Your Local Pharmacy

Your local Pharmacy is the place to go to get any prescription medicines and clinical advice for minor health concerns.

Pharmacy Teams play a key role in providing quality healthcare.

Pharmacists can also help you decide whether you need to see a medical health professional.

Pharmacies closest to our Elstree surgery

• Elstree Pharmacy Corner Shop B, High Street, Elstree, WD6 3BY 020 82075925
• Boots Borehamwood Shopping Pk, Borehamwood, Hertfordshire, WD6 4PR 02089531401
• Wellswood Pharmacy Wellswood House, Borehamwood, Hertfordshire, WD6 1PU 020 8207 6530
• Tesco Superstore Shenley Road, Borehamwood, Hertfordshire, WD6 1JG 0345 6779069
• Andrews Pharmacy 9 Canons Corner, Edgware, Middlesex, HA8 8AE 020 89587137
• Greenlight Pharmacy 148 Manor Way, Borehamwood, Hertfordshire, WD6 1QX
• Metro Pharmacy 11-13 Leeming Road, Borehamwood, Hertfordshire, WD6 4EB 0208 9533320
• Cullimore Chemist 13-15 Glengall Road, Edgware, Middlesex, HA8 8TB 0208 958 8957
• Singer Pharmacy 74 Edgware Way, Mowbray Parade, Edgware, HA8 8JS 02089586768

Pharmacies closest to our Bushey Surgery

• Heath Pharmacy 104 High Road, Bushey Heath, Hertfordshire, WD23 1GE 020 8950 1866
• Lister Chemist 31-33 High Road, Bushey Heath, WD23 1EE 020 89503370
• Triangle Healthcare (Uk) Ltd 29 Harcourt Road, Bushey, Watford, WD23 3PP 020 8950 1357
• Bushey Pharmacy 62-64 High Street, Bushey, Hertfordshire, WD23 3HE020 89500934
• Tweens Pharmacy 47 High Street, Bushey, Watford, WD23 1BD 020 89501263
• Reems Pharmacy 107 Uxbridge Road, Harrow Weald, Middlesex, HA3 6DN 020 89540404
• Care Chemists 5 Buckingham Parade, The Broadway, Stanmore, HA7 4EB 020 89540265

Your Repeat Medication

If you need regular medication and your doctor does not need to see you every time, you will be issued with ‘repeat prescription’. When you collect a prescription you will see that it is perforated down the centre. The left-hand side is the actual prescription.The right-hand side (re-order slip) shows a list of medicines that you can request without booking an appointment to see a doctor. Please tear off this section (and keep it) before handing the prescription to the chemist for dispensing.

Run out or just about to run out of medication requests

Unfortunately a small minority of patients are repeatedly running out (or just about to run out) of their medication. ‘Urgent’ requests of this nature cause a great deal of disruption to the smooth running of the practice. Please be aware that such requests will be questioned very carefully by the reception staff and may well be refused by the GP. A record is kept of such requests.

Had a recent change of medication from the hospital

Please be aware, any letters received regarding medication changes from the hospital can take up to 7-10 working days from receipt of the letter to be actioned so may not be visible for you to order straight away.

If you forget to request a repeat prescription

If you forget to obtain a prescription for repeat medication and thus run out of important medicines, you may be able to get help from your Pharmacy. Under the Urgent Provision of Repeat Medication Service, Pharmacists may be able to supply you with a further cycle of a previously repeated medicine, without having to get a prescription from your GP.

If you have run out of important medication, telephone your usual Pharmacy to check that they offer this service; if they don’t, they may either direct you to another Pharmacy who does provide it, or ask you to phone 111 where you can request details of a local Pharmacy that provides the service.

You must then take with you to the relevant Pharmacy, proof of both your identification and of your medication (for example, your repeat prescription list or the empty box which should have your details printed on it). Please note that controlled drugs and antibiotics are not provided through this service, you will need to ring 111 for these.

If you receive stoma products from your Pharmacy or other supplier and/or receive items such as continence products, please ensure you have sufficient supplies as you may encounter difficulties in obtaining these over Bank Holidays, or when the Surgery is closed.

Requesting an NHS prescription for medication recommended by a private consultant

Following your appointment with your private specialist, you may be prescribed medications or treatment. You may wish to receive this prescription via your GP on the NHS. We have clear guidelines regarding this situation and your specialist will have been informed of these guidelines.

Can I get my private prescription transferred to an NHS prescription?

If you see a private doctor or specialist and they recommend a particular medication or treatment for you, this will be a private prescription. The GP practice will not usually be able to transfer a private prescription onto an NHS prescription.

What happens when I continue the treatment on the NHS?

If you ask your GP to take over prescribing of a medication or treatment recommended by the private doctor or specialist, they will need to be satisfied that prescribing is appropriate, responsible and what they would prescribe for other NHS patients with the same diagnosis / condition.

In order for us to prescribe the medication, Schopwick Surgery must have received a legible (preferably typed) letter from the specialist with details of the medication (a copy of a private prescription will not be sufficient)

Your GP may not prescribe the particular medication suggested by a private doctor in the following circumstances:

• • The medication is generally not prescribed on the NHS.

• • The use of the medication is not compatible with national or local prescribing guidelines.

• • The medication is not licensed in the UK or is being used for a purpose not included in its UK licence.

• • The GP does not believe the medication is appropriate or necessary for you.

• • The medication is complex and must remain with the prescribing consultant.

• • The treatment is a ‘shared care’ medication (see below for more details)

If your GP is unable to prescribe the medication suggested by the private doctor, they may give you the option of having a different but equally effective medication prescribed on the NHS.

Alternatively, if you prefer, you can pay for your private prescription through your private doctor.

This will not affect any other medications, which are currently prescribed for you by your GP.

*Herts and West Essex ICB Shared Care Policy with Private providers

Schopwick Surgery is obliged to follow the guidelines set by the Local Integrated Care Board (ICB). We have provided below their policy regarding the continued prescribing of shared care medications first started by private providers. The ICB is the is the local NHS organisation that plans and oversees how NHS money is spent and makes sure health services work well and are of high quality. https://hertsandwestessex.icb.nhs.uk/

A small number of medications that require ongoing monitoring and specialist input are specifically classified as ’Shared care’ medications.  The prescribing and monitoring of these complex medicines is always held by the specialist for longer than routinely prescribed medicines before being moved to shared care.  The shared care medicines also have locally agreed documents ‘Shared Care Agreements’ to support all parties to share the care between the patient, the NHS specialist and the NHS GP and to keep patients safe.

Examples of medications that require shared care include specialist medications for arthritis and skin complaints such as methotrexate, ciclosporin, and some specialist drugs with known side effects that require additional monitoring.

In general, GPs and other NHS services will not issue NHS prescriptions for shared care medications for conditions where patients are being treated privately.  This is because it is important to ensure that private specialists treating patients remain in control of, and are responsible for, prescribing treatments for the conditions they are managing.

Locally defined ‘Shared Care Agreements’, allow specialist NHS services to share care with primary care (e.g. NHS GPs).

Where appropriate, and agreed, NHS GPs can then prescribe the ‘shared care’ medicine.
If the patient’s condition becomes unstable, or if there are any issues with their ongoing care, prescribing should be able to be seamlessly transferred back to specialist NHS care.

This strategy aims to ensure that it is clear both to the patient and to all the clinicians involved in a patient’s care, where the clinical responsibilities associated with prescribing lie at all times and to keep patients safe.

Note:  NHS GPs can decline to prescribe a ‘shared care’ medicine for example if they do not feel clinically comfortable with prescribing it.  In NHS care this would result in the NHS GP asking the NHS specialist to continue the medication.

How can patients access medications requiring shared care on the NHS?

All patients are able to ask their primary care clinician (e.g. NHS GP, NHS nurse) to refer them to an NHS specialist service for management of their condition.  Where appropriate, following an NHS specialist review, prescribing can occur on the NHS under a shared care protocol.  Every attempt is made by the NHS services to do this as quickly as possible.

Whilst patients are being seen privately, the current expectation for medications that require shared care, is for these to continue to be prescribed on a private basis from their private provider.

To discuss concerns with the above policy, you can contact the medicines authority directly;

Email: [email protected]

Telephone: 01992 566122.

References

1. 1. https://www.england.nhs.uk/wp-content/uploads/2018/03/responsibility-prescribing-between-primary-secondary-care-v2.pdf  <Accessed 8^th March 23>

1. 1. https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-practice-in-prescribing-and-managing-medicines-and-devices  <Accessed 8^th March 23>

NHS ‘Shared Care’ ADHD Medicines Prescribing after Initiation by a Private Provider

Schopwick Surgery is obliged to follow the guidelines set by the Local Integrated Care Board (ICB). We have detailed below their policy regarding the continued prescribing of ADHD medications first started by private providers via shared care agreements.

The ICB is the is the local NHS organisation that plans and oversees how NHS money is spent and makes sure health services work well and are of high quality. https://hertsandwestessex.icb.nhs.uk/

Policy

A small number of medications that require ongoing monitoring and specialist input are specifically classified as ’Shared care’ medications.  The prescribing and monitoring of these complex medicines is always held by the specialist for longer than routinely prescribed medicines before being moved to shared care.  The shared care medicines also have locally agreed documents ‘Shared Care Agreements’ to support all parties to share the care between the patient, the NHS specialist and the NHS GP and to keep patients safe.

Examples of medications that require shared care include medications for Attention Deficit Hyperactivity Disorder (ADHD), specialist medications for arthritis and skin complaints such as methotrexate, ciclosporin, and some specialist drugs with known side effects that require additional monitoring.

GPs and other NHS services will not issue NHS prescriptions for shared care medications for conditions where patients are being treated privately.  This is because it is important to ensure that private specialists treating patients remain in control of, and are responsible for, prescribing treatments for the conditions they are managing.

Locally defined ‘Shared Care Agreements’, allow specialist NHS services to share care with primary care (e.g. NHS GPs).  Where appropriate, and agreed, NHS GPs can then prescribe the ‘shared care’ medicine. If the patient’s condition becomes unstable, or if there are any issues with their ongoing care, prescribing should be able to be seamlessly transferred back to specialist NHS care.

This strategy aims to ensure that it is clear both to the patient and to all the clinicians involved in a patient’s care, where the clinical responsibilities associated with prescribing lie at all times and to keep patients safe.

Note:  NHS GPs can decline to prescribe a ‘shared care’ medicine for example if they do not feel clinically comfortable with prescribing it.  In NHS care this would result in the NHS GP asking the NHS specialist to continue the medication.

How can patients access medications requiring shared care on the NHS?

All patients are able to ask their primary care clinician (e.g. NHS GP, NHS nurse) to refer them to an NHS specialist service for management of their condition.  Where appropriate, following an NHS specialist review, prescribing can occur on the NHS under a shared care protocol.  Every attempt is made by the NHS services to do this as quickly as possible.

Whilst patients are being seen privately, the current expectation for medications that require shared care, is for these to continue to be prescribed on a private basis from their private provider.

How do I raise concerns with the health authority about this policy:

To discuss concerns with the above policy, you can contact the medicines authority directly;

Email: [email protected]

Telephone: 01992 566122.

Use of antibiotics

Antibiotics are important medicines to help treat infections that are caused by bacteria. Different antibiotics are used to kill different types of bacteria. They can be used to treat relatively mild conditions such as acne as well as potentially life-threatening conditions such as pneumonia (a type of lung infection). Antibiotics are usually taken by mouth, but can sometimes be given into a vein (intravenous), into a muscle (intramuscular) or applied to the skin (topical).

Why might the GP not prescribe antibiotics?

Our practice will only prescribe antibiotics if we feel that they will benefit your condition – many conditions will improve without the need for medication.The majority of common ailments such as colds, most coughs and sore throats are caused by viruses. Antibiotics do not work against infections caused by viruses and generally these will get better on their own.

Antibiotic resistance (when an antibiotic is no longer effective) is a major problem. This is caused by overusing and inappropriately prescribing antibiotics. The resistance of bacteria to antibiotics has led to the emergence of superbugs such as meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. diff) which are often in the headlines.

Some antibiotics are not suitable for people with certain medical conditions, or for women who are pregnant or breastfeeding. You should only ever take antibiotics that are prescribed to you – never ‘borrow’ them from a friend of family member. You are also be prescribed certain antibiotics if you are known to have had an allergic reaction in the past. This is estimated to effect about 1 in 15 people in the UK.

What can I do to help combat antibiotic resistance

There are a number of things that you can do to help manage antibiotic resistance.

ŸDon’t expect to be prescribed antibiotics when you are unwell, particularly if your GP believes your illness is caused by a virus.

ŸIf you are prescribed antibiotics please make sure you take the complete course in order to get rid of the bacteria completely. If you have tablets left over or ‘save some for next time’ some bacteria may be left to develop resistance.

ŸTreat viral infections such as colds by drinking plenty of fluids and resting. Seek advice from your pharmacist to help manage your condition. If your cold lasts for more than three weeks you should consider seeing you GP.

By not using them unnecessarily, they’re more likely to work when we do need them.It is important to read the information leaflet that comes with your medication carefully in order to get most benefit and avoid side effects.

Where can I find more information about antibiotics?

You can find lots more useful information about antibiotics on the NHS Choices website including, what they are used for, side effects and more details about antibiotic resistance. You can also watch a short video about antibiotics. If you would like more information about how to get well without antibiotics your can download or view our leaflet.

Get well soon without Antibiotics

Here you will find the local policy regarding the prescribing of flash-glucose monitoring;

This guidance is not decided by us, but rather imposed by the local Integrated Care Board (ICB) https://hertsandwestessex.icb.nhs.uk/. The ICB is the local NHS organisation that plans and oversees how NHS money is spent and makes sure health services work well and are of high quality.

To discuss concerns with this policy, you can contact the medicines authority directly;

Email: [email protected]

Telephone: 01992 566122

Frequently Asked Questions (FAQs)

Summary

This document provides key information about FreeStyle Libre/Libre 2®, and is designed for patients
and/or members of the public. It includes answers to the following questions:

1. • How do I get FreeStyle Libre/Libre 2® sensors on the NHS?

• • Who is entitled to FreeStyle Libre/Libre 2® sensors on the NHS?

• • My review is not due for several months – can I request an earlier review by my specialist?

• • How do I request an earlier review if my diabetes needs have significantly changed?

• • Can my GP prescribe these sensors before I have been seen by the specialist?

• • Once I have been seen by the specialist, how soon will I get the FreeStyle Libre/Libre 2® system?

• • Is there anything else I need to do?

• • If I have further questions on how to use the sensors, who do I ask?

• • When will my GP take over prescribing FreeStyle Libre/Libre 2® for me?

• • How many sensors will be prescribed for me?

• • What happens if my sensor falls off and/or I run out of sensors?

• • How Should the FreeStyle Libre/Libre 2® sensor components be disposed of after use?

• • Will GPs continue to prescribe glucose testing strips for me if I meet the criteria for use of sensors?

• • Can drivers use the Flash Glucose Sensors to monitor blood glucose levels prior to driving?

• • What if I am already self-funding FreeStyle Libre/Libre 2®?

• • What if I want to use (or continue using) FreeStyle Libre/Libre 2® but do not meet the criteria for
    funding?

• • Will the recommendations for funding be reviewed?

• • How can I switch from FreeStyle Libre® to FreeStyle Libre 2®?
    The NHS England funding criteria for FreeStyle Libre/Libre 2® are also given in Appendix 1.
    This document contains electronic links and web addresses to supporting information.

Please note that any clinical questions about FreeStyle Libre/Libre 2® should be directed to a member of a
Specialist Diabetes Team.

1. How do I get FreeStyle Libre/Libre 2® sensors on the NHS?
In March 2019, NHS England issued guidance relating to national arrangements for funding of Flash
Glucose Monitoring for qualifying diabetes patients. As a result Herts Valleys CCG has reviewed its
commissioning policy. Flash Glucose Monitoring using FreeStyle Libre/Libre 2® is recommended for
restricted use as an option for:

1. • patients who satisfy the NHS England funding criteria. Details are available online at the
     following address:
     https://www.england.nhs.uk/publication/flash-glucose-monitoring-national-arrangements-forfunding-of-relevant-diabetes-patients/
     See Appendix 1 on the last page of this FAQ for the full criteria;

• • existing patients funded under the previously approved Hertfordshire Medicines Management
    Committee (HMMC) guidelines.
    If you are already under the care of the Specialist Diabetes Team, they will discuss your eligibility at
    your next routine review and if you meet the criteria, you will receive FreeStyle Libre/Libre 2®
    funded by the NHS. If you are not under the care of the diabetes specialist team but you clearly
    meet the strict criteria, you will need to ask to be referred to the specialist team for assessment
    and you will be seen at the next available routine appointment.

2. Who is entitled to FreeStyle Libre/Libre 2® sensors on the NHS?
The national criteria are set out in Appendix 1. Under the national criteria, approximately 20% of
patients with Type 1 diabetes are expected to meet the criteria for NHS funded FreeStyle
Libre/Libre 2®. NHS England wanted to prioritise patients who are in greatest need. For example,
patients with pre-existing Type 1 diabetes in pregnancy, patients with severe disabilities on insulin
and patients on insulin treatment on haemodialysis.
NHS care of patients with Type 1 diabetes is already at a high standard. If you don’t meet the
FreeStyle Libre/Libre 2® criteria, you will not be considered for it, but the healthcare teams will
continue to support you in all aspects of your diabetes care.

3. My review is not due for several months – can I request an earlier review by my specialist?
Only patients whose diabetes needs have significantly changed since their last review and clearly
meet the strict criteria for NHS funded FreeStyle Libre/Libre 2® should ask for an earlier
appointment. Our diabetes specialists have limited capacity and must prioritise the patients with
highest clinical needs.
If you are unsure whether changes in your diabetes needs require an earlier review, please contact
your diabetes specialist for advice

4. How do I request an earlier review if my diabetes needs have significantly changed?
If you are already under the care of the Specialist Diabetes Team, please contact them directly
using the contact details they provided. You do not need your GP or Practice Diabetes Nurse to
make a referral. If you are not already under the care of the specialist team, please contact your GP
Practice.

5. Can my GP prescribe these sensors before I have been seen by the specialist?
No – GPs are only permitted to prescribe these sensors once you have been assessed by the
specialist as someone meeting the strict criteria for NHS funding. One of the reasons for this is that
patients obtain most benefit from using FreeStyle Libre/Libre 2® with the focussed educational
Version 1.3 February 2021
Page 3 of 6
support of specialist teams. The device relies on educational support on how to interpret and act on
the results it generates. The specialist team will also ensure that patients with Type 1 diabetes who
meet the funding criteria have already undertaken or will complete, an appropriate diabetes
education programme.

6. Once I have been seen by the specialist, how soon will I get the FreeStyle Libre/Libre 2® system?
In order to use the system correctly, all patients must attend a training session, which lasts
approximately one hour. At this session, you will be supplied with the scanner and an initial supply
of sensors. The training session usually takes place within a month of your assessment, but may
take longer owing to the anticipated high demand for training.
The initial 2-months’ supply will be provided by the specialist team. If you and your specialist decide
to continue treatment after this, your GP will take over your supplies.

7. Is there anything else I need to do?
You will be expected to use the system regularly to improve your diabetes management, upload
data for central monitoring, participate in audits to assess outcomes and complete a diabetes
structured education programme – if you have not already done so. A copy of the patient
agreement forms can be found at this link.

8. If I have further questions on how to use the sensors, who do I ask?
Contact your Specialist Diabetes Team using the details they have provided to you. FreeStyle
Libre/Libre 2® is a complex device, therefore specialist support is needed.

9. When will my GP take over prescribing FreeStyle Libre/Libre 2® for me?
For the first 2 months you will receive all supplies of FreeStyle Libre/Libre 2® sensors from your
Specialist Diabetes Team who will monitor you closely and will help you use FreeStyle Libre/Libre 2®
properly. Your specialist team will conduct a review to check that you are benefitting from using the
device. At this point, they will decide whether to continue (or stop) FreeStyle Libre/Libre 2®. If your
specialist team agrees to continue FreeStyle Libre/Libre 2®, they will ask your GP to take over
prescribing.

10. How many sensors will be prescribed for me?
You will usually be supplied with a maximum of 2 sensors every 28 days.
If any of the sensors are defective or fall off, you will need to contact the manufacturer to obtain a
replacement. Your specialist and GP cannot issue prescriptions to replace defective sensors or
those that have fallen off.
You should contact the Abbott Customer Careline, on 0800 170 1177, on the day that the FreeStyle
Libre/Libre 2® sensor falls off/is defective or, if it is closed, when the office is next open. Details of
office opening hours can be found at: https://freestylediabetes.co.uk/contact-us. You will need to
keep the defective FreeStyle Libre/Libre 2® sensor and follow the instructions given by the Abbott
Customer Careline representative.
Please note that Abbott will only replace a maximum of 3 FreeStyle Libre/Libre 2® sensors per
individual. More information/education on replacement sensors will be provided by diabetes
specialist teams at the initial training session

11. What happens if my sensor falls off and/or I run out of sensors?
See information under section 10 concerning replacement sensors if they fall off. You should return
to monitoring your glucose levels using blood glucose testing strips, increasing the frequency of
testing as necessary and as advised by your specialist to compensate for lack of sensor. You may
have to request extra blood glucose testing strips from your GP if you have insufficient to last until
your next routine prescription for your sensors/strips is due. Alternatively you may be able to
purchase a sensor from your community pharmacy (i.e. a pharmacy that can be found on the high
street).

12. How Should the FreeStyle Libre/Libre 2® sensor components be disposed of after use?
Used or unused sensor packaging can go in general waste.
Once the FreeStyle Libre/Libre 2® sensor has been placed on the arm, the used applicator (which
contains a needle) and the lid can be screwed back together and must be placed in a yellow
biohazard bag or sharps box.
The used FreeStyle Libre/Libre 2® sensor must be placed in a clinical waste sharps box.
More information/education on disposing of FreeStyle Libre/Libre 2® sensor components will be
provided by diabetes specialist teams at the initial training session.

13. Will GPs continue to prescribe glucose testing strips for me if I meet the criteria for use of
sensors?
Yes – however it is anticipated that the use of these strips will be reduced to a lower level. You may
be asked to change to a lower cost meter and strip if not already using one.

14. Can drivers use the Flash Glucose Sensors to monitor blood glucose levels prior to driving?
The Driver and Vehicle Licensing Agency (DVLA) has updated the guidance on glucose testing prior
to driving which now permits the use of devices such as Flash Glucose Scanning (FreeStyle
Libre/Libre 2®) for group 1 drivers only. CLICK HERE FOR FULL INFORMATION as finger prick tests
are still required (even for group 1 drivers) under certain circumstances (for example if your glucose
level is 4.0 millimoles per litre or below or you have symptoms of hypoglycaemia).
All pre-existing DVLA requirements and responsibilities for safe driving still lie with the patients. The
DVLA must be informed by any patient if there is any significant change in their driving status in
accordance with these national DVLA guidelines.

15. What if I am already self-funding FreeStyle Libre/Libre 2®?
If you have been buying the FreeStyle Libre/Libre 2® directly from the manufacturer (and wish to
continue using the device) you should still purchase your sensors via this route until you are
reviewed, if appropriate, by the Specialist Diabetes Team at your next routine clinic appointment.
Herts Valleys CCG will only fund FreeStyle Libre/Libre 2® for new patients who fulfil the eligibility
criteria as stated in Appendix 1.

16. What if I want to use (or continue using) FreeStyle Libre/Libre 2® but do not meet the criteria for
funding?
You can buy FreeStyle Libre/Libre 2® directly from the manufacturer –
https://www.FreeStylelibre.co.uk/libre/ or Tel: 0800170 1177.

17. Will the recommendations for funding be reviewed?
Yes, these recommendations will be kept under review. In particular, a further review will be
undertaken when national funding of the device and sensors ceases in March 2021.

18. How can I switch from FreeStyle Libre® to FreeStyle Libre 2®?
A switch to FreeStyle Libre 2® will be led by your diabetes specialist. You will be either be contacted
by your diabetes specialist to arrange the switch, or this will be discussed at your next routine
review. Alternatively, you can contact your diabetes specialist to discuss/arrange the switch. Please
note that your GP will not be able to switch your prescription to FreeStyle Libre 2® until advised
to do so by your diabetes specialist.

Appendix 1 – Criteria for NHS England Flash Glucose Monitoring Reimbursement
Patients must meet at least one of the following criteria to be eligible for NHS funding:

1. • People with Type 1 diabetes
     OR with any form of diabetes on haemodialysis and on insulin treatment
     who, in either of the above, are clinically indicated as requiring intensive monitoring >8 times daily, as
     demonstrated on a meter download/review over the past 3 months
     OR with diabetes associated with cystic fibrosis on insulin treatment.

• • Pregnant women with Type 1 Diabetes – 12 months in total inclusive of post-delivery period.

• • People with Type 1 diabetes unable to routinely self-monitor blood glucose due to disability who
    require carers to support glucose monitoring and insulin management.

• • People with Type 1 diabetes for whom the specialist diabetes multidisciplinary team (MDT) determines
    have occupational (e.g. working in insufficiently hygienic conditions to safely facilitate finger-prick
    testing) or psychosocial circumstances that warrant a 6-month trial of Libre with appropriate additional
    support.

• • Previous self-funders of Flash Glucose Monitors with Type 1 diabetes where those with clinical
    responsibility for their diabetes care are satisfied that their clinical history suggests that they would
    have satisfied one or more of the funding criteria prior to them commencing use of Flash Glucose
    Monitoring, had these criteria been in place prior to April 2019 AND have shown improvement in
    glycated haemoglobin (HbA1c) since self-funding.

• • For those with Type 1 diabetes and recurrent severe hypoglycemia or impaired awareness of
    hypoglycemia, the National Institute for Health and Care Excellence (NICE) suggests that Continuous
    Glucose Monitoring with an alarm is the standard. Other evidence-based alternatives with NICE
    guidance or NICE technology appraisal (TA) support are pump therapy, psychological support,
    structured education, islet transplantation and whole pancreas transplantation. However, if the person
    with diabetes and their clinician consider that a Flash Glucose Monitoring system would be more
    appropriate for the individual’s specific situation, then this can be considered.

• • People with Type 1 diabetes or insulin treated Type 2 diabetes who are living with a learning disability
    and recorded on their GP Learning Disability register.
    Other requirements:
    Patients must meet all of the following criteria to be eligible for continued NHS funding:

• • Education on Flash Glucose Monitoring has been provided (online or in person).

• • Agreement to scan glucose levels no less than 8 times per day and use the sensor >70% of the time.

• • Agreement to regular reviews with the local clinical team.

• • Previous attendance, or due consideration given to future attendance, at a Type 1 diabetes structured
    education programme (DAFNE or equivalent if available locally).
    Note:
    Continuing prescription for long-term use of Flash Glucose Monitoring, after the initial six months, would
    depend on evidence of agreement with the above conditions and that on-going use of the Flash Glucose
    Version 1.3 February 2021Monitoring is demonstrably improving an individual’s diabetes self-management – for example,
    improvement of HbA1c or Time In Range; improvement in symptoms such as diabetic ketoacidosis (DKA) or
    hypoglycaemia; or improvement in psycho-social wellbeing.
    With thanks to West Essex CCG / Mid and South Essex STP

We are unable to prescribe sleeping tablets, such as zopiclone, to treat fear of flying.

Sleeping tablets are medicines which make you sleepy and relaxed.

Our decision to cease prescribing sleeping tablets for flying anxiety is based on the most current medical guidelines and patient safety considerations. This policy has been agreed upon by all clinicians at our practice, as part of a local and national drive to improve safety in the prescribing of hypnotic medications (such as zopiclone). We have recently reviewed a number of similar medications, as part of our commitment to the highest standards of care.

There are several reasons why healthcare practitioners at Schopwick Surgery do not prescribe these medicines for flying:

If an emergency were to occur on a flight, being under the influence of this kind of medicine would worsen your ability to react.

The Civil Aviation Authority (CAA) also advises against the use of sleeping pills on flights due to the increased risk of DVT when immobile in one’s seat for prolonged periods.

Although zopiclone makes most people who take it sleepy, in some rare situations it can have an opposite effect, and make people aggressive or agitated, which would be dangerous on a plane, and may lead you to suffering legal consequences.

Being able to sleep while flying can make the flight more comfortable and easier, however this isn’t necessarily a medical need and generally shouldn’t prevent ability to fly.

Airlines offer specialised Fear of Flying courses that could provide significant relief:

• Easy Jet Fearless Flyer program (Tel: 0203 8131644)
• British Airways Flying with Confidence course (Tel: 01252 793250)
• Virgin Fear of Flying workshop (Tel: 01423 714900)

These resources, along with additional advice on managing flight anxiety available How to manage a fear of flying and flying anxiety, may offer you long-term benefits and decrease your reliance on medications.

We are unable to prescribe sedatives, such as diazepam, for any procedure or scan being undertaken outside of Schopwick Practice, this includes MRI scans and dental procedures.

If you feel you need sedation in such circumstances, please request the patient speak to the team undertaking the procedure or scan, as they are responsible for providing this if needed.

Sedatives are medicines which make patients sleepy and relaxed. There are several reasons why healthcare practitioners at Schopwick Practice do not prescribe these medicines for procedures outside of our practice:

• GPs are not trained to provide the correct level of sedation for a procedure / scan. Providing too little sedation won’t help you, providing too much sedation can make you too sleepy, which could lead to the procedure being cancelled. Too much sedation can dangerously affect your breathing. After taking a sedative for a procedure or scan, you will need to be closely monitored to keep you safe.
• Although diazepam makes most people who take it sleepy, in some rare situations it can have an opposite effect and make people aggressive or agitated.
• Scans and hospital procedures are often delayed, therefore the team performing he procedure or scan should provide the sedation, to ensure you become sleepy and relaxed at the right time.

Feel free to provide this policy to patients so they can show their hospital team or dentist.

Weight loss injections are not available for prescribing in Primary care, please see further information below:

01) Semaglutide (Wegovy^®) for managing overweight and obesity –  NICE TA875 – not recommended for primary care prescribing

On 8 March 2023 the National Institute for Health and Care Excellence (NICE) published a Technology appraisal guidance on the weight-loss drug semaglutide (Wegovy®).

NICE has recommended semaglutide as an option, alongside a reduced-calorie diet and increased physical activity, within specialist weight management services, to people with at least one weight-related co-morbidity and a body mass index (BMI) of at least 35kg/m2 or between 30kg/m2 – 34.9kg/m2 who meet the defined criteria for referral to specialist services.

There has been significant media coverage and attention from members of the public.

Semaglutide for weight loss/maintenance is not recommended for primary care prescribing at the current time. It can only be initiated via specialist weight management services

This guidance is not decided by us, but rather imposed by the local Integrated Care Board (ICB) https://hertsandwestessex.icb.nhs.uk/. The ICB is the local NHS organisation that plans and oversees how NHS money is spent and makes sure health services work well and are of high quality.

The ICB have reported to us that work is being progressed with local specialist weight management services and other stakeholders to initiate the national guidance, and will issue further advice in due course.

Patients who are eligible for weight management referrals should be managed appropriately in line with current pathways.

What is the pathway for weight management services?

Currently, the pathway is as follows – patients must move across a tier system

Tier 1: Healthy eating, physical activity, population-wide services. Such as ‘Active Herts’ https://www.activeherts.org.uk/

Tier 2: The ICB have only provided the ‘NHS digital weight management programme’ for our surgery. The NHS Digital Weight Management Programme supports adults living with obesity who also have a diagnosis of diabetes, hypertension or both, to manage their weight and improve their health.

It is a 12-week online behavioural and lifestyle programme that people can access via a smartphone or computer with internet access https://www.england.nhs.uk/digital-weight-management/

Inclusion criteria:

– Must not have accessed the programme in the last 18months.

– BMI >30 (patients with BMI >50 can be referred directly to Tier 3

Tier 3:

Tier 3 weight management services offer weight management support for people who live with obesity. The service includes:

• Psychologists/psychotherapists.
• Weight management advisers
• Specialist dietitians/nutritionists.

Inclusion Criteria:

• BMI > 40  AND must have already completed two 12 week courses of Tier 2 (one funded, one self-funded) in the last 12 months
• Have BMI >35 and OTHER SIGNIFICANT DISEASE (hypocholesteraemia / Diabetes / Sleep Apnoea) that would improve if they lost weight AND must have completed two 12 week courses of Tier 2 (one funded, one self-funded) in the last 12 months
• BMI > 50 can be referred straight to Tier 3 without any other requirements

Tier 4:

GP’s cannot direct refer for Tier 4 services. At Tier 4 services options such as weight loss injections and/or bariatric surgery can be considered, via a multidisciplinary team

Inclusion Criteria:

– BMI >40 or >35 with comorbidity

– Patient must have complied with Tier 3 12-24months

– Raised BMI >5years

Where we can use semaglutide:

Ozempic® brand semaglutide pre-filled pens are only licensed for use in the management of type 2 diabetes. They should not be prescribed off label for weight loss. Prescribing should be for the management of type 2 diabetes only and this also avoids any potential pressure on the supply chain resulting in stock shortages. As per local and national guidance, this agent is a 3rd line medication, so you have to be on two other diabetes medications before we can start this. We would not tend to use this if you sugars are already well controlled.

Liraglutide for managing overweight and obesity is also not recommended for primary care prescribing.

How do I raise concerns with the health authority about this policy:

To discuss concerns with the above policy, you can contact the medicines authority directly;

Email: [email protected]

Telephone: 01992 566122.

If there are any medications you no longer use, please advise the receptionist who will arrange to have them removed from your repeat medications.

The video shown below shows how we can reduce the waste on repeat prescriptions, wasted medication impacts on our NHS services.

We are getting requests for medications to support fertility. We understand that NHS provision can be lacking and there are long waits to receive treatment, so often patients go privately for their treatment and ask for this medication on an NHS prescription. Unfortunately we are not able to prescribe. Please note this is not due to funding restrictions, but to protect patient-safety. We are of course sympathetic to the difficult experiences patients go through.

Schopwick Surgery is obliged to follow the guidelines set by the Local Integrated Care Board (ICB). We have detailed below their policy regarding the continued prescribing of fertility medications. Fertility medications are specialist only under this guidance.

The ICB is the is the local NHS organisation that plans and oversees how NHS money is spent and makes sure health services work well and are of high quality. https://hertsandwestessex.icb.nhs.uk/

COMMON EXAMPLES:

• Clexane
• Cyclogest
• Lubion

In addition to the ICB policy, the prescribing of these medicines to maintain a pregnancy would be highly specialised as various factors would need to be considered such as:

• Ensuring that the doses prescribed are correct and adjusted according to patient need
• Ensuring that the medications are prescribed for the correct durations
• Management of any change in treatment required in line with response
• Understanding the outcomes of treatment
• Undertaking any monitoring requirements
• Management of any complications which may arise

Please also note that an NHS prescriber can decline a request to prescribe should they feel the treatment does not fall in line with locally agreed decisions/national guidelines, or is likely to be beyond the scope of their current clinical practice. Patient are advised to continue to source their medicines privately until they are seen by an NHS Obstetrician.

Please note, this is a practice policy and has been agreed with all clinicians at the surge