Somerset LMC Weekly Update Friday 25th October 2019
Date sent: Friday 25 October 2019
Sent to all Somerset GPs and Practice Managers This and previous updates are available here
- 'Of Mice and Men' the latest blog from LMC Chairman Dr Nick Bray
- Notes from the GP Board meeting
- Somerset Domestic Abuse Newsletter
- Directories of Services
- CAS (Central Alerting System) Alerts for Locums
- Live Attenuated Influenza Vaccine (LAIV)
- Dispensing Services Quality Scheme
- Creatinine Clearance vs eGFR For Dose Adjustment
Somerset Domestic Abuse Newsletter: Please find attached the latest edition with information on: specialist service commissioning update; a new service for young victims of domestic abuse (and other crimes); a new programme for perpetrators of domestic abuse and learning from domestic homicide reviews. Reading and reflecting on this could also contribute towards safeguarding CPD.
CAS (Central Alerting System) Alerts for Locums: If you are a locum and wish to receive the CAS Alerts from the MHRA please follow these instructions. You can register with them directly by sending an email to email@example.com, you will need to confirm the email address you would like alerts sent to, and to make clear in the email they are a locum. It may take a few days for them to respond but they will make contact with you.
Live Attenuated Influenza Vaccine (LAIV): The LMC is well aware of the difficulties that some practices are experiencing with problems with flu vaccine supplies and in particular with the LAIV for children. Paula Messenger our GPN rep thinks this is due to the school programme being expanded this year and getting priority for deliveries. SW Screening & Immunisation has produced a guide to help practices who need to prioritise patients (attached). For further information please contact firstname.lastname@example.org.
Dispensing Services Quality Scheme: The DSQS dispensing process audits led to a number of practices running in to trouble with their submissions last year and, as DSQS is “all or nothing”, being paid nothing for the work done any of its parts. Appeals to NHSR have been unsuccessful we regret. NHSE state that if the audit could have been done by a non dispensing practice it is not valid. Essentially then, for an audit think of what a pharmacist might do ONCE THEY HAVE RECEIVED THE SCRIPT. As a “conciliatory gesture” NHSE will review audit plans to check compliance. Also be aware they expect the submissions to be made early (by January 31st) to give them time to thoroughly check and respond, despite the stated DSQS requirement being March 31st. Guy Miles, LMC Dispensing Lead.
Creatinine Clearance vs eGFR For Dose Adjustment: Shaun Green reported this week that MHRA has clarified that doses for all patients prescribed DOACs (and certain other drugs) should be based upon their creatinine clearance (CrCl) using the Cockcroft-Gault formula rather than eGFR. The MHRA reports, “…, a recent cross-sectional study of data from 80 general practices in the UK…[found p]rescribing of drugs outside recommendations for use in patients with reduced kidney function was widespread for the eight drugs analysed. The prescribed dose was too high for kidney function in up to 40% of people aged 65 years and older, and up to 80% of people aged 85 years and older. Use of eGFR overestimated kidney function for up to 28% of those aged 65 years and older, and up to 58% of those aged 85 years and older.” Importantly this concerns direct-acting oral anticoagulants (DOACS) but also patients aged 75 and older, patients at extremes of muscle mass (BMI <18 kg/m2 or >40 kg/m2) and for medicines that are largely renally excreted and have a narrow therapeutic index, such as digoxin and sotalol. The CCG indicator uses eGFR as an audit measure because that data can be collected by the CCG eclipse live system as being recorded or not therefore SG needed to clarify the MHRA guidance on using CrCl to determine the safe DOAC dose. EMIS has a template for calculating CrCl. Deaths and harm from anti-coagulants warfarin and DOACs remain significant hence inclusion in the Somerset prescribing scorecard. CCG prescribing advisers can help with this work.
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