Prescribing


COVID-19 virus and medicines

We have had a large number of queries about Covid-19 and medicines use. There are also a large number of resources published nationally to support and advise on issues around prescribing. This page aims to bring all these resources together. Where available we will link to national guidance and websites so that it reflects the most up to date information, if and when things change.

Practices are reminded to follow guidance which has been sent out regarding prescription quantity and duration. Stockpiling will exacerbate pressures on prescribed medicine stocks and may create shortages. The current advice is for patients to continue ordering prescriptions as usual (via phone or on-line), maintaining current prescription length.

Information on out-of-stock drugs is available here

NHS England coronavirus advice page is available here

  • NHSE are hosting speciality guides - available here

NICE rapid guidelines and evidence reviews are hosted here

NSAIDS - see link to CAS alert here

The Commission on Human Medicines’ Expert Working Group on coronavirus (COVID-19) has concluded that there is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and contracting or worsening of COVID-19 here 

RCGP Guidance on workload prioritisation during COVID-19 can be found here

The Medicines Management Team are currently supporting GP Practices in their response to COVID-19 out-break, rather than the 20/21 PAF indicators. A decision will be made in due course about the 20/21 PAF. Prescribers are advised to continue to practice good antibiotic stewardship and in particular to continue to adhere to NICE/PHE guidelines for antibiotic choice.

Some general evidence reviews are available here, these are not national recommendations but may help in the management of individual patients https://www.cebm.net/oxford-covid-19/

Third Party Ordering

The Medicines Management Team are keen that the benefits from GP Practices limiting third party ordering is not undone during the Covid-19 outbreak, but accept that community pharmacies ordering on behalf of certain “vulnerable” patients may be helpful/necessary at the current time.

Electronic Repeat Dispensing (eRD)

Primary care is being asked to increase the use of electronic Repeat dispensing (eRD) in suitable patients, as part of the pandemic response. NHSBSA are supporting this initiative by creating individual practice lists of NHS patient numbers identified from their dispensing information to be potentially suitable for eRD. Please note that eRD cannot be used currently for dispensing patients. The CCG’s Medicines Management team have produced a number of materials to support GP practices that are wanting to implement eRD here.

Note -  local pharmacies are integral to a successful implementation, so it is essential that GP practices discuss their plans with them for switching patients to eRD prior to switching.

Community pharmacy

  • Pharmacy opening – Pharmacies are currently dispensing three times their usual volume of prescriptions. In order to catch up they are currently allowed to close for certain hours every day, but are expected to be open to the public between 10am-12 noon and 2pm-4pm; 100 hours pharmacies should be open from 10am-12pm and 2pm-6pm. If they need to further reduce their core hours unexpectedly they need to let Area Team and DOS know.
  • Deliveries to patients - Deliveries from pharmacies is not a commissioned (funded) service. Many pharmacies do not have capacity to cope with the current unprecedented demand. Details on utilisation of the NHS Volunteer Army are still to be cascaded, but so far it is understood that the service is being used for ‘shielded’ patients.  

Yellow Card Reporting Site for Healthcare Products Used in Coronavirus (Covid-19)

  • The Medicines and Healthcare products Regulatory Agency (MHRA) has launched a dedicated Yellow Card reporting site for adverse reactions to healthcare products that are used in Coronavirus (COVID-19) treatment.  Healthcare professionals, patients and carers are asked to report all suspected side effects to medicines or medical device adverse incidents related to COVID-19 treatment. This also includes medicines that patients and healthcare professionals are using off-label to treat COVID-19. Reporting for clinical trials should be in line with the trial protocols. For more information go to https://coronavirus-yellowcard.mhra.gov.uk/

Drug / condition specific national / local advice;

Antimicrobial

Cardiovascular

  • ACEi / ARBs – Position statements have been released from the European Society of CardiologyBritish Cardiovascular SocietyBritish Society for Heart Failure and the Renal Association highlighting that there is no evidence to support an increased risk to patients taking ACEi or ARB. It is strongly recommended that all patients on these medications for systemic hypertension, heart failure, post-myocardial infarction or for those with diabetes and diabetic nephropathy should continue on their therapy.
  • Warfarin - A Tablet Press Extra on Switching warfarin to direct oral anticoagulants (DOACs) in patients with non-valvular AF and venous thromboembolism (DVT/PE) during the COVID-19 pandemic is available here

Central Nervous System

  • Substance misuse – See CGL letter on current service here
  • Valproate Pregnancy Prevention Programme: Temporary advice for management during coronavirus (COVID-19)

    Due to the ongoing COVID-19 pandemic and the reduced potential for face to face clinic appointments due to shielding, the MHRA has made some temporary amendments to the pregnancy prevention programme for valproate and valproic acid products.

    For initiation: In women or girls of childbearing potential a face to face consultation with a specialist is still required, except where the patient is shielding, where a remote consultation may be considered based on an individual risk assessment.

    For existing patients: No woman or girl should stop taking valproate without first discussing it with their doctor. Annual specialist reviews and completion of the Annual Risk Acknowledgement From (ARAF) should not be delayed but may take place via video (preferred) or telephone consultation.  The ARAF should be completed by the specialist with verbal confirmation that the patient understands the requirements of the pregnancy prevention programme. A copy of the ARAF should be sent to the patient and their GP with the patient asked to confirm receipt and understanding of the ARAF.   

     Pregnancy Testing: Where pregnancy testing is required and a face to face consultation is not possible, home pregnancy testing may be acceptable at the discretion of the specialist. The clinic should send a recommended pregnancy test and a spare to the patient. The result should be verified by taking a photograph and emailing the result or video conferencing.

    Additional information is available on the MHRA website  here

Endocrine

  • Patient leaflets with advice on Sick Day Rules are available Type I diabetesType 2 diabetes

  • Diabetes - A Tablet Press Extra on Diabetes and COVID-19 is available here 
  • The Primary Care Diabetes Society have published an at-a-glance factsheet for primary care with some important and useful information for primary care HCPs – including information around prescribing.  Please balance the recommendation that people have adequate supplies of medication with the risk of putting pressure on supply chains.
  • Adrenal Insufficiency - The Society for Endocrinology is advising a slightly different sick day rules for patients with adrenal insufficiency during the COVID-19 (Coronavirus) pandemic. To support this their web-page has very clear and easy to use guidance here

MSK, Dermatology and GI DMARD (Disease Modifying Anti-Rheumatic Drugs) prescribing

  • A Tablet Press Extra on the Prescribing and monitoring of Disease Modifying Anti-rheumatic Drugs (DMARDs) during the COVID – 19 Pandemic is available here.  This includes advice on patients where frequency of monitoring can safely be reduced to reduce the need for vulnerable patients to leave home and also relieve some pressure on primary care.  Some other areas are suggesting less frequent testing (eg every 4 or 6 months) in certain situations. It is anticipated that there will be national guidance. We will update our advice when this is available.

Nutrition

  • The Nutrition and Dietetic department is offering a fast track telephone service for patients that require oral nutritional support due to malnutrition here
  • A Tablet Press Extra on B12 Injection - what are the alternatives during Coronavirus? Is available here with a flow chart here

Palliative Care

  • NICE have produced guidance to provide  recommendations for managing COVID‑19 symptoms for patients in the community, including at the end of life. COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community – guidance NG163
  • Please see Local Palliative care section under Guidelines here
  • This updated CAS alert recommends a permanent move to morphine sulphate 10mg/ml injection as the opioid of choice, where clinically appropriate. This is in place of diamorphine 5mg and 10mg and is due to the continuing unpredictability of supply of diamorphine 5mg and 10mg injection. 
  • Morphine and diamorphine are not equipotent, and care should be taken when switching patients from one opioid analgesic to another to ensure equipotent dosage.  Specialist Pharmacy Services have provided more information here.
  • The following pharmacies here have been commissioned to hold stocks of palliative care medicines. Details of drugs stocked are here

Renal (Acute Kidney Injury [AKI])

Respiratory

  • *COVID-19 and respiratory illness (asthma and COPD) - BTS has produced advice here for healthcare professionals treating patients with asthma here and COPD here.  
  • Asthma UK inhaler technique videos for patients are available here
  • Local inhaler guidance is available for asthma (adult) here (children) here and COPD here
  • NICE have produced guidance to maximise the safety of adults and children with severe asthma during the COVID-19 pandemic, while protecting staff from infection here COVID-19 rapid guideline: severe asthma – guidance (NG166)

Sexual Health Service

  • There is access to information to Covid-19 related issues here 
  • The Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Effectiveness Unit has produced clinical advice to support ongoing provision of effective contraception whilst there are restrictions on face-to-face contact during the Covid-19 pandemic here 

Last updated: 13/05/2020