SW London Primary Care Clinical Effectiveness Bulletin

Wandsworth Issue No. 27: January – February 2014

Welcome to this electronic digest of best practice relevant to primary care distributed to all GP practices in South West London. This information is collated 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 to section)
  1. SouthWest London Effective Commissioning Initiative (SWLECI)
  2. Locally approved Guidelines and Care Pathways
  3. NICE Clinical & Public Health Guidelines
  4. NICE Technology Appraisalsand OtherGuidance
  5. Other News and Clinical Effectiveness information sources

1. South West London Effective Commissioning Initiative (ECI)

TheSWLondon 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. This month we showcase another ECI topic:

Body contouring(Other skin excision for

contour e.g. buttock lift, thigh lift, arm lift

(brachioplasty)

The patient should be 18 or over at the time of application;

AND

At the time of the application the patient must have a BMI of equal to or below 27 kg/m2 and must have maintained a BMI in this range for at least 18 months;

(For apronectomy/abdominoplasty in respect of body contouring see criteria for apronectomy/adominoplasty);

AND

Have severe functional problems which may include:

  • Documented record of recurrent intertrigo beneath the skin folds that recurs or fails to respond despite appropriate conservative treatment for at least 6 months.
  • Severe difficulties with daily living i.e. ambulatory restrictions.

2. Locally approved Guidelines and Care Pathways

The following has been approved by Wandsworth Clinical Effectiveness and Medicines Management Group (CEMMaG) in February:

  • Medicines Management of Asthma: Guidelines for Primary Care

3. NICE Clinical Guidelines & Public Health Guidelines

Head injury (CG176)

NICE’s updated guidance on head injury stresses the importance of early detection and prompt treatment for both children and adults who have suffered trauma to the head to avoid potentially serious complications, including disability or death.

Osteoarthritis: Care and management in adults(CG175)

Exercise is a core treatment in managing osteoarthritis, according to this updated NICE guidance. It recommends that healthcare professionals offer advice on activity and exercise to all people with clinical osteoarthritis, as well as interventions to lose weight for those who are overweight or obese, advice on joint surgery, and on follow-up and review.Advice on the pharmacological management of osteoarthritis remains unchanged until the Medicines and Healthcare products Regulatory Agency (MHRA) reviews the use of drug treatments including paracetamol which will mean that all of the relevant painkillers can be looked at together.

Psychosis and schizophrenia in adults: treatment and management (CG178)

The guidance recommends that people considered to be at increased risk of developing psychosis should be offered cognitive behavioural therapy (CBT). Antipsychotic medication should not be offered to anyone at increased risk of developing psychosis, or with the aim of decreasing the risk of psychosis. The guidance recommends that clinicians should provide information and advice to patients about effective use of medication, identifying and managing symptoms, accessing mental health and other support services, coping with stress and other problems, what to do in a crisis and preventing relapse as well as setting personal recovery goals. Other recommendations cover:

  • Referral from primary care
  • Treatment options to prevent psychosis
  • First episode psychosis
  • Greater help and support to relatives and carers
  • Service users are offered support from people who have recovered from psychosis or schizophrenia.
  • Promoting recovery and possible future care

Domestic violence and abuse - how services can respond effectively(PH50)

This new guidance aims to help identify, prevent and reduce domestic violence and abuse by outlining how health services, social care and the organisations they work with can respond effectively to domestic violence and abuse. GPs and practice nurses should receive training so that they can recognise the signs of domestic violence and abuse and ensure that those affected are aware of the help and support available to them, says NICE.

Each year at least 1.2 million women and 784,000 men experience domestic violence and abuse in England and Wales. This can take the form of physical abuse, threats, emotional abuse, sexual assault or stalking by a partner, ex-partner or family member. It is more commonly inflicted on women by men, particularly true for severe and repeated violence and sexual assault. This is believed to be a conservative estimate given the degree of under-reporting. Recommendations include:

  • Information in waiting areas and other suitable places about the support on offer for those affected by domestic violence and abuse should be clearly displayed.
  • Training of frontline staff to recognise the indicators of domestic violence and abuse and encourage people to disclose their past or current experiences of such violence or abuse.
  • People's safety should be prioritised and regularly assessed to determine what type of service someone needs - immediately and in the longer term.
  • Those responsible for safeguarding children, commissioners and providers of specialist services for children and young people affected by domestic violence and abuse should address the emotional, psychological and physical harms arising from a child or young person being affected by domestic violence and abuse, as well as their safety. This includes the wider educational, behavioural and social effects.
  • Specific training should be provided for health and social care professionals in how to respond to domestic violence and abuse.

4. NICE Technology Appraisals and Other Guidance

This table lists TAs published in January & February 2014. NB: For detailed recommendations, please access via the hyperlinks below.

TA303 / Multiple sclerosis (relapsing) - teriflunomide / Jan 2014
TA304 / Arthritis of the hip (end stage) - hip replacement (total) and resurfacing arthroplasty (Review of TA2, TA44) / Feb 2014
TA305 / Macular oedema (central retinal vein occlusion) - aflibercept solution for injection / Feb 2014
TA306 / Lymphoma (non Hodgkin's, relapsed, refractory) - pixantrone monotherapy / Feb 2014

It is possible to access all previous NICE guidance by clicking on the hyperlinks below:

Clinical Guidelines

Public Health Guidance

Technology Appraisals

Interventional Procedure Guidance

Diagnostic Guidance

Medical Technologies Guidance

Quality Standards

5. Other News and Clinical Effectiveness information sources

Increasing GP involvement with NICE

GPs are being encouraged to become more involved in the work of NICE and will be offered greater reimbursement rates to help draw up guidance and standards….

Good practice guide on Patient Group Directions

NICE has produced good practice guidance on providing medicines without prescription under a Patient Group Direction (PGD). The guidance on PGDs has been developed to help individuals and organisations who are considering the need for developing, authorising, using and/or updating PGDs to ensure they are appropriate, legal and that relevant governance arrangements are in place within commissioning and provider organisations.

Minimum pricing for alcohol 'effectively targets harmful drinkers'

A minimum price per unit of alcohol, as recommended by NICE, effectively targets high-risk drinkers while having little impact on moderate drinkers, according to a new study. Introducing a minimum price per unit of alcohol is one of several public health measures recommended by NICE to tackle alcohol misuse.

Clinical Knowledge Summaries

Clinical Knowledge Summaries (CKS) service has been re-launched by NICE last year. Why not take a look?

’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 EvidenceUpdateson NICE guidance

Guidance is continually under review in the light of new scientific evidence.

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