OCCG Weekly Bulletin
Wednesday 16 December 2015
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Oxford University Hospitals
Directly Bookable Services
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IMPORTANT RECALL: Recent
Email from Circle Independent
Hospital in Reading –
8 December 2015
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Risk Management of Diabetic
Ketoacidosis during Treatment
with SGLT2 inhibitors
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December Pathology Newsletter
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Information Governance - New
Trial IG Toolkit Demonstration
Opportunity
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Last Call for Practice Manager
Training
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Planned Care News – London
Commissioning Team Survey
Clinical Policies & Procedures
Oxford University Hospitals Announce New Directly Bookable Services:
From Monday 14 December 2015, Oxford University Hospitals NHS Trust (OUHT) is offering
directly bookable appointments for:
 Physiotherapy Outpatients (East Oxford Health Centre)
 Respiratory Outpatients
GP practices can generate an appointment referral request with appropriate priority (urgent or
routine) for the service on the E-Referral System (CaB) and UBRN in the usual way. Read more
about the changes for the services here
Practices can view the complete list of Directly Bookable Services offered by Oxford University
Hospitals NHS Foundation Trust on the OCCG intranet at
http://occg.oxnet.nhs.uk/GeneralPractice/Pages/Directlybookableservices.aspx
IMPORTANT RECALL: Recent Email from Circle Independent Hospital in Reading 8 December 2015:
OCCG has been informed that an email has been sent to all Oxfordshire GPs from the GP Liaison
and Consultant Engagement Lead at Circle Independent Hospital in Reading. The email suggested
that a new proforma or ‘funding form’ needed to be completed before patients could proceed to
surgery with the provider.
This email has been sent to Oxfordshire GPs in error so please do ignore it. In addition, Circle
have been asked to retract this statement immediately.
Risk Management of Diabetic Ketoacidosis during Treatment:
Previously sent on 8 December to Practice Prescribing leads and Practice Managers to cascade to
all colleagues involved in care of type 2 diabetes patients.
Sodium-glucose co-transporter-2 (SGLT2) inhibitors (dapagliflozin, canagliflozin, empagliflozin)
have been associated with cases of diabetic ketoacidosis (DKA). In Oxfordshire these drugs are for
specialist diabetes consultant initiation only.
• Serious, sometimes life-threatening cases of diabetic ketoacidosis have been reported in
patients on SGLT2 inhibitor treatment (canagliflozin, dapagliflozin or empagliflozin) for
type 2 diabetes.
• In a number of these reports, the presentation of the condition was atypical with only
moderately increased blood glucose levels observed. Such atypical presentation of
diabetic ketoacidosis in patients with diabetes could delay diagnosis and treatment.
• Patients on SGLT2 inhibitors should be tested for ketones when they present with
symptoms of acidosis in order to prevent delayed diagnosis and patient management.
• Cases of diabetic ketoacidosis were also reported in patients with type 1 diabetes who
were given SGLT2 inhibitors. Prescribers are reminded that type 1 diabetes is not an
approved indication for this drug class.
Following the MHRA Drug Safety Update (June 2015) and Prescribing Points 24.5 (Sept 2015) a
local risk management plan has been adopted and implemented.
Risk Management Plan
1. Please click here to view the Patient Information Leaflet (PIL) which is also available on
DXS and has been distributed to community pharmacies.
 It advises patients of the DKA risk, and potential symptoms
 Action if symptomatic - contact GP practice or 111 (if out of hours)
2. Please click here to view the letter sent to Community and Primary Care Healthcare
Professionals which is also available on DXS and has been distributed to community
pharmacies.
 It summarises the risk, and prescribing information
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Provide PIL to all SGLT2i patients
Check blood ketones for any SGLT2i patient presenting with symptoms suggestive of
DKA regardless of blood glucose levels.
If blood ketone concentrations are 1 mmol/l or higher, contact the on call diabetes
service via the Oxford University Hospitals NHS Foundation Trust switchboard (via
01865741166) stating that you have a patient in whom you are concerned about
“SGLT2 inhibitor induced diabetic ketosis”. This service is available 24 hours per day.
All patients who are undergoing any surgery or procedure which will require them to
be nil by mouth should stop SGLT2 inhibitors 48 hours prior to the surgery. SGLT2
inhibitors can be restarted post operatively once oral intake is back to normal.
3. Letter to colleagues in secondary care, emergency admitting services, (Emergency
Department, Emergency Admission Units, Ambulance Service, Surgical Assessment Units,
anaesthetists, theatres, all medical consultants and medical registrars, pharmacy), Out of
Hours, NHS Pathways, Oxford Health, Community Hospitals.
 Summarising the risk, recommendations, and actions
It is recommended that all settings possess a blood ketone meter and in-date blood ketone test
strips to ensure timely diagnosis of DKA in SGLT2i patients. This is already recommended for type
1 and pregnant diabetes patients.
December Pathology Newsletter:
Please click here to view the December 2015 Pathology newsletter. This edition includes:
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Point of care testing (POCT)
Faecal Occult Blood testing
Metabolic Investigation of renal stones
Lab reporting of blood glucose and HbA1c
Other Information for Practices
Information Governance New Trial IG Toolkit Demonstration Opportunity:
HSCIC is developing a new Information Governance Toolkit for GPs, dentists, ophthalmic services
and care homes and is keen to hear your feedback on the trial alpha version of the new IG toolkit
assessment. If you would like a demo of the trial Toolkit at one of your Practice Manager
meetings, please contact HSCIC to register your interest via IG Secretariat.
Alternatively you can check out the trial version of the Toolkit at:
https://www.igt.hscic.gov.uk/igaf using your existing IG toolkit login. If you do not have login
details you can request a temporary login from the HSCIC Contact us page.
If you have any other IG queries, or would like assistance with IG training for your staff or would
like to book a support visit to help you complete your IG toolkit (the deadline for publishing V13 is
31st March 2016) please contact: Lindsay Blamires, Information Governance Manager for GP
Practices - lindsay.blamires@nhs.net
Last Call for Practice Manager Training:
Thames Valley and Wessex Leadership Academy has designed a five day programme specifically to
support Oxfordshire’s Practice Managers and Deputy Practice Managers to deliver more effective
leadership within their practices and to develop the skills and confidence to support the
transformation of primary care. It is fully funded by Thames Valley and Wessex Leadership
Academy and OCCG as part of support received from the Prime Ministers Challenge Fund.
This programme is a personalised approach to developing and strengthening leadership skills and
qualities which will give Practice Managers competence, confidence and motivation to build on
their existing skills.
It will provide managers with the opportunity to network not only with each other but with
system wide colleagues, build trust and as a result develop robust relationships outside of their
practices.
Dates and Venue Information:
Day 1: 14 January 2016, CMS, Oxford
Day 2: 9 February 2016, Oxford Science Park
Day 3: 15 March 2016, Oxford Science Park
Day 4: 14 April 2016, Oxford Science Park
Day 5: 17 May, Oxford Science Park
Please click here to read more about the leadership programme and to access the application
form. Please complete the application form and return to
enquiries@tvwleadershipacademy.nhs.uk by 24 December 2015.
If you are not accepted on this course, a further course is being organised for Oxfordshire to
commence in March 2016.
Planned Care News - London Commissioning Team Survey:
OCCG Commissions Optum to manage all referrals into London hospitals. Referrals to London
appear to have increased by 13% in the last two years. This increase is costing OCCG
additional money each year with no easily apparent benefit to the patients.
Optum is trying to understand the reasons for this shift and would be grateful if you could spend two-three
minutes completing a Survey Monkey – please follow the link https://www.surveymonkey.co.uk/r/RG2YHKW
We will let you know the outcome of this survey and would be delighted to provide more
information if so requested. Your contribution will help us to help OCCG improve services for
patients.
To give us your feedback please email: OCCG.GPbulletin@nhs.net
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