Primary Care Clinical Effectiveness Bulletin
Edition No. 23: April and May 2013 -FINAL
Welcome to this digest of best practice relevant to primary care distributed to all GP practices in South West London. This information is collated each month from national and local sources, with hyperlinks to the more detailed guidance within each section – simply [control + click] within the sections to follow the links to websites.
Contents (Ctrl+Click to go straight to section)- South West London Effective Commissioning Initiative (SWLECI)
- NICE Clinical & Public Health Guidelines
- NICE Technology Appraisals (TAs)
- Other news
1. South West London Effective
Commissioning Initiative (ECI)
TheSW London Effective Commissioning Initiative(ECI),is driven by the need to ensure that NHS funded treatments are effective, evidence-based, provide value for money, and that access to them is equitable across the cluster. Please follow the link above for the 2013/14 ECI Policy Document.
2. NICE Clinical Guidelines & Public Health Guidelines
Social anxiety disorder (CG159)
A prompt diagnosis of social anxiety disorder is crucial in ensuring people access the most clinically and cost effective treatment, NICE says.While a range of effective psychological and pharmacological treatments exist for the disorder, many may not access them, and only half seek treatment. Social anxiety disorder is one of the most common anxiety disorders, with around one in ten people affected. It involves a persistent fear of one or more social situations, such as meeting new people, talking in meetings or in groups, working, eating or drinking while being observed, going to school, using public toilets, and public speaking. Although anxiety about these situations is common in the general population, people with social anxiety disorder worry excessively about them, avoid them and this has major consequences for their personal lives, education and in the workplace. Recommendations cover:
- Improving access to services
- Identification of adults with possible social anxiety disorder
- Initial treatment options for adults with social anxiety disorder
- Treatment for children and young people with social anxiety disorder
Feverish illness in children (CG160)
NICE has updated the traffic light system for predicting the risk of serious illness from fever in children under 5, and issued new advice on the use of paracetamol and ibuprofen. In the UK raised temperature is the most common reason for a child to be taken to the doctor and the second most common reason, after breathing difficulty, for an acute admission to hospital. As a general rule, in children, a temperature of over 37.5°C is a fever and most will settle by themselves but a few are caused by serious infections such as meningitis or pneumonia. Despite advances in healthcare, infections remain the leading cause of death in children under the age of 5 years in the UK. Key priorities for implementation include:
- Using the traffic light system to assess children for the presence or absence of symptoms and signs that can be used to predict the risk of serious illness.
- Recognise that children with tachycardia (defined using Advanced Paediatric Life Support (APLS) criteria) are in at least an intermediate-risk group for serious illness.
- Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose.
- Using paracetamol or ibuprofen
- only as long as the child appears distressed
- consider changing to the other agent if distress is not alleviated
- do not give both agents simultaneously
- only consider alternating agents if the distress persists or if it recurs before the next dose is due.
Implementation tools have been published to help GPs implement thisguideline including a clinical case scenario, on how ibuprofen and paracetamol should be used for children under 5 with a fever of unknown cause.
3. NICE Technology Assessments
NB: For detailed recommendations,please access via the links below.
Asthma (severe, persistent, patients aged 6+, adults) - omalizumab (review of TA133, TA201)(TA278)
NICE recommends omalizumab as possible additional treatment to standard asthma therapy for some people aged 6 years and over with severe persistent allergic asthma.
Vertebral fractures - vertebroplasty and kyphoplasty (TA279)
NICE recommends vertebroplasty and kyphoplasty (without stenting) as possible treatment options for some people with spinal compression fractures caused by osteoporosis.
Rheumatoid arthritis - abatacept (2nd line) (rapid review of TA234) (TA280)
NICE recommends abatacept taken with methotrexate as a possible treatment option for some adults with rheumatoid arthritis.
Gout - canakinumab (terminated appraisal) (TA281)
NICE is unable to recommend its use because no evidence submission was received from the manufacturer of the technology.
Idiopathic pulmonary fibrosis - pirfenidone (TA282)
NICE recommends pirfenidone as a possible treatment for some people with idiopathic pulmonary fibrosis.
Macular oedema (retinal vein occlusion) - ranibizumab (TA283)
NICE recommends ranibizumab as a possible treatment for some people who have sight problems because of macular oedema caused by retinal vein occlusion
Bevacizumab in combination with paclitaxel and carboplatin for first-line treatment of advanced ovarian cancer (TA284)
NICE does not recommend bevacizumab, given with paclitaxel and carboplatin, as first-line treatment for advanced ovarian cancer (including fallopian tube and primary peritoneal cancer).
Ovarian, fallopian tube and primary peritoneal cancer (recurrent advanced, platinum-sensitive or partially platinum-sensitive) - bevacizumab (TA285)
NICE does not recommend bevacizumab given with gemcitabine and carboplatin for treating adults with the first recurrence of platinum-sensitive advanced ovarian cancer (including fallopian tube or primary peritoneal cancer) that has not been previously treated with bevacizumab or other vascular endothelial growth factor inhibitors.
Schizophrenia or bipolar disorder - loxapine inhalation (terminated appraisal) (TA286)
NICE is unable to recommend the use in the NHS of loxapine inhalation for treating acute agitation and disturbed behaviours associated with schizophrenia and bipolar disorder because no evidence submission was received from the manufacturer of the technology.
For other NICE guidance please click on the titles below:
Public Health Guidance
Interventional Procedure Guidance
Diagnostic Guidance
Medical Technologies Guidance
Quality Standards
4. Other news
NICE Support for commissioning helps commissioners to work with, clinicians and managers to commission high-quality evidence-based care to improve health and social care outcomes. Recent NICE commissioning guides include:
Supporting the commissioning of anticoagulation therapy for adults advises on commissioning for anticoagulation therapy for adults with atrial fibrillation, venous thromboembolism (VTE) and other conditions such as prosthetic heart valves and cardiomyopathy. This includes service model examples, and will help commissioners achieve the outcomes set out in the NHS, Public Health and Adult Social Care Outcomes Frameworks, as well as achieving improvement areas in the Clinical Commissioning Group outcomes indicator set.
Commissioning health and social care for people with dementiaguide aims to help improve the commissioning of health and social care support for people with the condition and for their carers. The guide aims to ensure more people with dementia receive an early diagnosis and can access the care and support that they and their carers need to live well and independently.
Practical support for general practice
NICE provide a collection of resources to enable general practice professionals toimprove outcomes for their patients by ensuring that their practice is up to date with current recommendations from NICE on clinical practice, public health, social care and support for GP led commissioning.
NICE expands into social care
NICE’s first quality standards for social care will help support people with dementia to live well, and improve the health and wellbeing of looked-after children and young people.
New Clinical Knowledge Summaries
NICE launches new version of the Clinical Knowledge Summaries (CKS)
’Eyes on Evidence’ (NHS Evidence)
This monthly newsletter covers major new evidence as it emerges, with an explanation about what it means for current practice.
New Evidence Updateson NICE guidance
Guidance is continually under review in the light of new scientific evidence.
First set of NICE public health quality standards revealed
NICE's quality standards programme will be substantially broadened to cover topics affecting public health. In his keynote speech at the NICE annual conference 2013, Lord Howe said that NICE will work with experts from Public Health England to initially develop three new public health quality standards. The standards will cover reducing tobacco use in the community, preventing harmful alcohol use, and strategies to prevent obesity in adults and children.
Have your say!
We welcome your comments and suggestions regarding this regular publication. Please contact any member of the editorial team. Previous editions of this Bulletin can be found at the SW London Public Health Network.
Editorial Team:
Tracy Steadman, Public Health
Alastair Johnston, Public Health
Usman Khan, Public Health Richmond,
Livia Royle, Public Health Kingston
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