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. South West London Effective
Commissioning Initiative (SWLECI)
2. Locally approved Guidelines and Care
Pathways
3. NICE Clinical & Public Health
Guidelines
4. NICE Technology Appraisals and
Other Guidance
5. Other News and Clinical Effectiveness
information sources
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 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.
SW London Primary Care Clinical Effectiveness
Bulletin
Wandsworth Issue No. 27: January – February 2014
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)
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.
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.
4. NICE Technology Appraisals and
Other Guidance
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,
TA304 Arthritis of the hip (end
Feb
stage) - hip replacement
2014
(total) and resurfacing
arthroplasty (Review of TA2,
TA44)
This table lists TAs published in January &
February
2014.
NB:
For
detailed
recommendations, please access via the
hyperlinks below.
TA303 Multiple sclerosis (relapsing) - Jan
teriflunomide
2014
SW London Primary Care Clinical Effectiveness
Bulletin
Wandsworth Issue No. 27: January – February 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 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.
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