Primary Care Clinical Effectiveness Bulletin
Edition no: 13 - February 2012
Welcome to your South West London digest of
best practice relevant to primary care. This
information is collated each month from
national and local sources, with hyperlinks to
the more detailed guidance – simply [control +
click] to follow the link to the website.
Cataract surgery (as from 1st April 2012)
The PCT will only fund elective cataract
surgery where the following apply:
The best corrected visual acuity is 6/9 or
worse in either the first or second eye.
AND
The patient has impairment in lifestyle such
as substantial effect on activities of daily
living, leisure activities, and risk of falls.
Contents (Ctrl+Click on section titles)
1. South West London Effective
Commissioning Initiative (SWLECI)  Cataract surgery
 Individual Funding Requests for ECI
procedures
2. NICE Clinical Guideline & Quality
Standard on patient experience
3. Wandsworth Guidelines
Prescribing guidelines recently approved
by CEMMaG
4. NICE Technology Appraisals
 Exenatide for Type 2 diabetes
 Tocilizumab for rheumatoid arthritis
 Immunotherapy pharmalgen for venom
anaphylaxis
5. Other news
 Clinical case scenarios for self harm and
epilepsy in children
 ‘Help with spotting a sick child’ website
OR
Surgery is indicated for management of
ocular co-morbidities such as control of
glaucoma, view of diabetic retinopathy etc.
OR
Patients with cataract having visual acuity
better than 6/9 where there is a clear clinical
indication or symptoms affecting lifestyle. For
example, the patient with a visual acuity of
6/6 and symptomatic posterior subcapsular
cataract, affecting activities of daily living and
driving.
2. Clinical Guidelines & Quality Standards
Patient experience in adult NHS services
(CG138)
1. South West London Effective
Commissioning Initiative
This guidance promotes person-centred care
that takes into account a patient's needs,
concerns and preferences. It underlines the
significance of the entire patient experience
within the NHS, ensuring people are treated
with compassion, dignity and respect within a
clean, safe and well-managed environment.
The SW London Effective Commissioning
Initiative (ECI), driven by the need to ensure
that NHS funded treatments are effective and
evidence-based and provide value for money,
and that access to them is equitable across
the cluster. This months featured criteria are
from the recently finalised 2012/13 ECI list
which will be available from 1st April.
It acknowledges the value patients place on
healthcare professionals acknowledging their
individuality and the unique way in which each
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Primary Care Clinical Effectiveness Bulletin
Edition no: 13 - February 2012
person experiences a condition and its impact
on their life. The guidance makes a number of
recommendations including:
3. Wandsworth Guidelines
The following primary care prescribing
guidelines have been approved recently by the
Wandsworth
Clinical
Effectiveness
and
Medicines Management Group (CEMMaG):
1. Primary Care Protocol for GLP-1
mimetics: exenatide and liraglutide
2. Medicines Management of COPD
3. Ivabradine for chronic heart failure
The latest versions of all Wandsworth
approved prescribing guidelines can be
accessed primary care prescribing pages of the
SW London Public Health Network website.
 Develop an understanding of the patient as
an individual, including how the condition
affects the person, and how the person's
circumstances and experiences affect their
condition and treatment.
 Ensure that the patient's personal needs (for
example, relating to continence, personal
hygiene and comfort) are regularly
reviewed and addressed.
 Regularly ask patients who are unable to
manage their personal needs what help
they need.
 Address their needs at the time of asking
and ensure maximum privacy
4. NICE Technology Appraisals
Diabetes (type 2) - exenatide (prolonged
release) (TA248)
Patient experience in adult NHS services
– Quality Standard
NICE has approved the use of exenatide in
triple therapy regimens for patients with type
2 diabetes if they are struggling to control
their blood glucose levels or if they remain
inadequate, defined as an HbA1c of 7.5 per
cent or above, or other higher level as agreed
with the individual.
The new quality standard for improving the
quality of patient experience includes:
 Ensuring that patients are given the
opportunity to discuss their health beliefs,
concerns and preferences in order to
individualise their care.
 That patients have their physical needs
(such as nutrition, hydration, personal
hygiene and pain relief) and psychological
concerns (such as fear and anxiety)
assessed.
 That patients are made aware that they
have the right to choose, accept or decline
treatment and these decisions are
respected and supported.
Eligible patients should have:
 a body mass index (BMI) of 35kg/m2 or
higher in those of European family origin
and specific psychological or medical
problems associated with high body
weight, or
 a BMI below 35 kg/m2 and therapy with
insulin would have significant occupational
implications or weight loss would benefit
other
significant
obesity-related
comorbidities.
To deliver the best possible experience for
patients who use NHS services, high quality
care should be clinically effective and safe.
This quality standard and accompanying
clinical guidance aim to ensure that patients
have an excellent experience of care from the
NHS.
Treatment with prolonged-release exenatide
in a triple therapy regimen should only be
continued if a beneficial metabolic response
has been shown.
Exenatide can also be offered to some
patients in dual therapy regimens, in
combination
with
metformin
or
a
sulphonylurea, but only if the patient is
intolerant of either metformin or a
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Primary Care Clinical Effectiveness Bulletin
Edition no: 13 - February 2012
sulphonylurea, or treatment with metformin or
a sulphonylurea is contraindicated.
common conditions managed in primary care.
See new and updated topics.
Rheumatoid arthritis - tocilizumab
TA247
’Eyes on Evidence’ (NHS Evidence)
This guidance is a rapid review of the 2010
guidance, TA198, following a new patient
access scheme which the manufacturer has
agreed with the Department of Health.
Is a monthly newsletter which covers major
new evidence as it emerges, with an
explanation about what it means for current
practice.
The guidance sets out that in specific clinical
circumstances, and only if the manufacturer
provides tocilizumab with the discount agreed
as part of the patient access scheme,
tocilizumab is also now recommended
alongside
other
options
for
treating
rheumatoid arthritis at an earlier point in the
treatment pathway. This is where the disease
has responded inadequately to diseasemodifying anti-rheumatic drugs (DMARDs)
and tocilizumab is used as described for
tumour necrosis factor (TNF) inhibitor
treatments in NICE guidance TA130.
Clinical Case scenarios
NICE has produced new clinical case scenarios
on the management of self-harm and epilepsy
in children and adults to help improve
knowledge of our guidance.
Help with spotting a sick child
GPs and other healthcare professionals can
improve their skills in assessing acutely sick
children thanks to a new interactive website.
Spotting the Sick Child draws on NICE
guidance, and is commissioned by the
Department of Health and developed in
collaboration with academics and clinicians.
Venom anaphylaxis - immunotherapy
pharmalgen (TA246)
NICE recommend Pharmalgen (made by ALKAbelló) as a treatment option for IgEmediated bee and wasp venom allergy in
people who have had:
Editorial team
Thank you to those who have fed back on the
usefulness of this bulletin and made
suggestions for improvement. All comments
are helpful to continually improve it.
 a severe systemic reaction to bee or wasp
venom, or
 a moderate systemic reaction to bee or
wasp venom and who have one or more
of the following: raised baseline serum
tryptase, a high risk of future stings, or
are anxious about future stings.
Contact details for your borough leads are:
Dr. Usman Khan, Richmond Borough Team,
usman.khan@rtpct.nhs.uk
Tracy Steadman, Croydon Borough Team,
tracy.steadman@croydonpct.nhs.uk
Alastair Johnston, Wandsworth Borough Team,
alastair.johnston@wpct.nhs.uk
Livia Royle, Kingston Borough Team,
livia.royle@kpct.nhs.uk
Jacqueline Lindo, Sutton & Merton Borough
Team, Jacqueline.Lindo@swlondon.nhs.uk
Treatment with Pharmalgen should be
initiated and monitored in a specialist centre
experienced in venom immunotherapy.
5. Other News
PRODIGY (formerly CKS)
Is a reliable source of evidence-based
information and practical 'know how' about the
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