Hertfordshire Medicines Management Committee

Here are the October 2018 Hertfordshire Medicines Management Committee (HMMC) recommendations summary spreadsheets for East and North Hertfordshire CCG and Herts Valley CCG. These documents have been filtered for October 2018 and to display the decisions that are most relevant to primary care. The recommendations likely to have most impact on primary care are summarised below:


Management of chronic asthma in adults – Guidelines updated (recommended for use)

Update to existing asthma guidelines. Guidance highlights include: what ‘good control’ is and how it should be monitored; use of SABAs; significant change to therapy options at step 2 to include montelukast; how to step-up/down treatment; when to refer to respiratory specialist. Supporting documents include: Maintenance and Reliever Therapy (MART) regimes; Categorisation and Formulary choices of ICS; Step-down guidance and algorithms.


COPD treatment guidelines Guidelines updated (recommended for use)

Update to existing COPD guidelines. Main changes include: formulary choices made locally at PCMMG; offering both Symbicort Turbohaler and DuoResp Spiromax as options; inhaler costs updated.


ONS prescription request form – Letter updated (recommended for use)

Update to existing hospital dietitian ONS prescription request letter. Main changes include: streamlining of information; automatically directs to CCG first-line product (Aymes Shake); promotes Food First; highlights that ONS are not required in the majority of care home patients.


Pigmanorm for melasma – DOUBLE RED (not recommended for prescribing in primary or secondary care)

Not recommended for treatment of melasma as treatments for melasma are considered cosmetic and evidence to support efficacy/safety of Pigmanorm is lacking.


Thickeners and thickening ONS – New guidelines (recommended for use)

New guidance developed on the use of thickeners and thickening ONS, including pre-thickened ONS. Key points include a quick reference regarding cost effective prescribing of thickeners; quantities to prescribe; prescribing pre-thickened ONS rather than thickening standard ONS.


Please can you circulate to all relevant pharmacists & staff within your community pharmacy. Please consider these recommendations during interactions with patients. Also you may wish to review your pharmacy’s stock levels & re-order quantities of the affected medicines and adjust them accordingly.


The summary spreadsheets, recommendation documents and guidelines have been added to http://www.enhertsccg.nhs.uk/local-decisions (for NHS East and North Hertfordshire CCG) and https://hertsvalleysccg.nhs.uk/clinicians/medicines-guidance (for NHS Herts Valleys CCG).


The recommendations have been circulated to primary care prescribers in Hertfordshire and also to local provider Trusts and Herts Urgent Care.

Please contact your locality Pharmaceutical Adviser if you have any questions.



Benzodiazepines and risk of suicide – memo from HMMC 

In a recent letter to mental health providers from NHS England and NHS Improvement, the potential risks of suicide associated with benzodiazepine prescribing and withdrawal were highlighted. In view of this letter, please find here a memo from HMMC . This reminds all prescribers of good practice when prescribing and withdrawing benzodiazepines and encourages consideration of the need to seek specialist advice from the local substance misuse service, CGL Spectrum.