Monthly Archives: November 2017

Plea as temperatures drop and pressure on the NHS increases

People in the North East and Cumbria are being encouraged to take care of themselves as temperatures drop and pressure on the NHS increases.

More than three and a half million people across the country visit A&E departments every year for self-treatable conditions, such as stomach complaints, colds, flu and colic.

Good self-care is about keeping fit and healthy and ensuring medicine cabinets and first aid kits are well stocked. Prescriptions should also be collected in advance of bank holidays over the winter period.

In addition, before visiting A&E, people are being asked to consider whether there is a service better suited to their health needs, such as seeing their GP or a local pharmacist, or calling NHS 111.

NHS England’s Medical Director for Cumbria and the North East, Professor Chris Gray, said, “Our NHS staff work extremely hard around the clock to provide the best possible care for people. At this time of year they are under significant pressure. We all have a responsibility to use our NHS services wisely and to help ensure that those who really need urgent and emergency care in A&E departments can access that care.

“Pharmacists, for example, are highly qualified health care professionals who offer expert, confidential advice and treatment for minor health problems. Many of our pharmacies are in accessible locations, such as supermarkets and are open during evenings and over weekends. Importantly, most have a confidential room where people can discuss their medical needs in private.”

NHS Choices website is a trusted source of health related advice and information. Services can be ‘looked up’ by simply selecting the service needed and doing a postcode search.

Advice for parents and carers is also available on the free NHS child health app. The app has been developed by doctors, health visitors and pharmacists and can be downloaded from Google Play or Apple’s App Store.

Dr Neil O’Brien, Chief Clinical Officer at NHS North Durham CCG, said, “Self-care is about understanding when you can look after yourself, when a pharmacist can help and when to get advice from your GP or another health professional.

“We know how worrying it can be when a child isn’t well, especially when they are very young. The child health app is an excellent source of information and advice at peoples’ fingertips. It can help you recognise when your child is ill and gives guidance on when and where to seek further treatment. I encourage parents and carers to download the app today – you never know when you might need it!

“I urge people to please take time to think about how you can look after yourself this winter and if you do need health care, to consider which service is best suited to your health need. We can all do our bit to help relieve the pressure on A&E.”

The child health app is part of the NHS awareness and education ‘plasticine people’ campaign, which has been launched this week, in Cumbria and the North East, to help influence the decisions people make about which health service to use and to improve patient flow and experience across the health system in the region.

Right place, first time!

A new process aimed at getting patients seen in the right place, first time is being introduced across the CCG area from 1 November 2017. The Rapid Specialist Opinion (RSO) process will support GPs to access a specialist opinion to determine the most appropriate next steps in the patients care. Consultants and GPs with a specialist interest are looking closely at some hospital referrals to see whether patients require a hospital appointment, or whether their treatment can be delivered by their local GP practice, with specialist support.

This is consistent with the CCG’s responsibility to make the best use of resources and is in the best interest of patients for them to be seen in the right place first time, ensuring hospital appointments are used by those patients who really need them.

Read more at accessing care and treatment.

Doctors face legal action to prescribe cheap, safe and effective sight loss drug

  • Cheaper drug could release more than £13.5m a year within the next five years for other services
  • GMC guidance is deterring doctors from prescribing cheaper alternative
  • CCG Chief says drug companies should not be able to restrict patient choice

Doctors in the north east of England face legal action from two of the world’s largest pharmaceutical companies for offering patients with a serious eye condition the choice of a safe, effective but much cheaper drug, reports The BMJ today.

Prescribing the cheaper drug could save the region’s NHS up to £13.5m a year within the next five years. But drug companies Bayer and Novartis are threatening legal action, claiming it would breach a patient’s legal right to an approved drug.

Some estimates suggest that a switch to bevacizumab for relevant eye conditions could save the NHS around £500 million per year.

Lucentis (ranibizumab) and aflibercept (Eylea) are licensed to treat wet age related macular degeneration (AMD) – a leading cause of blindness among older patients. Avastin (bevacizumab), is not licensed for wet AMD, but several publicly funded trials have shown that it is as safe and effective as aflibercept and ranibizumab.

Patients in the region will be told they could have ranibizumab and aflibercept if they would rather. They will also be told about how much cheaper bevacizumab is and the cost savings to the NHS.

However, both Bayer and Novartis spokespeople say that using unlicensed medicines instead of a licensed NICE approved option undermines the regulatory framework and NHS constitution. “Bayer feels it has to act to challenge the decision taken by these CCGs,” a Bayer spokesperson said.

Allowing doctors to offer bevacizumab as the preferred treatment could save hundreds of millions of pounds every year that the NHS could re-invest in other frontline services. But prescribing an off-label drug goes against GMC prescribing guidance.

It is this guidance that doctors say has deterred them from prescribing bevacizumab despite the evidence of its efficacy and safety, and the financial strain on the NHS. Andrew Lotery, Professor of ophthalmology at Southampton University told The BMJ: “It’s purely the regulatory framework that is stopping bevacizumab’s widespread use in the NHS.”

Back in 2015, The BMJ questioned the interpretation of European law that led to  the GMC’s stance. The advice appeared at odds with clinical practice in other European countries.

In 2014, Roche and Novartis were fined €180m by the European Court of Justice for allegedly colluding to prevent the use of bevacizumab by exaggerating the risks of using it to treat wet AMD and portraying ranibizumab as safer. The companies have challenged this at the European Court of Justice (ECJ).

But a recent opinion by a senior adviser to the ECJ suggests that off label drugs can be considered in place of licensed drugs for various reasons and this includes their price.

Faced with this news, the GMC said it is “sympathetic to the frustrations of doctors and organisations seeking to use resources effectively”.

Assistant Director of Standards and Ethics Mary Agnew said: “We hope that some sort of licensing solution for drugs such as Avastin may be forthcoming, or alternatively that the situation is clarified in the courts to give doctors more assurance about when they can prescribe this drug safely and within the law.”

Professor Lotery says his eye unit is experiencing “extreme pressure” due to a lack of capacity, as are other hospital eye services across the country. “Savings made by using bevacizumab should be reinvested into the hospital eye service to build capacity to deliver sight saving treatment for age-related macular degeneration,” he argues.

In an accompanying commentary, Dr David Hambleton, Chief Officer at South Tyneside Clinical Commissioning Group (CCG), says offering patients the choice of bevacizumab could save the region’s NHS up to £13.5m a year within the next five years, helping it to fund important medical treatment in other areas.

He argues that pharmaceutical companies “should not dictate which drugs are available to NHS patients. The choice between three clinically effective drugs should be one for NHS clinicians and patients to make together.”

He is confident that EU drug marketing laws do not allow drug companies to restrict the ability of the NHS to offer patients a choice, and that the CCGs are acting lawfully.

“Clinical safety and effectiveness are paramount but, as the legal guardians of finite NHS resources, we commissioners also have a duty to act efficiently, effectively and economically,” he writes. “Difficult choices are having to be made about the NHS to ensure safety and sustainability – this is one choice that is morally and ethically clear.”

Briefing use of Avastin for wAMD

NHS Avastin leaflet