722 Prince of Wales RoadDarnall

SheffieldS9 4EU

Email: garybarnfield@nhs.net

Dear Colleague, Mar 2019

Re: NHS Sheffield CCG QIPP Programme 2019-20

I am writing to share the detail of the Sheffield CCG Medicines Optimisation Team QIPP programme for 2019-20. We continue to work towards achieving maximum efficiencies and best value prescribing practice for the people of Sheffield. As I am sure you can appreciate, achieving this aim is becoming more challenging each year.

Below are the main areas that Sheffield CCG is currently intending to review as part of this programme of work however as you will understand this focus may change if substantial efficiencies are brought to our attention in year. Any changes will be communicated to you if and when they become evident.

Workstream

Blood Glucose Test Strips - TEE2® test strips are approved as Sheffield Formulary blood glucose testing strips of choice where appropriate for diabetics with a clinical need for self-monitoring of blood glucose (SMBG)

Buprenorphine Patches – Switching where appropriate to Butec

Colecal & calc- Calci-D® is the Sheffield formulary choice if a chewable calcium and vitamin D preparation is indicated on prescription. Patients over the age of 50 will be switched from Adcal D3® chewable tablets or Calcichew-D3 Forte® or (generic equivalents)

Dipyridamole - Switching patients with a diagnosis of ischaemic stroke or TIA from the combination of aspirin and dipyridamole to monotherapy with clopidogrel:

Current supply issues with dipyridamole: it will allow patients to continue with appropriate treatment for ischaemic stroke or TIA

Medication will be prescribed in line with NICE guideline and local guideline Patient will need to take less tablets (1 vs usually 3 per day) Clopidogrel is generally better tolerated than dipyridamole with less associated headache A cost saving will be achieved

Fentanyl patches - Switch from generic fentanyl TD (+ Durogesic TD) to Sheffield Formulary choice Mezolar®

Galantamine – Switching to Galzemic

Glucosamine/Chondroitin/Rubefacients - NICE does not recommend glucosamine, chrondroitin or rubefacients are prescribed to treat osteoarthritis. Glucosamine, chrondroitin and rubefacients are also included in the NHS England list of items which should not be routinely prescribed in primary care due to low clinical effectiveness and are included in the Sheffield STOP list and patients should be advised to purchase these items OTC if they wish to use them.Methylphenidate - Delmosart XL is cheaper branded generic which is bioequivalent to Concerta XL

Chair: Dr Tim Moorhead Accountable Officer: Maddy Ruff

Metformin - Switching metformin prolonged release 500mg, 750mg and 1000mg tablets including Glucophage and Sukkarto to Yaltormin Prolonged Release Tablets

Morphine - Switch from generic morphine MR (+ MST Continus®) to Sheffield Formulary choice Zomorph®

Pen needles - Switching appropriate pen needles to formulary choice which is to Carepoint or BD Viva

Quetiapine - Switch to Sondate XL

Rivastigmine - Switch to Alzest

Salbutamol tabs - Potential deprescribing of these or switching to syrup

Salmeterol - Soltel® CFC free 25mcg MDI provides a cost-effective branded generic alternative to Serevent Evohaler® or generic salmeterol MDI inhalers

Tiotropium - Patients over 18 years of age who receive a prescription for Tiotropium (Spiriva®) 18 microgram inhalation powder can have an alternative brand Tiotropium ( Braltus®) 10microgram inhalation powder with Zonda® Inhaler

Tramadol M/R – Switch to Tramulief

Vitamin B - There is only one indication, other than medically diagnosed deficiency where the prescribing of this medication is clinically appropriate (refeeding syndrome). Stopping prescribing for other indications would result in a cost saving and would ensure we are complying with national guidance from NHS England (NHSE)

We intend to roll the majority of this programme out from April to June 2019

As part of the roll out the team will be asked to discuss the changes with local community pharmacies so any stock adjustments can be taken into consideration. Community pharmacy colleagues’ support in helping patients manage these changes will help to optimise medicines use in Sheffield.

If you require any additional information or want to discuss any of the areas in more detail please contact me as above

Yours sincerely

Gary Barnfield

Deputy Director of Medicines Optimisation (AHPs)NHS Sheffield Clinical Commissioning Group