Guidance, guidelines and policies
Mental Health
TEWV have created a Medicines Optimisation – Interactive Guide for external stakeholders, such as GPs, other PCN healthcare professionals and acute trust colleagues which will remain up to date with newly published documents and up to date links when things move on their website. To access the guide click here
To search all TEWV documents please search pharmacy publications.
North Yorkshire and York Area Prescribing Committee (APC) position statement on Dosulepin (May 2022)
Uncomplicated Hypertension
For the latest treatment guidance for uncomplicated hypertension, click here
HRT
For the latest guidelines on prescribing HRT click here
Topical testosterone for management of low libido in menopausal women
For the SPS page giving up-to-date information about available HRT products click here (please note that you will need to be registered with SPS to access this)
Dry eyes
For the latest North Yorkshire and York Are Prescribing Committee prescribing guidance for ocular surface diseases, including dry eye please click here
Respiratory
Asthma
The current guidelines for all of the following can be found on the Clinical Guidance and Pathways section on the Humber and North Yorkshire Integrated Medicines Optimisation Committee (IMOC) page here
- Humber and North Yorkshire Adult Asthma Guideline 2023
- Humber and North Yorkshire Children and Young People 12-17 years Asthma Guideline 2023
- Humber and North Yorkshire Children and Young People 6-11 years Asthma Guideline 2023
COPD
Greener Inhalers
Update your clinical knowledge on high quality and low carbon asthma care. Access the Greener Practice Asthma Toolkit page here
Green Inhalers informational video
SABA inhaler prescribing
Leeds Road GP Practice Case Study: Reduction in SABA inhaler prescribing
Nutrition
NHS website - 8 tips for healthy eating, click here
Information from the former Scarborough & Ryedale CCG
- Adult Oral Nutrition Formulary
- Are you getting enough to eat? - information for patients, relatives and carers
- Fabulous Fortified Feasts
- GP Guidance: Management of nutrition following bariatric surgery
- MUST screening tools
- Nutrition and Dietetics - information for GPs
- Nutrition and Dietetics Team
- Prescribing Oral Nutrition Supplements (ONS) for Adults in the Community
- Request for a review for a person who is not eating well ( not under dietetic care)
Information from the former Hambleton, Richmond & Whitby CCG
- South Tees Hospitals Trust Nutrition & Dietetics patient information leaflet for patients at risk of malnutrition
- South Tees pathway for the management of under-nutrition for adults in their own homes
- South Tees pathway for the management of under-nutrition for adults in Care/Nursing Homes
Specialist infant formulae (infant milks) prescribing guidelines
For the Guidelines for recognition and management of non- IgE cow's milk allergy in children click here
For the Quick Reference Guide click here
Useful resources:
- Infant milk info. - First Steps Nutrition Trust website
- Specialised milks marketed for infants with allergies in the UK - Information for health professionals, Jan 2021 click here
Gluten Free foods
A policy for use across Humber and North Yorkshire ICB is currently being written. Until this is finalised please refer to the guidelines applicable to the former CCG locality for your Practice:
Gluten Free Prescribing Guidelines for former HaRD CCG locality
Gluten Free Prescribing Guidelines for former HRW CCG locality
Gluten Free Prescribing Guidelines for former ScR CCG locality
For queries and/or further information relating to the prescribing of Gluten Free foods please contact the North Yorkshire and York Medicines Management Team via: hnyicb-ny.rxline@nhs.net
Vitamin D treatment guidelines
Click here for the current guidelines for North Yorkshire and York (APC approved Dec 2023)
Devices
Click here for the North Yorkshire and York APC commissioning position on Medical Devices. Approved October 2023.
Osteoporosis Guidelines
Click here for the North Yorkshire and York APC Osteoporosis Guidelines Flow Chart identifying patients at risk. Approved Feb 2024.
Prescribing intervals
Humber and North Yorkshire ICB does not have a formal policy on repeat prescription quantities that should be issued to patients but has some written guidance for prescribers which gives some points to consider including clinical and safety reasons for prescribing shorter of longer durations. The guidance can be found here.
Travel
Vaccines
Under construction - documents to follow
Patients living outside the UK: guidance for GP practices and individuals
GPs have a responsibility to monitor a patient for whom they are providing healthcare or prescribing medicines.
When a patient registered with a GP practice in the Vale of York or North Yorkshire travels abroad, provision of medicines for the treatment of existing long-term conditions may be provided at NHS expense for up to three months.
If a patient is travelling abroad for longer than three months, they are expected to arrange for an alternative supply of medicine in their location. Most medicines are available in most countries, so they are likely to be able to access a continuing supply for long-term conditions.
Read the North Yorkshire CCG guidance here
Swallowing difficulties
Useful resources:
- Top tips and techniques to help conquer swallowing tablets - information for patients from Leeds Children's Hospital. Click here
- Swallowing Difficulties website for Health Care Professionals. Click here
- mgp guidance - Medication management of patients with nasogastric (NG), percutaneous endoscopic gastrostomy (PEG), or other enteral feeding tubes. Click here
- SPS has produced this very useful and practical step by step guide with linked guidance to support decision making when prescribing or advising on the administration of medication for adults with swallowing difficulties. Click here
NEWT Guidelines online: users need to log in to access the full content; GPs and members of Practice and PCN pharmacy teams in North Yorkshire can request the password by emailing: hnyicb-ny.rxline@nhs.net
* Please note that a new NEWT password was issued on the 1st June 2024
Falsified Medicines Directive (FMD)
For an explanation, click here
GOV.UK Guidance - Implementing the Falsified Medicines Directive: Safety Features
Gender Identity Services
Leeds and York Partnership NHS Foundation Trust click here for the Gender Identity Service website, scroll down the page and open Information for GPs on hormone prescribing for information on prescribing for this service.
Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust click here for the Northern Region Gender Dysphoria Service General Guidelines for the use of Hormone Treatment in Gender Dysphoria.
Recording non-practice medications prescribed by other parties (not the GP) e.g. Red drugs/Hospital only drugs on to GP clinical systems
There are several medications which are prescribed and/or supplied directly to the patient by other parties outside of the GP practice. Typically these include specialist drugs prescribed by secondary or tertiary care only, including RED drugs or drugs used in addiction/alcohol services. This poses a challenge to primary care to ensure that all clinical staff are aware of the patient’s current medication prescribed elsewhere.
When GP practices receive a patient’s discharge note from an alternative care setting, information on any prescribed medications should be added to their GP practice record. Instructions from NHS Digital on how to do this for both SystmOne and EMIS Web can be found here
STOMP
Stopping over medication of people with a learning disability, autism or both with psychotropic medicines.
For links to various resources - click here
Tees, Esk and Wear Valleys (TEWV) STOMP medication review pathway - click here
NHS England STOMP professional resources website - click here
Drug monitoring
Click here for useful guidance from the Specialist Pharmacy Service (SPS) on the monitoring required for a number of drugs, listed alphabetically.
At the top of the page select the stage of treatment to display the monitoring required:
- before starting,
- after started or dose changed,
- continued until stable, or
- ongoing once stable
Using emollients with oxygen
For information and guidance on using emollients on patients who are also prescribed oxygen click here
Wound Care
Harrogate locality only: HDFT Wound Dressing Guideline
For a number of resources relating to:
- Hypertension
- Lipids
- Atrial fibrillation
- Heart failure
Please see here:
Cardiovascular disease (CVD)
Diabetes is a long-term condition which requires lifelong management. There are two main types – type 1 diabetes and type 2 diabetes.
People with diabetes are at risk of developing complications, for example with their feet. Untreated, these problems can lead to foot ulcer, infections and even (at worst) amputations. However, most foot problems are preventable with good, regular foot care.
For further information, visit Diabetes UK.
Psychological support
- Diabetes UK have added new webpages to provide lots of information about how diabetes can effect emotional wellbeing, and what can help.
- Diabetes UK have helpline staff on hand if you need to talk Call: 0345 123 2399 (Call rates apply check with your provider) Monday to Friday 9am to 6pm or via email: helpline@diabetes.org.uk.
- Diabetes UK have new information on prescription, “My emotions and diabetes,” provides easy to read information and individual action planning, helping people understand the impact of living with diabetes can have on their emotions and how to take steps to improve their emotional health.
See also
Humber Coast and Vale Partnership: support for patients to stay healthy and live well with a long-term condition - Diabetes
Useful resources
Humber and North Yorkshire IPMOC Algorithm for the management of Type 2 Diabetes - Nov 23
Humber and North Yorkshire ICB Continuous-Glucose-Monitoring-Policy
IPMOC approved Sept 2023: Humber and North Yorkshire Blood Glucose Meter Formulary
Medication review resources and tools
- Example letter to carer
- Example letter to patient
- Pharmacist clinical medication review checklist
- Meeting agenda for medication reviews undertaken in practices
The following websites and resources may be useful when carrying out a medication review:
- SPS - using-tools-to-support-medication-review . This page contains a selection of tools (some also listed below) that health care professionals may find helpful when undertaking medication review.
- NHS Scotland - Polypharmacy Guidance Seven Steps
- Anticholinergic Burden score calculator - acbclac.com
- NO TEARS medication review tool
- MEDSTOPPER
- NHS England - Stopping over medication of people with a learning disability, autism or both STOMP
- The Medicines Communication Charter - meandmymedicines.org.uk
- NICE - Patient Decision Aids
- Patient.co.uk - Multimorbidity
- The Health Foundation - The MAGIC programme
- Deprescribing.org
- NHS England - Frailty Toolkit
- NHS England - Frailty Resources
- STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high FALL risk)- Bulletin 300: Medication and falls | PrescQIPP C.I.C
- National Falls Prevention Co-ordination Group (NFPCG) endorsed by the RPS Medicines and Falls
- NICE - Polypharmacy and Multimorbidity Advice
- TEWV - Mental Health Conditions, Treatments and Medication
- PrescQIPP - IMPACT Tool (Apr 23)