SW London Primary Care Clinical Effectiveness Bulletin
Edition No. 24: June and July 2013
Welcome to this 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.
AND
Acupuncture is used in conjunction with other
conventional treatments as part of a pain management
programme.
2. NICE Clinical Guidelines & Public
Health Guidelines
Falls (CG161)
This clinical guideline extends and replaces
NICE CG21 (2004), offers evidence-based
advice on preventing falls in older people, and
is applicable to primary, community and
secondary
care
services.
New
recommendations have been added about
preventing falls in older people during a
hospital stay. Falls cost the NHS an estimated
£2.3 billion a year. Nearly 209,000 falls were
reported in hospitals in England between 1
October 2011 and 30 September 2012. While
the majority (97%) of these people
experienced no or low harm, 90 patients died
because of their falls, and around 900 patients
experienced severe harm, such as hip
fractures and head injuries.
CONTENTS (Ctrl+Click to go to section)
1. South West London Effective
Commissioning Initiative (SWLECI)
2. NICE Clinical & Public Health
Guidelines
3. NICE Technology Appraisals and
Other Guidance
4. Other News and Clinical Effectiveness
information sources
1. South West London Effective
Commissioning Initiative (ECI)
Stroke rehabilitation (CG162)
This guideline offers evidence-based advice on
the care of adults and young people aged 16
years and older who have had a stroke with
continuing impairment, activity limitation or
participation restriction. It is aimed at
improving outcomes for people who have a
disability caused by a stroke. Thanks to
improvements in stroke care, each year most
of the 125,000 people in England, Wales and
Northern Ireland who have a stroke survive
but often at the cost of long-term disability.
NICE says people should be given targeted
therapy immediately after their stroke while
staying in a dedicated stroke inpatient unit, to
give them the opportunity to relearn old skills
or get new ones. When they return home,
they should receive care from a specialist
community stroke team.
The SW 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. This
month we showcase another ECI topic:
Acupuncture for Non-Specific Low Back Pain
(LBP). CCGs will only fund acupuncture if all of the
following criteria are met under the following
circumstances. A maximum of 10 sessions should
be offered over a period of 12 weeks as a one-off
treatment. Any additional treatments sessions will
require prior approval for funding. Acupuncture is
more effective if it is offered as an adjunct to other
conventional treatments. The treatment may be
offered in primary care. Criteria:
Idiopathic pulmonary fibrosis (CG163)
Idiopathic pulmonary fibrosis is a chronic,
progressive disease in which the lungs become
scarred. Each year around 4,000 adults in the
UK are diagnosed with IPF with only 20%
surviving for longer than five years. This
clinical guideline offers evidence-based advice
on the diagnosis and management of
LBP exists for more than 6 months
AND
LBP is severe as assessed by one of the grading
systems e.g. RMDQ
AND
All other conventional treatments such as exercise ,
pharmacological management, physiotherapy etc. have
been tried without any improvement in symptoms for a
minimum of 6 months
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SW London Primary Care Clinical Effectiveness Bulletin
Edition No. 24: June and July 2013
suspected idiopathic pulmonary fibrosis in
adults. It recommends that healthcare
professionals, particularly family doctors,
should be aware of the symptoms of this
disease (persistent cough, breathlessness and
respiratory crackles) to make sure patients
have access to chest X-rays and specialists so
a prompt diagnosis can be made. NICE also
recommends that as soon as a person is
diagnosed with IPF, they should be assessed
to see if their quality of life can be improved
though exercise and education.
Myocardial infarction with ST-segment
elevation (CG167)
This clinical guideline offers evidence-based
advice on the care and treatment of adults
with spontaneous onset of myocardial
infarction with ST-segment elevation. It is
applicable to ambulance, secondary care acute
and tertiary care services.
Varicose veins in the legs (CG168)
This clinical guideline offers evidence-based
advice on the diagnosis and management of
varicose veins in adults aged 18 years and
over, and is applicable to primary and
secondary care acute services. NICE has
recommended that some people with varicose
veins, such as those causing pain and ulcers,
should be offered alternatives to surgery
which are less invasive with a much speedier
recovery time. Many with varicose veins have
no symptoms, but for some they can cause
pain, aching or itching. Some can also develop
into leg ulcers, which can be difficult to heal
and can have a significant effect on their
quality of life.
Familial breast cancer (CG164)
This clinical guideline updates and replaces
NICE CG41. It offers evidence-based advice on
the classification and care of people at risk of
familial breast cancer. It also makes
recommendations
on
genetic
testing
thresholds, surveillance and risk reduction and
treatment strategies for people with a
diagnosis of breast cancer and a family history
of breast, ovarian or a related cancer. These
areas are not covered by Early and locally
advanced breast cancer (NICE CG80).
Hepatitis B (chronic) (CG165)
This covers the diagnosis and management of
Hepatitis B in adults, young people and
children. The NICE guideline covers: where
adults, children and young people with chronic
hepatitis B should be assessed; criteria for
offering antiviral treatment; the efficacy,
safety and cost effectiveness of currently
available treatments; selection of first-line
therapy; management of treatment failure or
drug resistance; whether there is a role for
combination therapy; when it is possible to
stop treatment; and monitoring for treatment
response, severity of fibrosis and development
of primary liver cancer. It updates, replaces
and/or incorporates the recommendations of
all previous NICE Technology Appraisals in
relation to drug treatments for Hep B.
Tobacco harm reduction (PH45)
The best way to quit smoking is to stop in one
step. However, there are other ways of
reducing the harm from smoking, even though
this may involve continued use of nicotine.
This guidance recommends harm-reduction
approaches which may or may not include
temporary or long-term use of licensed
nicotine-containing products, and is especially
aimed at those involved in providing advice
about stopping smoking, including those
working in smoking cessation services.
BMI and waist circumference - black,
Asian and minority ethnic groups (PH46)
NICE says Body Mass Index, a standard core
measure used to identify risk of conditions
such as type 2 diabetes or heart disease, may
be being applied wrongly to people from
black, Asian and other minority ethnic groups.
This guidance urges doctors, nurses and other
healthcare workers to follow its new guidance
to reduce the risks to people from minority
ethnic groups of diseases linked to lifestyle
and weight.
Ulcerative Colitis (CG166)
This clinical guideline offers evidence-based
advice on the care and treatment of adults,
children and young people with a diagnosis of
ulcerative colitis, and is applicable to
secondary and tertiary care services.
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SW London Primary Care Clinical Effectiveness Bulletin
Edition No. 24: June and July 2013
3. NICE Technology Appraisals and
Other Guidance
commissioning groups, the cornerstone of the
coalition government's NHS reforms. The
report focuses on six CCGs and reveals that
many GPs don't currently have a strong sense
of ownership of their local CCGs.
This table lists eight TAs published in June and
July 2013. NB: For detailed recommendations,
please access via the hyperlinks below.
TA287
Pulmonary embolism and recurrent
venous thromboembolism - rivaroxaban
(TA287)
Jun
2013
TA288
Type 2 diabetes - Dapagliflozin
combination therapy (TA288)
Jun
2013
TA289
Myelofibrosis (splenomegaly, symptoms) Jun
- ruxolitinib (TA289)
2013
TA290
Overactive bladder - mirabegron
(TA290)
Jun
2013
TA291
Gout (tophaceous, severe debilitating,
chronic) - pegloticase (TA291)
Jun
2013
TA292
Bipolar disorder (adolescents) aripiprazole (TA292)
Jul
2013
TA293
Thrombocytopenic purpura eltrombopag (TA293)
Jul
2013
TA294
Macular degeneration (wet age-related)
- aflibercept (1st line) (TA294)
Jul
2013
Co-ordinated care for people with
complex chronic conditions
This King’s Fund project involves an in-depth
examination of approaches to care coordination undertaken in primary care settings
in different parts of the UK. The project is
being undertaken with five case study sites
who have developed innovative primary carebased approaches to care co-ordination for
people with complex chronic conditions. Each
final case study includes an organogram
showing the care planning/co-ordination
process, patient stories and a video
highlighting the work of the team.
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.
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
New Evidence Updates on 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.
4. Other News and Clinical
Effectiveness information sources
Avoid drug treatment for children and
young people with moderate ADHD
NICE advises against using drugs as a firstline treatment for children and young people
with moderate attention deficit hyperactivity
disorder (ADHD), as latest figures suggest a
sharp rise in the number of drugs prescribed
for the condition….
Editorial Team:
Tracy Steadman, Public Health Croydon
Tracy.Steadman@croydon.gov.uk
Alastair Johnston, Public Health Wandsworth
AJohnston@wandsworth.gov.uk
Usman Khan, Public Health Richmond,
Usman.Khan@richmond.gov.uk
Livia Royle, Public Health Kingston
Livia.Royle@rbk.kingston.gov.uk
How are clinical commissioning groups
evolving?
This week the Kings Fund published new
research into the early development of clinical
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