Monthly News Update: Scotland Edition: December 2024/January 2025

ScriptSwitch™ Monthly Summary: Scotland edition – December 2024/January 2025

Welcome to the KINES Scotland Monthly News Update for December 2024 to January 2025. Other KINES Rapid Updates published this month have discussed the following (ScriptSwitch users, please login or register to access KINES articles online):

  • A retrospective longitudinal cohort study has evaluated the longer term outcomes of sore throat consultations carried out in the Welsh Sore Throat Test and Treat service (STTT) compared with general practitioner (GP) consultations. Patient-level data for all STTT consultations in two health boards were anonymised and linked to GP and hospital admission records. Outcomes were levels of antibiotic use, re-consultations, hospital admissions for quinsy (a complication of sore throat) and cost effectiveness. The study found that significantly fewer antibiotic prescriptions were issued during the pharmacy consultations compared with GPs, even allowing for some later GP reconsultations (24% vs. 39%). Within 28 days of the initial consultation 14% of STTT patients reconsulted the GP compared with 7% from the original GP group. The use of the STTT service was found to be cost effective and rates of hospital admissions from both groups were very low.
  • A randomised controlled trial (SUMMIT, n = 731) has assessed the effect of tirzepatide in people who were obese (body mass index [BMI] ≥ 30kg/m2) and had heart failure with preserved ejection fraction. The study found that over a median follow-up duration of two years, subcutaneous tirzepatide (up to 15 mg once weekly) was superior to placebo in reducing the composite outcome of death from cardiovascular causes or worsening heart failure (absolute risk reduction 5.4%). In addition, health status (assessed by the Kansas City Cardiovascular Questionnaire clinical summary score [KCCQ-CSS]) improved more among patients in the tirzepatide group than the placebo group. However, discontinuation due to adverse events (mainly gastrointestinal) was more frequent with tirzepatide than with placebo (6.3% 1.4%).

KINES Scotland Update:

  • The Scottish General Practice Committee (SGPC) of the BMA published a position statement on the current GMS contract last month, which includes a focus on Pharmacotherapy. This is likely to influence future policy in this area:
    • The statement is critical of what has been delivered within the contract as a whole, to date, and the lack of clarity in expectations. It notes the complexity of the ambitions of the current contract.
    • It notes that the SGPC is prepared to accept that full transfer of Pharmacotherapy and CTAC services cannot be achieved with the current MDT workforce and that additional investment in and expansion of the MDT is not the right approach.
    • There is a short term goal proposed around the establishment of a service specification based on current levels of workforce. This will cross GMS services and includes Pharmacotherapy.
  • The Scottish Government has published a helpful summary of mental health and wellbeing resources in primary care, aimed at clinicians working in general practice. This provides signposting and brief explanations across 27 distinct areas, which include social prescribing tools, eating disorders, and dementia support organisations. Recognising the complexity of the primary care landscape, this resource may be valuable to pharmacy professionals across a variety of patient facing settings.
  • PHS have added new PGDs, and updated a range of others around hepatitis, as well as other travel related vaccinations. The full list can be found here.
  • Diabetes UK have provided a helpful summary of the current supply issues with insulin in the UK, covering shortages and discontinuations. Current MSANs (Medicines Supply Alert Notices) are available here.

Update from NICE:

  • New guidance on Tirzepatide for managing overweight and obesity recommends it as an option for managing overweight and obesity alongside a reduced-calorie diet and increased physical activity in adults, only if they have an initial BMI of at least 35 kg/m2 and at least one weight-related comorbidity. A lower BMI threshold (usually reduced by 2.5 kg/m2) is advised for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds.
  • An early value assessment of new digital technologies to support self-management of COPD (HTE19) has advised that seven products can be used in the NHS whilst more evidence is generated. These are Active+me REMOTE, Clinitouch, COPDhub, COPDPredict, Lenus COPD Support Service, Luscii, and myCOPD. They must have appropriate regulatory approval including NHS England’s Digital Technology Assessment Criteria (DTAC) approval.
  • The guidance on antimicrobial prescribing for recurrent urinary tract infection (NG112) has been updated with new recommendations for the use of methenamine hippurate. The recommendations relating to referral and seeking specialist advice, choice of antibiotic or antiseptic prophylaxis, and oestrogens without an evidence review have been amended in line with current practice and the latest NICE guideline on menopause.
  • The quality standard on Meningitis (bacterial) and meningococcal disease (QS19) has been updated with a new statement on the use of lumbar puncture: “People with suspected meningitis have lumbar puncture without neuroimaging unless they have a contraindication to lumbar puncture that requires neuroimaging”.

DHSE/UKHSA/NHS England:

  • With the start of the 2024/25 Influenza season, the Chief medical officer and Chief Pharmaceutical Officer have notified healthcare professionals that the prescription and supply of antiviral medicines (oseltamivir and zanamivir) for the prophylaxis and treatment of influenza is now permitted. Antiviral medicines may be prescribed for patients in clinical at-risk groups as well as anyone at risk of severe illness and/or complications from influenza if not treated. It is important that:
    • People start taking oseltamivir within 48 hours of onset of symptoms.
    • For zanamivir, treatment should begin within 48 hours of onset of symptoms for adults and within 36 hours of onset of symptoms for children who are 5 years old or over.
    • Children over 12 months and adults who are not able to swallow capsules can be prescribed oral oseltamivir suspension.
    • Prescribing for children under 12 months: Oseltamivir is indicated in children including full term neonates who present with symptoms typical of influenza, when influenza virus is circulating in the community. Efficacy has been demonstrated when treatment is initiated within two days of first onset of symptoms

Other:

  • A report on the Pharmacy First service in England from the Company Chemists’ Association found that over 1.4 million patient appointments had been transferred to pharmacies from general practice between January and September 2024, and that levels of antibiotic prescribing were similar to, or lower than found in other parts of primary care. The report also pointed out the limitations of the current system in that the treatment options available in the clinical pathways were limited, and largely based on use of antibiotics. The report calls for integration of independent prescribing within the service to enable greater choice of treatments prescribed.
  • The All Wales Medicines Strategy Group has published National Prescribing Indicators for 2025-2028. The indicators focus on four priority areas, with additional indicators focusing on safety and efficiency:
    • Analgesics (including opioids, tramadol, and gabapentin and pregabalin)
    • Antimicrobial stewardship (including total antibacterial prescribing and the ‘4C antimicrobials’: co-amoxiclav, cephalosporins, fluoroquinolones and clindamycin, and course duration for respiratory tract infection antibiotics)
    • Respiratory (including decarbonisation of inhalers and short acting beta agonist inhalers)
    • SGLT-2 inhibitors in patients with and without diabetes.
    • Safety: Prescribing safety indicators, hypnotics and anxiolytics, Yellow card reports
    • Efficiency: Best value biological medicines and low value prescribing
  • A report by the Women and Equalities Committee (WEC) has found that women experiencing painful reproductive health conditions (i.e. endometriosis, adenomyosis, and heavy menstrual bleeding) are frequently finding their symptoms ‘normalised’ and their ‘pain dismissed’ when seeking help. It calls on the NHS to “urgently implement a training programme to improve the experience” of women and girls when accessing treatment and improve early diagnosis, and the provision of follow up appointments.

Medicines Update:

Medicines supply notifications

  • Coal tar extract (Neutrogena® T/Gel® Therapeutic) 2% shampoo is being discontinued from February 2025. Alternative coal tar extract preparations remain available and are able to support an increase in demand.
  • Estradiol (Estradot®) transdermal patches: will be out of stock at the beginning of the year:
    • Estradiol (Estradot®) 75micrograms/24hours and 100micrograms/24hours transdermal patches will be out of stock until mid-January 2025
    • Estradiol (Estradot®) 50micrograms/24hours transdermal patches will be out of stock until late February 2025.
    • Alternative brands of estradiol patches (Evorel® and Estraderm MX®), and FemSeven® (estradiol) transdermal patches (once weekly application) are available and can support a full uplift in demand.
    • Progynova® (estradiol) transdermal patches also remain available but cannot support an uplift in demand.
  • Isosorbide mononitrate 10mg, 20mg and 40mg tablets (immediate-release):
    • Isosorbide mononitrate 10mg and 20mg immediate-release (IR) tablets are in limited supply until late February 2025.
    • Isosorbide mononitrate 40mg IR tablets are out of stock until late February 2025
    • Isosorbide mononitrate 30mg IR tablets remain available but cannot support any additional demand.
    • Isosorbide mononitrate modified-release (MR) tablets and capsules (available in strengths of 25, 40, 50 and 60mg) remain available and can support an increased demand (except 60mg capsules).
    • Isosorbide dinitrate IR tablets remain available but can only support a limited increase in demand.
  • Prednisolone 20mg/100ml rectal solution is out of stock until February 2025. Alternative rectal steroids remain available and can support an increase in demand.
  • Cefalexin 125mg/5ml and 250mg/5ml oral suspensions, sugar free:
    • Cefalexin 125mg/5ml and 250mg/5ml oral suspension (sugar free) are out of stock until mid-2025
    • Cefalexin 125mg/5ml and 250mg/5ml oral suspension (non sugar free) remain available and can support a full uplift in demand.
    • Serious Shortage Protocols (SSP) for cefalexin 125mg/5ml and 250mg/5ml oral suspensions (sugar free) were issued on 10/12/2024.
  • Insulatard® (isophane insulin, human) Penfill® 100units/ml suspension for injection 3ml cartridges
    • Insulatard® (isophane insulin, human) Penfill® 100units/ml suspension for injection 3ml cartridges are being discontinued; stock is anticipated to be exhausted by June 2025.
    • Humulin® I KwikPen® (isophane insulin, human) 100units/ml suspension for injection 3ml pre-filled pens are available and can support a full increase in demand from April 2025.
    • Humulin® I (isophane insulin, human) 100units/ml suspension for injection 3ml cartridges are available but cannot support an increase in demand.
    • Further information to follow on the discontinuation of all Levemir presentations. Clinicians should not initiate new patients on Levemir® or make any switches from Levemir® to alternative insulins

Important New Evidence is produced by Optum as part of the ScriptSwitch Medicines Management Bulletin in partnership with The Centre for Medicines Optimisation at Keele University. The views expressed are Keele’s and may not reflect local prescribing guidance. External hyperlinks are provided as a convenience to users but are out of Keele’s and Optum’s control and do not constitute an endorsement by Optum or Keele.

Published 14/01/25

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