Primary Care Clinical Effectiveness Bulletin
Edition No. 17: July 2012
2. NICE Clinical Guidelines
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 within each
section – simply [control + click] within the
sections to follow the links to websites.
Spasticity in children and young people
(CG145)
For the first time, NICE has published a clinical
guideline on care for under-19s who have
spasticity; a condition that makes the muscles
more stiff and rigid than usual and can cause
spasms and severe problems with walking,
sitting, speech and swallowing. Nearly 24,000
children and young people under 19 years of
age are believed to have spasticity in England
and Wales. It is associated with nonprogressive brain disorders, such as cerebral
palsy, meningitis, stroke and severe brain
injury. The recommendations include:
 Prompt referral of children and young
people diagnosed with spasticity to
specialists.
 Prompt assessment by a physiotherapist
and, where necessary, an occupational
therapist.
 Considering treatment with continuous
pump-administered intrathecal baclofen
for pain or muscle spasms, problems with
posture, everyday activities and personal
care, despite trying
less invasive
treatments (e.g. physical therapies,
orthoses, oral drugs and Botox injections).
 Offering an individualised and goalfocused
management
programme
developed and implemented with the child
or young person and their parents or
carers
 Helping implement this management
programme
by
offering
relevant
information, regular opportunities for
discussion and advice on how their
different treatment options could affect
their potential to develop.
Contents (Ctrl+Click to go straight to section)
1. South West London Effective
Commissioning Initiative (SWLECI)

Hysteroscopy for abnormal uterine
bleeding
2. NICE Clinical Guidelines

Spasticity in children & young people
3. NICE Technology Appraisals and IPGs

Venous thromboembolism and
ulcerative colitis
4. Other news
1. South West London Effective
Commissioning Initiative (ECI)
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. This months featured
criteria are from the current 2012/13 ECI list.
Hysteroscopy for abnormal
bleeding will be funded:
uterine
If transvaginal ultrasound and Pipelle
endometrial aspirate are not possible
due to cervical stenosis or pain
OR
If transvaginal ultrasound demonstrates focal
pathology
OR
In women taking tamoxifen who experience
post-menopausal bleeding
NICE also encourages doctors who perform
the spinal operation selective dorsal rhizotomy
into a national research programme which
compares this surgery with other treatments.
This is so that more can be learnt about how
well the procedure can improve mobility in the
short and long term.
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Primary Care Clinical Effectiveness Bulletin
Edition No. 17: July 2012
3. NICE Technology Appraisals and IPGs
to the support for commissioners' tools for the
guidelines on:
Patient experience in adult NHS services
Service user experience in adult mental health
Venous thromboembolism (treatment and long
term secondary prevention) - rivaroxaban
(TA261)
Rivaroxaban is recommended as an option for
treating deep vein thrombosis and preventing
recurrent deep vein thrombosis and pulmonary
embolism after a diagnosis of acute deep vein
thrombosis in adults.
PRODIGY (formerly CKS)
Is a reliable source of evidence-based
information and practical 'know how' about the
common conditions managed in primary care.
See new and updated topics
Ulcerative colitis (moderate to severe, second
line) - adalimumab (terminated appraisal)
(TA262)
’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.
NICE is unable to recommend the use in the
NHS of adalimumab for the treatment of
moderate to severe ulcerative colitis because
no evidence submission was received from the
manufacturer or sponsor of the technology.
New Evidence Updates on NICE guidance
Guidance is continually under review in the
light of new scientific evidence. Recent
evidence updates have included constipation
in children and nocturnal enuresis.
Interventional Procedure Guidance
If you are interested in seeing the latest NICE
IPGs these can be accessed directly from the
NICE Website.
Practical support for general practice
NICE provide a collection of resources to
enable general practice professionals to
improve 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.
4. Other News
Help with identifying meningitis in children and
young people
NICE's latest quality standard on bacterial
meningitis in children and young people can
help spot early signs and symptoms of the
condition.
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. Contact
details for your borough leads are:
Identify patients at high risk of type 2 diabetes
GP practices should identify patients on their
register who are at high risk of developing
type 2 diabetes and refer them for lifestyle
interventions, as experts warn of a "diabetes
tsunami" engulfing the NHS.
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
Online
training
resources
for
patient
experience themes such as dignity, pain
management, communication and social
inclusion and equality, have now been added
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