Position Statement for prescribing malaria prevention medicines on the NHS for travel abroad
NHS Southwark CCG is committed to delivering best value by ensuring that we use our resources well. Therefore, NHS Southwark CCG no longer supports the routine prescribing of the following malaria prevention medicines on the NHS for travel abroad:
Atovaquone with Proguanil hydrochloride (Malarone®, Mafamoz®, Reprapog®)
Chloroquine phosphate (Avloclor®, Malarivon®)
Chloroquine phosphate with Proguanil hydrochloride (Avloclor/Paludrine®)
Chloroquine sulfate (Nivaquine®)
Proguanil hydrochloride (Paludrine®)
Guidance for prescribers
NHS patients are entitled to receive free advice on malaria prevention
Ensure patients are fully informed of the importance of appropriate malaria prevention in order to reduce the risk of disease
Patients should be advised about the importance of mosquito bed nets, suitable clothing and insect repellents such as DEET, to protect against being bitten
Remember the Public Health England ABCD of malaria prevention: (Aware of the risks; use Bite prevention; take Chemoprophylaxis (malaria tablets); seek early Diagnosis if they become unwell).
Information on which malaria prevention medicines are necessary or recommended for the areas your patients will be visiting is available from:
Travel Health Pro https://travelhealthpro.org.uk/countries
Fit forTravel www.fitfortravel.nhs.uk/advice.aspx
Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland 2
Patients should be advised to purchase or obtain sufficient prophylactic medicines to cover the period of travel, taking into account that malaria prevention medicines are commenced prior to travel, are taken whilst away and continued on return from travel.
Patients may purchase "Pharmacy only" malaria prevention medicines such as chloroquine (Avloclor ®), proguanil (Paludrine ®), chloroquine with proguanil (Avloclor/Paludrine ®) and atovaquone with proguanil (Maloff Protect ®) from a pharmacy.
Prescription only medicines for malaria prevention such as doxycycline,
Mefloquine (Lariam ®) and atovaquone with proguanil (Malarone ®, Mafamoz ®, Reprapog ®) must be prescribed on a private prescription.
Fees for private prescriptions
The NHS Standard General Medical Services Contract 2014 states that a GP may accept a fee for prescribing or providing drugs or medicines for malaria prevention.
The fee should be determined by the practice
Practices should give the patient written information on the dosing schedule proposed and the charges involved at the outset.
If a private prescription to obtain the malaria prevention medicines is being provided, patients should be advised to compare prices as there may be variation in the amount that individual pharmacies will charge to supply the medicines.
If a practice does not wish to provide a private service for the above mentioned malaria prevention medicines, patients should be advised that they may obtain advice and malaria prevention medicines from private travel clinics and community pharmacies.
Public Health England guidelines
Public Health England has developed practical guidelines for use by healthcare professionals advising travellers on malaria prevention but these may also be used by travellers who wish to read about options themselves.
Position Statement for prescribing preparations available to buy over the counter (OTC) for self-care
NHS Southwark CCG is committed to delivering best value by ensuring that we use our resources well. Therefore to help us to support the cost effective, evidence based use of medicines, NHS Southwark CCG no longer supports the routine prescribing on the NHS of medications for short term illnesses and minor conditions, and health supplements.
What treatments and preparations are included and why?
Pharmacy Only (P) purchased from a pharmacy and General Sales Lists (GSL) treatments that can be purchased from a pharmacy or other retail outlets often at a lower cost than would be incurred by the NHS on a prescription.
Self-limiting conditions that heal/resolve without medical intervention; and/or
Treatments that are used to treat a condition which lends itself to self-care, i.e. that the person suffering does not normally need to seek medical care or advice.
Examples of treatments available OTC which should no longer be routinely prescribed on the NHS in Southwark: (This list is not exhaustive)
Analgesics (painkillers) for short-term use
Herbal and complementary supplements
Anti-diarrhoeal medication for short term use (up to 72 hours)
Antifungal treatment for short term minor ailments
Laxatives for short term use (up to 72 hours
Cold sore treatment
Mouth ulcers treatment
Nappy rash treatment
Cough and cold remedies
Hay fever medicines
Ear wax removers
Topical acne treatment which is available over the counter
Eye lubricating products
Topical steroids for short term use (up to 1 week) for bites, stings or mild dermatitis
Head lice treatment and scabies treatment
Vitamins and minerals
Haemorrhoidal preparations for short term use (5-7 days)
Warts and verruca treatment
What general exclusions apply?
Medicines that can only be obtained with an NHS prescription - Prescription Only Medicines (POM)
Where an OTC medicine is outside of its marketing authorisation, also known as "off-label use" or "unlicensed use". For example when it is not licensed for use during pregnancy or where age or existing medical condition restrictions apply
Where an OTC medicine is being prescribed for a long-term (chronic) condition e.g. paracetamol regularly four times daily in osteoarthritis
Where there are safeguarding concerns, including, but not limited to, children, where there might be concerns that treatment might otherwise not be provided.
When patients access their medicines under the Pharmacy First scheme
Guidance for prescribers
General Medical Council (May 2013) guidance Good practice in prescribing and managing medicines and devices states the following:
‘Prescribing’ is used to describe many related activities, including supply of POMs, prescribing medicines, devices and dressings on the NHS and advising patients on the purchase of OTC medicines and other remedies
If a patient asks for a treatment that the doctor considers would not be of overall benefit to them, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. But they should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion.
Clinical judgment should be used when considering whether it is acceptable to ask patients to purchase their medication.
The Self Care Forum has produced numerous resources that can be used by healthcare professionals to help support people to self-care:
Patients should be advised that:
The NHS recommends everyone keeps a well-stocked medicine cabinet with self- care medicines.
Community pharmacists can offer advice on how to manage short term illnesses and minor conditions, when to seek medical advice, and what to take if they take other medications. They do not need to make an appointment to see the pharmacist, and many pharmacies are open late nights and at the weekend
If their problem is more serious and needs the attention of another healthcare professional such as your GP, the pharmacist will advise them on this.
Advice is also available from NHS Choices http://www.nhs.uk and NHS 111
Position Statement for prescribing selected vaccines on the NHS for travel abroad
NHS Southwark CCG is committed to delivering best value by ensuring that we use our resources well. Therefore, NHS Southwark CCG no longer supports the routine prescribing of the following vaccinations on the NHS for travel abroad:
Hepatitis B (single agent)
Japanese B encephalitis
Which vaccinations can be provided under the NHS?
NHS patients are entitled to receive free advice on travel vaccinations, however, only some vaccinations required for travel abroad are available on the NHS. These vaccinations are:
Combined hepatitis A and typhoid
Diphtheria and polio
These vaccinations for travel abroad are remunerated by the NHS as part of Additional Services under General Medical Services (GMS) and Personal Medical Services (PMS) contracts. No fee may be charged by the practice to a patient registered for NHS services with that practice for the process of administration of the vaccine or prescription writing.
Where a practice does not hold stock of these vaccines due to infrequent use, the practice may issue the patient with an NHS prescription to be dispensed at a pharmacy. If the patient usually pays for their prescriptions, the standard NHS prescription charge would apply.
Other vaccines such as hepatitis B, meningitis ACWY 135, yellow fever, Japanese B encephalitis, tick-borne encephalitis and rabies vaccine, for travel abroad, are not remunerated by the NHS as part of Additional Services under GMS and PMS contracts. These vaccines should not be prescribed on NHS prescription. Practices may charge a registered patient for travel vaccines not available on the NHS if requested for travel abroad.
Can the combined hepatitis A and hepatitis B vaccine be prescribed on the NHS?
The combined hepatitis A and hepatitis B vaccine is prescribable on the NHS because it contains hepatitis A. For the purposes of travel, because hepatitis B is not commissioned by the NHS as a travel vaccine, NHS Southwark CCG does not support the routine prescribing of this combination vaccine on NHS prescription. Patients requiring both hepatitis A and B for travel purposes should receive the vaccines separately, receiving the hepatitis A on NHS prescription and the hepatitis B on a private prescription. If the patient requests the combined vaccine this should not be prescribed on NHS prescription. The patient should be advised to obtain this privately.
Is there a cohort of patients with additional lifestyle risks and/or specific medical conditions who are travelling abroad who may still receive the hepatitis B monovalent vaccine under the NHS?
Patients with additional lifestyle risks and/or a medical condition that is listed in the Green Book (hepatitis B, chapter 18) are entitled to NHS provision of hepatitis B whether or not they are travelling. In these circumstances, hepatitis B vaccination should be given as part of their general medical care on the NHS.
If an NHS prescription for hepatitis B vaccination is issued for a patient where there is a lifestyle risk and/or medical condition in addition to travel requirement, it is recommended that a record of the reason for the issue is maintained.
NHS England and Public Health England have developed Patient Group Directions to support practices in administering the hepatitis B monovalent vaccine to this cohort of patients. Please refer to: https://www.england.nhs.uk/london/our-work/immunis-team/
Can a patient requesting vaccination for occupational health purposes receive these under the NHS?
It is the view of the British Medical Association’s General Practitioners Committee that there is no obligation under the GMS regulations for a practice to provide occupational health services for patients. That responsibility rests with the employer under Health and Safety Legislation, and in occupations where there is a risk to health from any form of work related infection, it is the employer’s duty to assess that risk and, if present, to protect the workforce. Further information is available here: https://www.bma.org.uk/advice/employment/gp-practices/service-provision/hepatitis-b-immunisations
Does this guidance affect the complete routine immunisation schedule?
This guidance does not change or affect the complete routine immunisation schedule.
For further information on the schedule and NHS England and Public Health England Patient Group Directions to support delivery of the schedule please refer to:
Guidance for prescribers
Ensure patients are fully informed of the importance of appropriate travel vaccination in order to reduce the risk of disease.
Information on which vaccinations are necessary or recommended for the areas your patients will be visiting is available from:
Travel Health Pro https://travelhealthpro.org.uk/countries
Fit forTravel www.fitfortravel.nhs.uk/advice.aspx
The patient may either be given a private prescription to obtain the vaccines, or they may be charged for stock purchased and held by the practice. An FP10 must not be used to provide these vaccines.
A charge may also be levied for the process of administration of the vaccine and private prescription writing. The level of charges should be determined by the practice.
If a vaccine is provided privately to a patient, the vaccine and administration costs may not be claimed back from the NHS
Practices should give the patient written information on the vaccination schedule proposed and the charges involved at the outset
If a private prescription to obtain the vaccines is being provided, patients should be advised to compare prices as there may be variation in the amount that individual pharmacies will charge to supply the vaccination.
There may be further charges incurred after vaccination depending on where the patient is travelling. These charges should be arranged privately and funded by patients and not the NHS.
If a practice does not wish to provide a private service for the above mentioned vaccines, patients should be advised that they may obtain advice and travel vaccinations from private travel clinics. Some community pharmacies also provide travel healthcare services.
New Immunisation Schedule for 2017
Click Here Immunisation Schedule 2017
London Clinical Senate’s Patient and Public Voice (PPV) Group Recruitment
The London Clinical Senate is recruiting new members to join its Patient and Public Voice (PPV) Group. This is an exciting opportunity for people who want to help improve health services in London.
The London Clinical Senate provides independent advice to commissioners and other bodies, supporting them to make the best decisions about healthcare for people in London. The role of the Clinical Senate’s PPV Group is to act as the ‘voice’ of patients, carers and the public. Its views inform the advice given by the Clinical Senate.
As a PPV member, you will represent patients and carers who use London’s health services. You will also use your knowledge and experience to improve the quality of healthcare and to challenge the thinking of healthcare professionals where necessary.
Further information about the role and how to apply can be found in the Application Information Pack and also on http://www.londonsenate.nhs.uk/patient-public-voice/ppv-recruitment-2017/ . The application deadline is 8 September 2017.
PPV Recruitment Advert
Kings College Hospital - 1st Floor
Monday to Friday from 8:45am - 9:45am
IMPORTANT INFORMATION REGARDING HEPATITIS B VACCINES
NHS England (London) would like to make you aware of a global shortage of monovalent hepatitis B containing vaccines impacting severely on UK supply of monovalent and combined hepatitis A/hepatitis B vaccine. This is due to intermittent manufacturing issues which have resulted in increased demand on all manufacturers’ supplies of vaccine. The vaccine shortages are likely to continue for the rest of this year.
In light of these supply issues, Public Health England (PHE) has drafted temporary advice on prioritisation of groups, on alternative vaccine use and on dose sparing options. The aim of the guidance is to preserve adult and paediatric monovalent hepatitis B vaccine stock for those at highest immediate need and with the greatest ability to benefit. Manufacturers have instituted ordering restrictions to help prioritisation and prevent stock from being rapidly exhausted. Manufacturers have also put in processes to allow exceptional requests for additional doses if there is a clear clinical and/or public health need either for an individual patient or as part of an outbreak response.
Please be aware that infants born to Hepatitis B infected mothers are the highest priority for post-exposure immunisation as they are at the greatest individual risk of infection, having been exposed to a substantial amount of infected blood during the process. Immunisation in these at-risk infants should not be delayed.
We have enclosed a link to Public Health England’s temporary vaccine recommendations during supply constraints for further information: https://www.gov.uk/government/publications/hepatitis-b-vaccine-recommendations-during-supply-constraints
Welcome to DMC Chadwick Road
Welcome to our surgery website where we hope you will quickly benefit from a user friendly layout and a wealth of information about our healthcare services. Find out when we’re open and what to do when we’re not, all from the comfort of your own home.
Please use the link above to read our newsletter.
We now have a free WIFI service for our patients. Next time you come into visit us, you can logon by searching for Chadwick Road Free WIFI.
Appointments Lost!: Patients have failed to attend booked appointments with various clinical team members - We would really appreciate notification as soon as possible to ensure other patients have the oppotunity to be offered cancellations.
This is not only a waste of doctors & nurses time but is very frustrating for other patients who are unable to obtain appointments. If you know you are not able to make it to your appointment please call as soon as possible. We can then offer the appointment to another patient in need.
Takes place every Tuesday between 09:30am and 12Noon at the Townley Road Clinic SE22 8SW.
The clinic is longer at Chadwick Road.
Please note: Immunisation and 6 week checks remain unchanged. These can booked here at DMC Chadwick Road by calling the surgery.
For further enquiries please contact the Health Visiting Team on 02030497481 or 02030497540
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National Association for Patient Participation (N.A.P.P) Newsletter
N.A.P.P Newsletter January 2017