

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) approves the use of capsaicin patches for the treatment of neuropathic pain when prescribed by specialist pain teams within a secondary care setting only.

The APC recommend a RED traffic light status for the use of capsaicin patches for this indication only.

Primary care prescribers should be aware that their patient is receiving this medicine and ensure that this is recorded on the patient’s medication screen as a hospital-only drug in line with guidance on the PAD. This will also alert the prescriber to potential side effects and interactions with other medicines prescribed in primary care. It will also ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.”

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a BLUE (on recommendation) traffic light status for a trial (starter pack) and then ongoing prescribing if needed, of an intravaginal device for women with stress urinary incontinence, only if other non-surgical options have been unsuccessful.

Formulary choices were agreed as:

Efemia - 1st line choice for daily or intermittent use and 1st line choice of reusable product

Contiform - 2nd line choice for daily or intermittent use.

Diveen - 3rd line choice if other devices not able to be used i.e. due to insertion / comfort etc.

Contrelle Activgard - 

This is the only single-use product currently available.  This is the most expensive product for daily and intermittent use.  Please reserve for those who specifically require this product.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the updated ITP pathway.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

This drug / device falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.
Treatment should remain with the specialist (RED) hospital only drug.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication.

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

These drugs falls under the responsibility of NHS England Specialised Commissioning and should therefore not be prescribed in Primary Care.

Clinicians / specialists within the Acute setting should only prescribe in line with their Trust formulary / pharmacy advice.

GPs should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient’s medication

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Refer to the formulary document available on the stoma guideline page for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Refer to the formulary document available on the stoma guideline page for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Refer to the formulary document available on the stoma guideline page for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Refer to the formulary document available on the stoma guideline page for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Refer to the formulary document available on the stoma guideline page for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Refer to the formulary document available on the stoma guideline page for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Refer to the formulary document available on the stoma guideline page for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Refer to the formulary document available on the stoma guideline page for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Area Prescribing Committee approved the Stoma Accessory Formulary noting that:

• cost effective choices should be used first-line
• approved formulary products should be initiated by the specialist Stoma Teams

Refer to the formulary document available on the stoma guideline page for:

• a full list of agreed products
• recommended prescribing quantities
• contact details for local stoma care teams

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the following place in therapy for cabergoline and bromocriptine:

Suppression of lactation

• RED traffic light classification for cabergoline - as treatment should be part of obstetric care where necessary
• Non-Formulary for bromocriptine

For the treatment of hyperprolactinaemic disorders

• BLUE traffic light classification for initiation by specialists for 1 month before transfer of prescribing responsibilities to primary care
• Cabergoline 1st line & Bromocriptine 2nd line

For the treatment of drug induced hyperprolactinaemia

• 1st line - select alternative medicine (to remove cause of drug-induced effect)
• Non-Formulary for cabergoline and bromocriptine

Updated narrative from April 2025

Referral of patients to a smoking cessation service is the preferred management pathway.

GPs should only prescribe smoking cessation products for patients who decline referral in line with CKS guidance or through requests from the smoking cessation service (see below).

The ‘One You Surrey’ Smoking cessation service has been commissioned by Public Health (Surrey County Council) since April 2019 and provides support to clients as part of a 12 week programme.

Nicotine replacement therapy (NRT) will be provided as part of the service in pregnancy and for clients with defined long-term health conditions.

Requests to prescribe NRT will only be made to the GP in rare circumstances where the client requests further NRT beyond 12- weeks (at the discretion of the GP).

For clients requiring the following, a request form for prescribing (includes screening questions) will be sent to the client’s GP by the service:

• Bupropion (Zyban)
• Varenicline
• Cytisinicline

Clients will be monitored by ‘One You’ Surrey on a weekly basis for any side effects. At the end of treatment, patients will be issued with a letter to be given to their GP to update records and book a medication review (where appropriate).

Patients can be referred by a health care professional or can self refer: https://oneyousurrey.org.uk/stop-smoking/

Further information on the service is available at: https://oneyousurrey.org.uk/

There is a dedicated section for primary care health professionals: https://oneyousurrey.org.uk/professionals/

Bupropion, Varenicline and Cytisinicline will be given a GREEN (see narrative) traffic light status on the Joint Formulary

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approved the updated ITP pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the reviewed AMBER shared care document for Recombinant human growth hormone for children and young people.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed an updated AMBER shared care document for valproate for people of childbearing potential aged under 55 with:

Licensed uses:

• Epilepsy
• Treatment of mania in bipolar disorder
• Continuation of treatment after a manic episode

Off label uses (refer to primary care responsibilities in shared care document for advice)

• Mood stabiliser in mood disorders and primary psychotic disorders, under the direction of a consultant psychiatrist
• Prevention of atypical antipsychotic-induced seizures
• Management of compulsive and aggressive behaviour

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed an updated AMBER shared care document for valproate for people of childbearing potential aged under 55 with:

Licensed uses:

• Epilepsy
• Treatment of mania in bipolar disorder
• Continuation of treatment after a manic episode

Off label uses (refer to primary care responsibilities in shared care document for advice)

• Mood stabiliser in mood disorders and primary psychotic disorders, under the direction of a consultant psychiatrist
• Prevention of atypical antipsychotic-induced seizures
• Management of compulsive and aggressive behaviour

.The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the reviewed AMBER shared care document for Recombinant human growth hormone for children and young people.

Reminder for prescribers that referrals to specialist centres should be made for the assessment and treatment of chronic insomnia, where daridorexant may be one of the treatment options, and not for the purpose of initiating daridorexant’

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves atogepant for preventing migraine in line with recommendations made in NICE TA973 Atogepant for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians). Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a formulary status for tamoxifen, anastrozole and raloxifene for chemoprevention in women at moderate or high risk of developing breast cancer for a duration of 5 years.

A BLUE (with specialist initiation) with 1 month prescribing by the specialist team following discussions with the patient about the risks and benefits of treatment.

Tamoxifen can be used:

• Premenopausal except in those with past history or may be at increased risk of thromboembolic disease or endometrial cancer
• Postmenopausal who have severe osteoporosis or do not wish to take anastrozole if no past history or increased risk of thromboembolic disease or endometrial cancer

On occasion a patient may need time to consider treatment and may in those circumstances request that their GP prescribe. The GP will then need to consider if they have all the information from the specialist team in order to accept full clinical responsibility for prescribing for that patient.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a formulary status for tamoxifen, anastrozole and raloxifene for chemoprevention in women at moderate or high risk of developing breast cancer for a duration of 5 years.

A BLUE (with specialist initiation) with 1 month prescribing by the specialist team following discussions with the patient about the risks and benefits of treatment.

Anastrozole can be used:

• Postmenopausal  WITHOUT severe osteoporosis

On occasion a patient may need time to consider treatment and may in those circumstances request that their GP prescribe. The GP will then need to consider if they have all the information from the specialist team in order to accept full clinical responsibility for prescribing for that patient.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a formulary status for tamoxifen, anastrozole and raloxifene for chemoprevention in women at moderate or high risk of developing breast cancer for a duration of 5 years.

A BLUE (with specialist initiation) with 1 month prescribing by the specialist team following discussions with the patient about the risks and benefits of treatment.

Raloxifene (off-label for this indication) can be used:
- Postmenopausal in those with a uterus and have severe osteoporosis or do not wish to take anastrozole or tamoxifen if no past history or increased risk of thromboembolic disease

On occasion a patient may need time to consider treatment and may in those circumstances request that their GP prescribe. The GP will then need to consider if they have all the information from the specialist team in order to accept full clinical responsibility for prescribing for that patient.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee recommends the use of tenecteplase for the treatment of acute ischaemic stroke in line with NICE TA990.

Tenecteplase will be considered as RED on the traffic light system.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a formulary status for tamoxifen, anastrozole and raloxifene for chemoprevention in women at moderate or high risk of developing breast cancer for a duration of 5 years.

A BLUE (with specialist initiation) with 1 month prescribing by the specialist team following discussions with the patient about the risks and benefits of treatment.

Tamoxifen can be used:

• Premenopausal except in those with past history or may be at increased risk of thromboembolic disease or endometrial cancer
• Postmenopausal who have severe osteoporosis or do not wish to take anastrozole if no past history or increased risk of thromboembolic disease or endometrial cancer

On occasion a patient may need time to consider treatment and may in those circumstances request that their GP prescribe. The GP will then need to consider if they have all the information from the specialist team in order to accept full clinical responsibility for prescribing for that patient.

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement for all non-LCS participating practices (see shared care agreement below)

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices (see shared care agreement below)

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

The CKS guidance includes the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary Traffic Light Status / place in therapy advice for locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices (see shared care agreement below)

The Surrey Heartlands APC reviewed the Blue traffic light status for patients with epilepsy and WITHOUT child-bearing potential.

The Blue status remains with the expectation that treatment will be initiated and stabilised by a specialist and patients will receive a minimum of 1 month supply from the specialist before transfer of care.

No supplementary information sheet is required

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices (see shared care agreement below)

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

MODIFIED RELEASE TABLETS (18, 27, 36 and 54mg):

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the recommendation to prescribe the branded generic Methylphenidate modified release preparations (18, 27, 36 and 54mg) with the lowest acquisition cost.
Such products have an AMBER traffic light status and are the preferred alternatives to Concerta®.  
- See the "Branded generic methylphenidate letters" for information for patients and clinicians
N.B. This guidance does not apply to other strengths of modified release methylphenidate as these have different release characteristics

MODIFIED RELEASE TABLETS (18, 27, 36 and 54mg):

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the recommendation to prescribe the branded generic Methylphenidate modified release preparations (18, 27, 36 and 54mg) with the lowest acquisition cost.
Such products have an AMBER traffic light status and are the preferred alternatives to Concerta®.  
- See the "Branded generic methylphenidate letters" for information for patients and clinicians
N.B. This guidance does not apply to other strengths of modified release methylphenidate as these have different release characteristics

Shared Care arrangements for children and adolescents with ADHD are in place with Surrey and Borders Partnership NHS Foundation Trust.

Guildford & Waverley, North West Surrey and Surrey Downs have agreed a Locally Commissioned Service (LCS) for practices entering into the shared care agreement with Surrey & Borders Partnership. The LCS supports the provision of an annual physical medication review by the GP (with an annual review by the specialist so that the patient continues to receive a 6-monthly review in accordance with the product license)
See below for a copy of the Shared care with LCS agreement

There is also a non-LCS shared care agreement that is available for all non-LCS participating practices (see shared care agreement below)

Insulin Pump warranties

The Surrey Heartlands Integrated Care System Area Prescribing Committee have re-affirmed the position on insulin pump warranties.

The 'tethered' (with tubing) insulin pumps have a 4 year warranty. A patient can be switched 'in warranty', to another insulin pump where:

• The Diabetes specialist team consider that the use if the current tethered insulin pump poses a safety concerns OR
• The Diabetes specialist team consider that the patient is unable to maintain expected blood sugar levels with their current 'tethered' insulin pump.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands Integrated Care System agreed a RED traffic light status for Remdesevir in line with NICE TA971

The Surrey Heartland Integrated Care System Area Prescribing Committee have agreed a BLUE (with information sheet) traffic light status for:

·         Phenelzine

·         Isocarboxacid

·         Moclobemide

·         Tranylcypromine

Specialists will initiate and prescribe a minimum of 6 months or until the patient is stable, whichever is longer, prior to transfer of care

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the addition of

• Dexcom ONE PLUS & Freestyle Libre 2 PLUS

to the currently available CGMs used for Children and Young People living with Type 2 diabetes.

A BLUE traffic light status with an information sheet) was agreed. Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands Integrated Care System Area Prescribing Committed agreed a NON-FORMULARY traffic light status for Tixagevimab plus cilgavimab in line with NICE971 & NICE TA900

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands APC have adopted the CKS principles for the management of constipation in adults.

Management | Constipation | CKS | NICE

The CKS guidance covers the management of constipation in adults (including pregnant women and those who are breastfeeding), for short-duration and chronic constipation, and faecal loading and/or impaction.

Refer to the formulary for Traffic Light status / place in therapy of locally agreed treatment options.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartland Integrated Care System Area Prescribing Committee have agreed a BLUE (with information sheet) traffic light status for:

·         Phenelzine

·         Isocarboxacid

·         Moclobemide

·         Tranylcypromine

Specialists will initiate and prescribe a minimum of 6 months or until the patient is stable, whichever is longer, prior to transfer of care

The Surrey Heartland Integrated Care System Area Prescribing Committee have agreed a BLUE (with information sheet) traffic light status for:

·         Phenelzine

·         Isocarboxacid

·         Moclobemide

·         Tranylcypromine

Specialists will initiate and prescribe a minimum of 6 months or until the patient is stable, whichever is longer, prior to transfer of care

The Surrey Heartland Integrated Care System Area Prescribing Committee have agreed a BLUE (with information sheet) traffic light status for:

·         Phenelzine

·         Isocarboxacid

·         Moclobemide

·         Tranylcypromine

Specialists will initiate and prescribe a minimum of 6 months or until the patient is stable, whichever is longer, prior to transfer of care

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands APC has agreed a traffic light status and place in therapy for the treatments of menopausal disorders in line with the CKS recommenations:

Menopause | Health topics A to Z | CKS | NICE

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Nutriprem Breast Milk Fortifier for pre-term & low birthweight infants.

A BLUE (on specialist recommendation) Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed SMA Gold Prem 2 powdered preterm formula as an option for pre-term infants.

A BLUE (on specialist recommendation) Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Nutriprem 2 powdered preterm formula as an option for pre-term infants.

A BLUE (on specialist recommendation) Traffic light status was agreed.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed SMA High Energy as the preferred high energy formula for infants with faltering growth.

A BLUE (on specialist recommendation) Traffic Light Status was agreed.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Similac High Energy as a 2nd high energy formula option for infants with faltering growth.

A BLUE (on specialist recommendation) Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Infatrini as a 2nd high energy formula option for infants with faltering growth.

A BLUE (on specialist recommendation) Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Infatrini Peptisorb as a 3rd line high energy formula option for use in  infants with malabsorption or intolerance of whole protein feeds.

A BLUE (on specialist recommendation) Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed SMA Anti-Reflux should not be prescribed for infants with Gastro-Oesphageal Reflux Disease (GORD). Pre-thickened formula can be purchased from supermarkets, pharmacies and on-line at a similar price to standard formula.  

A NON-FORMULARY Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed SMA LF should not be prescribed when a lactose free formula is indicated. Lactose free formulas are available from pharmacies at a similar price to standard formula.

A NON-FORMULARY Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed SMA Gold Prem 2 Liquid. Ready to drink (200ml) presentation should not be prescribed in primary care unless a specific clinical need is identified and a community prescription is requested from a secondary care specialists under their ongoing care.

A RED Traffic Light Status was agreed

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed Nutriprem 2 Liquid. Ready to drink (200ml) presentation should not be prescribed in primary care unless a specific clinical need is identified and a community prescription is requested from a secondary care specialists under their ongoing care.

A RED Traffic Light Status was agreed

The Surrey Heartland Integrated Care System Area Prescribing Committee have agreed the Surrey Heartlands guidelines for the management of vitamin B12 deficiency.

Insulin Pump warranties

The Surrey Heartlands Integrated Care System Area Prescribing Committee have re-affirmed the position on insulin pump warranties.

The 'tethered' (with tubing) insulin pumps have a 4 year warranty. A patient can be switched 'in warranty', to another insulin pump where:

• The Diabetes specialist team consider that the use if the current tethered insulin pump poses a safety concerns OR
• The Diabetes specialist team consider that the patient is unable to maintain expected blood sugar levels with their current 'tethered' insulin pump.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends the phased implementation of NICE TA943 Hybrid Closed Loop Systems for managing blood glucose levels in type I diabetes.

The financial framework supporting the phased implementation of NICE TA943 is yet to be published. Until the financial framework is released, hospital diabetes specialist clinicians can discuss the suitability of HCL with eligible patients at their next scheduled clinic appointment taking into account those with the highest clinical need and the resources available in year. In line with the national guidance this will be a phased implementation over a 5 year period. Further work to clarify the phased implementation will be undertaken by the system wide HCL steering group when the financial framework is published.

The cost effective HCLs have been agreed as follows:

RED traffic light status (Initiation and continued supplies will be through the specialist diabetes service.)

Insulin Pumps:

• DANA I insulin pump
• Mylife Ypsopump insulin pump
• Medtronic 780g insulin pump
• Tandem t:slim insulin pump
• Omnipod 5 insulin pump

Continuous Glucose Monitoring

• Dexcom 6
• Dexcom 7
• FreeStyle Libre 3
• Guardian 4

Algorithm

• mylife CamAPS
• CamAPS

BLUE (with information sheet) traffic light status. Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

• FreeStyle Libre 2 plus

NON-FORMULARY      

• The APC did not support the use of the Medtrum A8 Touchcare Nano HCL system based on accuracy concerns with the continuous glucose monitoring. Previously discussed at APC in April 23

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the addition of

• Dexcom ONE PLUS & Freestyle Libre 2 PLUS

to the currently available CGMs used for people living with Type I diabetes.

A BLUE traffic light status with an information sheet) was agreed. Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care

The Surrey Heartlands APC have updated the recommended treatment options for erectile dysfunction.

Sildenafil remains a preferred treatment option.

Combination treatments (oral & non oral)
These treatments should not be used in combination with other treatments for erectile dysfunction due to the limited evidence available to support their use.

The Surrey Heartlands APC supportes the use of sildenafil for penil rehabilitation.

It has been assigned a Blue traffic light status and can be prescribed in primary care following recommendation from a specialist.

Combination treatments (oral & non oral). These treatments should not be used in combination with other treatments for erectile dysfunction due to the limited evidence available to support their use

The Surrey Heartlands APC have agreed the following update for tadalafil for erectile dysfunction:

Tadalafil "as required" dosing (10mg and 20mg) has a Green traffic light status. Tadalafil and sildenafil "as required" dosing are equally preferred treatment options.

Tadalafil once daily (5mg) has a Green traffic light status. If daily dosing is not tolerated, use "as required" dosing.

Tadalafil once daily (2.5mg) is non-formulary (very costly).

NOTE: SLS endorsement is still required for tadalafil prescribing on the NHS. Patients who do not meet the SLS criteria may purchase an over-the-counter product. 

Use in combination with any other oral / non-oral treatments for erectile dysfunction is not supported

The Surrey Heartlands APC has updated the recommendation for the use of tadalafil for penile rehabilitation as follows:

Tadalafil "as required" (10mg and 20mg) has a Blue traffic light status and may be prescribed in primary care on recommendation from a specialist.

Tadalafil daily dosing (5mg) has a Blue traffic light status and may be prescribed in primary care on recommendation from a specialist.

Tadalafil 2.5mg daily is non-formulary (very costly).

Use in combination with any other oral / non-oral treatments for erectile dysfunction is not supported

The Surrey Heartlands APC have reviewed the treatments for erectile dysfunction.

Vardenafil remains non-formulary.

Sildenafil or tadalafil are the preferred treatment options.

Combination treatments (oral & non oral)
These treatments should not be used in combination with other treatments for erectile dysfunction due to the limited evidence available to support their use.

The Surrey Heartlands APC do not recommend vadenafil or avanafil for penile rehabilitation.

Sildenafil or tadalafil are the preferred options.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed a change in traffic light status for Perampanel.

Perampanel for treatment in all licensed indications will be given a BLUE (with specialist initiation and supply for at least 12 weeks) traffic light status. 
 

The Surrey Heartlands APC have reviewed the treatments for erectile dysfunction.

Avanafil remains non-formulary.

Sildenafil or tadalafil are the preferred treatment options.

Combination treatments (oral & non oral)
These treatments should not be used in combination with other treatments for erectile dysfunction due to the limited evidence available to support their use.

Alprostadil intra-urethral applications may be initiated in primary care following specialist recommendation.

The patient must have been provided with, or directed to, training materials to support self-administration before prescribing is requested from the GP.

Alprostadil intracavernosal injections should be initiated in secondary care, patients trained to self-administer and treatment shown to be effective before discharge for GPs to prescribe.

Alprostadil cream (Vitaros) is restricted by SLS criteria as identified in the Health Service Circular (HSC) 1999/148 at a maximum frequency of dosing of four times per month.

Alprostadil cream (Vitaros®) is a treatment option in primary care for patients who do not respond to PDE-5 inhibitors. This can be initiated in primary care and is considered GREEN on the traffic light system

Combination treatments (oral & non oral)
These treatments should not be used in combination with other treatments for erectile dysfunction due to the limited evidence available to support their use. 

The traffic light status for drugs used in erectile dysfunction were updated by the APC In Jun 2024 (see document). A pathway is in development and will be made available on this page once approved by the APC

All preparations of ranitidine (tablets, effervescent tablets, oral solution, and injection) are out of stock until further notice. Following advice from the EMA, the MHRA have suspended all licenses for ranitidine products.

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for gender affirming hormones in children and young people.  This applies to recommendations from both NHS and private providers subject to appropriate shared care protocols being in place.

The following guidance has also been updated:

• Primary care prescribing guidance, for people who access Gender Identity Services.
• NHSE guidance on prescribing and dispensing restrictions for puberty blockers and gender affirming hormones

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for puberty supressing hormones in children and young people under the following circumstances:
i.    ONLY for current NHS and private patients at least until next reviewed by the service lead clinician.  Always ensure that appropriate shared care protocols are in place before continuing prescribing.  Private patients should be advised of the new NHS policy and recommendation made to return to the private provider for consideration of stopping.
ii.    DO NOT initiate in any new patients

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for gender affirming hormones in children and young people.  This applies to recommendations from both NHS and private providers subject to appropriate shared care protocols being in place.

The following guidance has also been updated:

• Primary care prescribing guidance, for people who access Gender Identity Services.
• NHSE guidance on prescribing and dispensing restrictions for puberty blockers and gender affirming hormones

The Surrey Heartlands APC have approved the use of 

Aviptadil 25microgram/ Phentolamine 2mg (Invicorp®) solution for injection, for the symptomatic treatment of erectile dysfunction in adult males due to neurogenic, vasculogenic, psychogenic, or mixed aetiology, or use in those who have failed on oral therapies (oral phosphodiesterase type-5 inhibitors) and other non-injectable formulations of erectile dysfunction medications

It has been assigned a BLUE (on initiation by a specialist) traffic light classification. Primary care would be asked to prescribe after the patient has been shown how to use it and is able to tolerate treatment.

The Surrey Heartlands Integrated Care System Area Prescribing Committee approves the prescribing of mexiletine for the management of drug resistant ventricular arrhythmia when initiated and continued by a specialist.

The APC recommend a RED traffic light status for the use of mexiletine for this indication.

All patients currently being prescribed mexiletine in primary care should be referred into a cardiologist for specialist review. Responsibility for prescribing must remain with the specialist.

Patients currently prescribed Namuscla® for the management of drug resistant arrhythmias should be reviewed by specialists to consider switching to the products licensed for ventricular arrhythmias noting that there isn’t an exact equivalent dose. 

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the Biologicals and biosimilar of best value policy.

The policy is intended to provide a process for Trusts to manage the introduction of new biologics/biosimilars in a timely manner and requires engagement across clinical teams, pharmacy, procurement and senior managers.

Cimetidine can be prescribed, for use only in situations where:
•    PPIs are not suitable AND
•    H2As are indicated and necessary OR
•    Liquid preparation required and no drug interactions

Nizatidine can be prescribed, for use only in situations where:

• PPIs are not suitable AND
• H2As are indicated and necessary. 

if Nizatidine 300mg is required prescribe as multiples of Nizatidine 150mg capsules as significantly more cost effective 

Famotidine can be prescribed, for use only in situations where:

• PPIs are not suitable AND
• H2As are indicated and necessary. 

With the publication of the final Cass Report and new NHSE commissioning policies for children & young people, guidance for primary care prescribing for people who access Gender Identity Services has been updated. See document.

NHSE guidance on prescribing and dispensing restrictions on puberty blockers and gender affirming hormones is also available - see documents
 

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves ritlecitinib as a treatment option in line with the recommendations made in NICE TA958, for treating severe alopecia areata in patients 12 years and over.

Ritlecitinib for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for puberty supressing hormones in children and young people under the following circumstances:
i.    ONLY for current NHS and private patients at least until next reviewed by the service lead clinician.  Always ensure that appropriate shared care protocols are in place before continuing prescribing.  Private patients should be advised of the new NHS policy and recommendation made to return to the private provider for consideration of stopping.
ii.    DO NOT initiate in any new patients

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for puberty supressing hormones in children and young people under the following circumstances:
i.    ONLY for current NHS and private patients at least until next reviewed by the service lead clinician.  Always ensure that appropriate shared care protocols are in place before continuing prescribing.  Private patients should be advised of the new NHS policy and recommendation made to return to the private provider for consideration of stopping.
ii.    DO NOT initiate in any new patients

With the publication of the final Cass Report and new NHSE commissioning policies, the APC has agreed an AMBER status for puberty supressing hormones in children and young people under the following circumstances:
i.    ONLY for current NHS and private patients at least until next reviewed by the service lead clinician.  Always ensure that appropriate shared care protocols are in place before continuing prescribing.  Private patients should be advised of the new NHS policy and recommendation made to return to the private provider for consideration of stopping.
ii.    DO NOT initiate in any new patients

Please note; alfentanil injection for palliative care use will be available through the community pharmacy palliative care drug access scheme.

In line with NICE NG28 (Type 2 diabetes in adults: management – Continuous Glucose Monitoring – last updated June 2022), the following CGM devices have been recommended by APC for use in adult patients with type 2 diabetes:

GREEN (PREFERRED) traffic light status

• Freestyle Libre 2 PLUS and Dexcom ONE PLUS

GREEN traffic light status

• Freestyle Libre 2 and Dexcom ONE

The above CGM for this indication will be considered, in the following circumstances when people living with type 2 diabetes:

1. are on multiple daily insulin injections (> 1x a day insulin dose) if any of the following apply:
   • they have recurrent hypoglycaemia or severe hypoglycaemia.
   • they have impaired hypoglycaemia awareness (Gold/Clarke score ≥4)
   • they have a condition or disability (including a learning disability or cognitive impairment) that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring but could use an isCGM device (or have it scanned for them)
   •  they would otherwise be advised to self-measure at least 8 times a day
2. are treated with insulin and who would otherwise need help from a care worker or healthcare professional to monitor their blood glucose.
3. have learning disabilities and are on the learning disability register and using insulin. (as per previous Surrey Guidance)
4. are pregnant and having difficulty managing their glucose levels.

A NON-FORMULARY traffic light status has been agreed for the following CGM

• Dexcom G6
• Dexcom G7
• GlucoRx Aidex
• Medtronic Guardian
• Freestyle Libre 3

Change to traffic light status:

Esomeprazole capsules are now considered Green (3rd line).

The decision of September 2022 has been superceded BUT lansoprazole capsules remain the preferred PPI in patients with and without swallowing difficulties and in patients with an enteral feeding tube.

Note - 40mg esomeprazole capsules are restricted for short-term use prior to step down OR Zollinger-Ellison syndrome

The Surrey Heartlands APC approved the Hypertension Drug Treatment Pathway.

See document for details.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the following in relation to prescribing of Omega 3 for raised triglycerides in primary care in line with NHSE guidance:

Omega 3 will be given a RED traffic light status.

Patients prescribed Omega 3 in primary care will be reviewed as follows:

• Do not initiate omega-3 fatty acid ethyl esters for any new patient in primary care (with the exception of icosapent ethyl prescribed in line with NICE TA805).
• Patients for whom omega-3 fatty acid ethyl esters are prescribed for specialist indications, e.g. schizophrenia (unlicensed), or where they have been recommended by a specialist lipid clinic e.g. patient with elevated triglycerides at risk of pancreatitis, should be referred back to the specialist for review. If there is any ongoing prescribing for specialist indications, this should take place in secondary care. GPs may continue to prescribe in the meantime for these patients whilst waiting to be seen by the specialist service.
• Patients with a high risk of cardiovascular events, prescribed omega-3 fatty acid ethyl esters with statin therapy for reducing the risk of cardiovascular events with raised triglycerides should be switched to icosapent ethyl, if appropriate and in line with NICE TA805.
• In all other patients deprescribe omega-3 fatty acid ethyl esters compounds (with the exception of icosapent ethyl prescribed in line with NICE TA805). Advise patients that they may purchase them over the counter if they still wish to take them after understanding that there is a lack of consistent evidence to support their use and a risk of atrial fibrillation. See MHRA drug safety update for more information.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the following traffic light statuses and place in therapy for treatments used in Bile Acid Malabsorption (BAM)

 BLUE traffic light status (on recommendation by a specialist)

·         1st line colestyramine (with sugar)

·         2nd line colesevelam

·         3rd colestyramine (sugar free) – for diabetic patients who request a sugar free formulation. Most costly preparation

A patient information leaflet is available - see Documentation

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves fluocinolone acetonide intravitreal implant as a treatment option in line with the recommendations made in NICE TA953, for treating diabetic macular oedema.

Fluocinolone acetonide for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands APC approved doxylamine with pyridoxine for use in nausea and vomiting in pregnancy, acknowledging that the drug is licensed for this indication.

However, it was agreed that it should only be considered after a trial of a more established drug (off-label cyclizine, promethazine, prochlorperazine or chlorpromazine).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the Patient Information Leaflet (PIL) to support patients taking off label continuous progesterone as part of continuous combined HRT

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed a change in fidaxomicin traffic light status from Blue to GREEN.

This is to facilitate the prescribing of fidaxomicin following the recurrence of C diff infection within 12 weeks of a previous infection (as per NICE NG199).

For any patient requiring a liquid preparation, fidaxomicin granules should be prescribed.  The APC notes that although current NICE guidelines recommend vancomycin first line, it is recognised that this was based on cost and in exceptional cases when a liquid is required, fidaxomicin granules are appropriate to prescribe as a licensed preparation that supports timely treatment.

SUPPLY:

Vancomycin and fidaxomicin are not routinely stocked in community pharmacies but are usually obtainable on next-day delivery. However, at weekends and bank holidays, a local arrangement has been put in place whereby a small number of pharmacies will hold supplies. Please refer to the document below called "Supply of oral vancomycin and fidaxomicin for treating Clostridioides difficile in Primary Care - Mar 23"

The Surrey Heartlands APC have agreed a traffic light status for each of the drugs used in the CKS guidelines for nuasea & vomiting in pregnancy:

1st line treatment options

Cyclizine - GREEN

Promethazine Teoclate - GREEN

Promethazine Hydrochloride - GREEN

Doxylamine/pyridoxine (Xonvea®) - GREEN (not preferred)

Prochlorperazine - GREEN

Chlorpromazine - GREEN

Where patient has swallowing difficulties

Promethazine oral Solution (Sugar Free) - GREEN

Prochlorperazine Buccal Tablets - GREEN

Chlorpromazine Oral Solution (Sugar Free) - GREEN

2nd line treatment options

Metoclopramide - GREEN

Ondansetron tablets - GREEN

Domperidone tablets - GREEN

Where patient has swallowing difficulties

Metoclopramide Oral Solution (Sugar Free) - GREEN

Ondansetron Orodispersible Film – GREEN

Domperidone Oral Suspension - GREEN

 NON-FORMULARY (Orodispersible film is a more cost-effective option)

Ondansetron orodispersible tablets

Ondansetron Oral Solution

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands APC agreed a traffic light status and place in therapy for drugs used to treat nausea and vomiting in pregnancy.

Visit  the Guideline Profile page for a full list of these drugs and to access the CKS guidelines for nasea & vomiting and pregnancy and the BUMPS website (Best Use of Medicines in Pregnancy).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the following traffic light statuses and place in therapy for treatments used in Bile Acid Malabsorption (BAM)

 BLUE traffic light status (on recommendation by a specialist)

·         1st line colestyramine (with sugar)

·         2nd line colesevelam

·         3rd colestyramine (sugar free) – for diabetic patients who request a sugar free formulation. Most costly preparation

A patient information leaflet is available - see Documentation

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the following traffic light statuses and place in therapy for treatments used in post cholecystectomy patients with undiagnosed diarrhoea.

 GREEN traffic light status – For patients after cholecystectomy (with undiagnosed diarrhoea) waiting for an appointment with the Gastroenterologist.

·         1st line colestyramine (with sugar)

·         2nd line colesevelam

·         3rd colestyramine (sugar free) – for diabetic patients who request a sugar free formulation. Most costly preparation

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the following traffic light statuses and place in therapy for treatments used in post cholecystectomy patients with undiagnosed diarrhoea.

 GREEN traffic light status – For patients after cholecystectomy (with undiagnosed diarrhoea) waiting for an appointment with the Gastroenterologist.

·         1st line colestyramine (with sugar)

·         2nd line colesevelam

·         3rd colestyramine (sugar free) – for diabetic patients who request a sugar free formulation. Most costly preparation

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathways (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathways (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathways (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

Status Epilepticus in all age groups (over 3 months of age)

The Surrey Heartlands Area Prescribing Committee agreed that:

• Buccolam (midazolam hydrochloride) and Epistatus (midazolam maleate) will be assigned a Blue traffic light status (no information sheet required) for all ages over 3 months of age when used for Status Epilepticus.
• Buccolam and Epistatus should be prescribed by brand (in line with MHRA & NICE guidance) https://surreyccg.res-systems.net/PAD/Guidelines/Detail/5045
• The least costly preparation should be used at the point of initiation (currently Buccolam - April 2024)

NOTE: the use of Buccolam and Epistatus in patients aged 18 years and over is off-label.

Unlicensed specials will be assigned a RED traffic light status.

Patients using unlicensed preparations should be reviewed for a potential switch to the licensed product following liaison with their specialist.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathways (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Area Prescribing Committee approved the Primary Care guidance for prescribing oral mucolytics to reduce sputum viscosity.

Carbocisteine should be prescribed generically.

Refer to the guidance for full details of product choice in adults, children and patients with swallowing difficulties.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathways (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated rheumatoid arthritis pathways (moderate and severe).

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated Psoriatic Arthritis pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the reviewed and updated  Psoriatic arthritis high cost immunomodulator treatment pathway.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed that dupilumab for Prurigo Nodularis will be given a NON-FORMULARY traffic light status following publication of NICE TA955

Dupilumab is not recommended, by NICE, within its marketing authorisation, for treating this indication

The Surrey Heartlands Area Prescribing Committee approved the Primary Care guidance for prescribing oral mucolytics.

Acetylcysteine should be prescribed generically.

Refer to the guidance for full details.

Status Epilepticus in all age groups (over 3 months of age)

The Surrey Heartlands Area Prescribing Committee agreed that:

• Buccolam (midazolam hydrochloride) and Epistatus (midazolam maleate) will be assigned a Blue traffic light status (no information sheet required) for all ages over 3 months of age when used for Status Epilepticus.
• Buccolam and Epistatus should be prescribed by brand (in line with MHRA & NICE guidance) https://surreyccg.res-systems.net/PAD/Guidelines/Detail/5045
• The least costly preparation should be used at the point of initiation (currently Buccolam - April 2024)

NOTE: the use of Buccolam and Epistatus in patients aged 18 years and over is off-label.

Unlicensed specials will be assigned a RED traffic light status.

Patients using unlicensed preparations should be reviewed for a potential switch to the licensed product following liaison with their specialist.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed that special-order Midazolam Oral Solution should be given the following traffic light status:

 Sedation and anxiolysis prior to diagnostic, surgical, therapeutic, or endoscopic procedures

o   RED traffic light status

Pre-medication before induction of general anaesthesia

o   RED traffic light status

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) agreed that special-order Midazolam Oral Solution should be given the following traffic light status:

 Sedation and anxiolysis prior to diagnostic, surgical, therapeutic, or endoscopic procedures

o   RED traffic light status

Pre-medication before induction of general anaesthesia

o   RED traffic light status

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves the Guidelines for Micronutrient monitoring and supplementation post bariatric surgery.

These guidelines include:

• the Primary Care monitoring requirements that commence 2-years after surgery
• whether supplements should be purchased by the patients and the exceptions where the prescribing of supplements is appropriate
• the signs and symptoms of nutritional deficiencies
• advice on the management of patients who have undegone privately funded surgery

The prescribing of vitamin and mineral supplements for other reasons is NOT recommended unless for a medically diagnosed deficiency. See Guidelines : Vitamin and mineral supplementation - PAD Formulary (res-systems.net) for further information.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has approved Guidelines for Micronutrient monitoring and supplementation post bariatric surgery.

This includes primary care monitoring and prescribing advice. Refer to guideline profiles for details.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has approved Guidelines for Micronutrient monitoring and supplementation post bariatric surgery.

This includes primary care monitoring and prescribing advice. Refer to guideline profiles for details.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has approved Guidelines for Micronutrient monitoring and supplementation post bariatric surgery.

This includes primary care monitoring and prescribing advice. Refer to guideline profiles for details.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has approved Guidelines for Micronutrient monitoring and supplementation post bariatric surgery.

This includes primary care monitoring and prescribing advice. Refer to guideline profile for details.

DEKAs Plus Softgel capsules have been agreed as BLUE (on recommendation from a Specialist healthcare professionl).

The Surrey Heartlands Area Prescribing Committee noted the ongoing shortages of pancreatic enzyme replacement therapies.

Updated information can be found on the Pancreatic Society of Great Britain & Ireland webite: Position Statement: Pert Shortage | Pancreatic Society of Great Britain and Ireland (psgbi.org)

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed the information for GPs for Preventing Infection in Asplenic or Hyposplenic adult patients.

Prescribing guidance has been agreed around quantities of stoma bags and other products required for stoma care. Initial prescriptions should be set up by the stoma specialist and any alterations to prescribed products should be approved by them. If quantities exceed those listed, refer to stoma specialist for advice – contact details are in the Surrey Heartlands Guidance document below.

A Patient Information Leaflet has also been produced to guide patients on the process for ordering their stoma-related products.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section below.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section below.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section below.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping mirabegron" can be found in the documents section.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section below.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section below.

The APC supports patients in trialling a treatment break of their overactive bladder medicines.

A "Leaflet for trial of stopping anticholinergics" can be found in the documents section below.

The following resources have been agreed by the APC to support patients in trialling a treatment break of their overactive bladder medicines:

• Leaflet for trial of stopping anticholinergics
• Leaflet for trial of stopping mirabegron

These resources can be found in the documents section.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves tirzepatide, a long-acting dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist for treating type 2 diabetes in line with the recommendations made in NICE TA924.

Tirzepatide will be given a GREEN traffic light status for this indication.

Dulaglutide remains the preferred choice among GLP-1 options for weekly injections and semaglutide stands as an alternative to dulaglutide for weekly injections.

Please consider tirzepatide as a third line option to dulaglutide and semaglutide weekly injection, only if:

·         dulaglutide and semaglutide are unsuitable.

or

the supply of dulaglutide and semaglutide weekly injections is unavailable.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves empagliflozin as a treatment option for treating chronic kidney disease in line with NICE TA942.

 NB: Check NICE guidance for recommended patient cohorts regarding eGFR.

Empagliflozin will be considered GREEN on the traffic light system.

Key considerations:

• If a patient with diabetes were on insulin and on multiple other treatments, a discussion with the specialist diabetes team may be prudent prior to empagliflozin initiation.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves targeted-release budesonide (Kinpeygo®) for treating primary IgA nephropathy in line with the recommendations made in NICE TA937. Targeted-release budesonide (Kinpeygo®) for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians). Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Area Prescribing Committee agreed the traffic light status of this drug and indication as part of the Joint Formulary review.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

Local guidelines have been produced for the use of non-subcutaneous medicines in palliative care patients.

Refer to the guidelines for specific patient and carer criteria and the recommended treatment options.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE Guidelines NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP.

The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the insulin brand, if so patients will need to be instructed on the correct u

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE Guidelines NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP.

The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the insulin brand, if so patients will need to be instructed on the correct use of the pen device when they are initiated on the insulin.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE Guidelines NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP.

The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the insulin brand, if so patients will need to be instructed on the correct u

The Surrey Heartlands Integrated Health System Area Prescribing Committee (APC) has agreed that topical testosterone should be prescribed generically, ideally using Drug Tariff descriptions.

The Surrey Heartlands Integrated Health System Area Prescribing Committee (APC) has agreed that topical testosterone should be prescribed generically, ideally using Drug Tariff descriptions.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approved an updated treatment pathway for chronic heart failure.

NICE guidance for Chronic Heart Failure in adults can also be found here: Chronic Heart Failure in adults

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves empagliflozin:

• as an option for treating adult chronic heart failure with reduced ejection fraction in addition to standard care (NICE TA773)
• as an option for treating adult chronic heart failure with preserved or mildly reduced ejection fraction in addition to standard care (NICE TA929)

Treatment should be initiated or recommended by a heart failure specialist in patients with a formal diagnosis of heart failure as per NICE guideline on Chronic Heart Failure in adults

Heart Failure specialist defined as:

 • Cardiology consultant, specialist, or registrar

 • Heart failure specialist nurse

 • GP with a specialist interest in heart failure or GP cardiologist

 • General physician with heart failure expertise

 • Renal physician

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves daridorexant for the treatment of long-term insomnia in line with NICE TA922

A BLUE traffic light status has been agreed after Cognitive Behavioural Therapy for insomnia (CBTi) where available.

Specialist clinics will need to provide the medicines for the first 4 months (if clinically indicated), providing a review at 3 months to confirm whether treatment should be continued, and prescribing an extra month for those who will continue on treatment to allow for transfer of care to Primary Care

The length of treatment should be as short as possible.

The Surrey Heartlands Integrated Health System Area Prescribing Committee (APC) has agreed that topical testosterone should be prescribed generically, ideally using Drug Tariff descriptions.

This drug/device has not yet been assessed for formulary status and is not currently on the APC work-plan.

This drug/device has not yet been evaluated by the Surrey Heartlands ICS Area Prescribing Committee (APC).  As such, advice regarding safety, effectiveness (including cost-effectiveness) and its place in therapy is yet to be determined. It is recommended that clinicians contact their medicines management team for further information and advice before prescribing this drug / device.

The APC will consider recommending prescribing of this treatment upon submission of a formal request with its associated evidence. Clinicians can contact syheartlandsicb.APC@nhs.net  if they wish to make a submission.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves rimegepant for the acute treatment of Migraine with or without aura in adults in line with NICE TA919.

A GREEN traffic light status has been agreed.

Treatment with rimegepant for acute migraine is recommended by NICE, only if for previous migraines:

• at least 2 triptans were tried and these did not work well enough or
• triptans were contraindicated or not tolerated, and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough.

Patients receiving 8 or more tablets per month should be considered for preventative treatment.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE Guidelines NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP.

The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the insulin brand, if so patients will need to be instructed on the correct u

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE Guidelines NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP.

The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the insulin brand, if so patients will need to be instructed on the correct u

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE Guidelines NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP.

The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the insulin brand, if so patients will need to be instructed on the correct u

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE Guidelines NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP.

The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the insulin brand, if so patients will need to be instructed on the correct u

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE Guidelines NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP.

The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the insulin brand, if so patients will need to be instructed on the correct u

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends biosimilar insulin as a treatment option for patients with diabetes mellitus where it is indicated, in line with NICE Guidelines NG17, NG28 & NG18

Biosimilar insulin will be considered for use for the same APC agreed indications and traffic light status as its reference product (RP).

The Medicines Healthcare Products Regulatory Agency (MHRA) states that biosimilar medicines are interchangeable with the original biological product and with other biosimilars when approved, which is reflected in government guidance on the licensing of biosimilar products and supported by the joint EMA-HMA statement on interchangeability. Once authorised, a biosimilar product is considered to be interchangeable with their RP, which means a prescriber can choose the biosimilar medicine over the RP (or vice versa) and expect to achieve the same therapeutic effect. Likewise, a biosimilar product is considered to be interchangeable with another biosimilar to the same RP.

The MHRA recommends prescribing biosimilar insulins by brand name and that the device is specified. This information should be included in patient documentation (eg, insulin safety card/patient insulin passport) to ensure that substitution of a biosimilar product does not occur when the medicine is prescribed or dispensed.

NHS England recommend that where a biosimilar is available, prescribers and patients are encouraged to have a shared decision-making conversation as part of their medicines review to consider using the biosimilar. This applies to both new patients and those who are already receiving the reference product.

The insulin pen delivery device may be unique to the insulin brand, if so patients will need to be instructed on the correct u

The Area Prescribing Committee agreed the updated list of preferred gluten free foods for
use in Surrey. The updated prescription request form includes only breads and mixes as per the Department of Health and Social Care (DHSC) restrictions announced in 2018.

In December 2023, a guide to support primary care prescribing for people who access gender identity services was agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

In December 2023, a guide to support primary care prescribing for people who access gender identity services was agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

The Surrey Heartlands Integrated Care System Area Prescribing Committee has agreed semaglutide for obesity and weight management in line with NICE TA875.

A RED traffic light status has been agreed.

Please Note that there will be a phased implementation in line with the guidance issued by the Society for Endocrinology and Obesity Management Collaborative UK.  Initially patients who meet the eligibility criteria listed in phase 1 of the guidance will be prioritised for referral to the specialist weight management service to allow those with the combination of highest and most urgent clinical need to be assessed.

Please see guidelines for further information

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves tofacitinib as a treatment option in line with the recommendations made in NICE TA920, for treating ankylosing spondylitis.

Tofacitinib for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

Treatment pathway is available on separate guidelines page.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approves mirikizumab as a treatment option in line with the recommendations made in NICE TA925, for treating moderately to severely active ulcerative colitis.

Mirikizumab for this indication will be considered as RED on the traffic light system (treatment should be initiated and continued by specialist clinicians).

Primary care prescribers should ensure that patient medication records include any medicine for which prescribing remains the responsibility of secondary or tertiary care. This will ensure that GP records, which are accessed by other healthcare providers, are a true and accurate reflection of the patient's medication.

After undertaking a review of previous decisions and resources relating to transgender health, the APC agreed an AMBER status for oestrogen, testosterone, cyproterone, finasteride, GnRH & medroxyprogeterone when used in adults. 

Primary care initiation of these drugs is supported by the APC if the prescriber is competent to exercise their share of clinical responsibility and is assured that the shared care protocol provides enough information for them to discharge their responsibilities safely.

A guide to support primary care prescribing for people who access gender identity services was also agreed by the APC. 

The guide includes information on children and young people, requests to prescribe, shared care, on-going care and private providers.

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) approved a change in traffic light status from BLUE to GREEN for testosterone gel.

The following testosterone products are NON-FORMULARY as they are either unlicensed in the UK or not available in biologically appropriate doses for the indication: Androfeme, Testogel, Testavan

Please note; Testim has been discontinued.

NHS England guidance to support clinicians on the prescribing of cannabis-based products for medicinal use:

https://www.england.nhs.uk/medicines-2/support-for-prescribers/cannabis-based-products-for-medicinal-use/

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) have reviewed and agreed the updated apomorphine AMBER shared care document.

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed  that the decision made by APC in March 2016 still stands and a RED traffic light status for Liothyronine (T3) as an option for treatment resistant depression in a niche group of adults whose depression has failed to respond to several antidepressants and is intolerant to lithium augmentation.

Where liothyronine is prescribed for the treatment of depression only, this should be under the care of an NHS consultant psychiatrist.

The most cost-effective formulation should be prescribed at initiation.

NHS England guidance to support clinicians on the prescribing of cannabis-based products for medicinal use:

https://www.england.nhs.uk/medicines-2/support-for-prescribers/cannabis-based-products-for-medicinal-use/