Topics and work programme

Title Submitted Action Committee Committee meeting Further details Expected guidance
Shared care protocol for GnRH analogues in prostate cancer, endometriosis and breast cancer 20/07/2021 RMOC work programme topic North
For consideration by North RMOC Shared Care working group, in future tranche of Shared Care Programme.
Shared care workplan 27/05/2021 RMOC work programme topic North
Request for maintenance of abstinence medication (acamprosate, naltrexone, disulfram) to be added to shared care work plan; for consideration by North RMOC Shared Care working group.
tacrolimus shared care 21/05/2021 RMOC work programme topic North
Request for tacrolimus to be added to shared care work plan; for consideration by the North RMOC Shared Care working group.
Shared Care Protocol for valproate (women of childbearing potential) 09/12/2020 RMOC work programme topic North
A draft shared care protocol has been opened for national consultation. The final version will be published following incorporation of consultation comments and approval by RMOC.
31/08/2021
Subcutaneous infliximab 07/10/2020 RMOC work programme topic South
NHSE funded NICE to produce an Evidence Summary (ES) for subcutaneous infliximab based on a scope worked up by the RMOC. An ES for subcutaneous infliximab for RA has now been published. A subsequent review for Crohn's disease and Ulcerative Colitis has been prioritised.
denosumab for osteoporosis prescribing and administration in primary care following secondary care initiation as per NICE TA204 16/09/2020 RMOC work programme topic North
For consideration under the shared care national programme.
Suggestion for RMOC to create a regional accelerated hypertension guideline 15/09/2020 RMOC work programme topic North
Not for national work programme; for discussion at regional/local level.
tertiary centres starting medications and asking secondary care to take on and non formulary for secondary care – drugs not nhse funded 15/09/2020 RMOC work programme topic Midlands and East
Not for national work programme; for discussion at regional level.
Harmonisation of formularies in the West Midlands region 14/09/2020 RMOC work programme topic Midlands and East
Not for national work programme; for discussion at regional level.
Melatonin 23/06/2020 RMOC work programme topic North
A NICE evidence summary covering use of melatonin is planned, based on a scope worked up by the RMOC system.
Dual Biological Agents 17/03/2020 RMOC work programme topic South 15/09/2020
RMOC South have published an advisory statement on combination use of biologics for different co-morbidities for use in the South West and South East regions only.
Combined biologics for multiple comorbidities 02/02/2020 RMOC work programme topic South 15/09/2020
RMOC South have published an advisory statement on combination use of biologics for different co-morbidities for use in the South West and South East regions only.
Aerochamber Plus (with and without mask) Flow-Vu Anti-Static 28/11/2019 RMOC work programme topic Midlands and East
For discussion at regional level.
Principles guiding the decision making about the route of supply of medicines to outpatients 12/11/2019 RMOC work programme topic South

Guidance published - June 2019


The RMOC have ratified guidance to support best practice in supply of medicines. It is intended to support acute trusts when considering the benefits and disadvantages of various routes of supply for high cost medicines: highlighting areas where such supply routes have been established and providing contact details for individuals who are willing to share their experiences.

Pitolisant 26/09/2019 RMOC work programme topic Midlands and East
RMOC Midlands and East are drafting a clinical commissioning framework for use of pitolisant in narcolepsy with and without cataplexy.
31/10/2021
Shared Care agreement for Amiodarone and dronedarone 21/08/2019 RMOC work programme topic North
Draft shared care protocols have been opened for national consultation. Final versions will be published following incorporation of consultation comments and approval by RMOC.
31/08/2021
Prescribing of preventative medicines in pregnancy 17/07/2019 RMOC work programme topic London 20/11/2019
The Deputy Chief Midwifery Officer for England has established a Short Life Working Group to look at improving access to preventative medicines in pregnancy, meetings are held quarterly. At the October 2020 RMOC meeting it was reported that the SLWG had met and has good representation across the system including relevant Royal Colleges, SPS, the national PGD group, NHS England, pharmacists and midwifes working in the relevant sector. Two subgroups have been established: one to work on changes in midwifery exemptions that are out dated but likely to take around 2 years for policy review, and one to look at development of PGDs that can support medicines supply in the interim.
31/10/2021
Vitamin B supplementation in alcoholism 15/05/2019 RMOC work programme topic North 06/11/2019

Guidance published - December 2019


An RMOC Position Statement on oral vitamin B supplementation has been published.

Insulin Quantity Review Policy 07/05/2019 RMOC work programme topic South
This topic will be discussed at the next meeting of South RMOC. More information coming soon.
Is there any evidence that vedolizumab is safer than other biologics used in UC and Crohns and if so in which patient groups should it be use first line? 01/05/2019 RMOC work programme topic South
This topic was discussed at the September 2020 meeting of RMOC South. The RMOC was asked to give guidance on whether there is evidence to support use of vedolizumab first line (instead of more cost-effective alternatives e.g. adalimumab) on grounds of safety in sub-groups of patients who suffer from co-morbidities e.g. respiratory issues and latent tuberculosis. NICE are currently not planning to update their guidance. There is some new evidence that isn’t included – the Varsity and PANTS studies. It is not the RMOC’s position to update NICE guidance and so this position along with a Summary of Evidence produced for the meeting will be shared with APCs.
Melatonin 29/04/2019 RMOC work programme topic North
A NICE evidence summary covering use of melatonin is planned, based on a scope worked up by the RMOC system.
PATIENT GROUP DIRECTION (PGD) – Administration of tranexamic acid injection by registered Paramedics and Nurses for treatment of severe haemorrhage 25/04/2019 RMOC fast-track topic South 23/05/2019
A 'do once' PGD is now available here.
PATIENT GROUP DIRECTION (PGD) – Administration of flumazenil injection by registered Paramedics or Nurses for the complete or partial reversal of the central sedative effects of midazolam used for conscious sedation. 25/04/2019 RMOC fast-track topic South 23/05/2019
A 'do once' PGD is now available here.
Slenyto (melatonin) 18/04/2019 RMOC work programme topic North
A NICE evidence summary covering use of melatonin is planned, based on a scope worked up by the RMOC system.
Optimisation of injectable depot buprenorphine (Buvidal) into substance misuse care pathways 03/04/2019 RMOC work programme topic South

Guidance published - April 2021


This guidance is intended for use by substance misuse service providers (SMSP) in all settings, commissioners, community pharmacies and acute Trusts in England. It covers: commencing treatment, practical considerations in different care settings, transfer of care, clinical scenarios and recommendations. A “Buvidal® cost calculator” is also available to provide guidance to organisations/commissioners on the potential financial impact of Buvidal® implementation for a local population.

Biosimilar Rapid Acting Analogue Insulin 20/03/2019 RMOC work programme topic South 23/05/2019
Individual products are not considered as separate items. This topic is being considered under the broader Best Value Biologics work stream. See biosimilar insulin topic for progress updates.
Antibiotic pack sizes 28/02/2019 RMOC work programme topic Midlands and East 08/08/2019
The Committee agreed in principle that antibiotic pack sizes should be aligned with the course lengths being advised through current best evidence via NICE guidance. Project priorities will be driven by the availability of relevant NICE guidance and the on-going ‘do once’ programme for national PGDs, although it was acknowledged that correct pack sizing needed to be available at the point of guidance publication. However, antibiotic pack sizes for UTIs and upper respiratory tract infections will be looked at first. Further work up is required how to operationalise this. The Committee also agreed to endorse all antibiotic PGDs being published as part of the national ‘do once’ programme as part of its oversight of AMR for RMOCs.
31/10/2021
Biosimilar to biosimilar switching 28/12/2018 RMOC work programme topic South 25/01/2019

Briefing published - July 2019


The RMOC had been asked to provide advice for circumstances where a patient does not tolerate a biosimilar and needs to switch to an alternative product. A draft statement providing guidance on biosimilar to biosimilar switching was produced and agreed and has been incorporated into the July RMOC briefing on adalimumab.

Biosimilar insulin 28/12/2018 RMOC work programme topic South 31/05/2019
The tool has been updated following comments received during the consultation. A final draft has been forwarded to the National Clinical Director for Obesity and Diabetes at NHSE for further comment prior to publication.
30/09/2021
Melatonin for treatment of insomnia in children with neurodevelopmental disorders and neurogenetic diseases: new medicines review 28/12/2018 RMOC work programme topic North
A NICE evidence summary covering use of melatonin is planned, based on a scope worked up by the RMOC system.
Sequential use of biologics 17/09/2018 RMOC work programme topic South 25/01/2019

Guidance published - January 2020


The RMOC has produced an advisory statement on the sequential use of biologic medicines.

Screening for retinopathy associated with taking hydroxychloroquine or chloroquine 13/09/2018 RMOC work programme topic South 13/09/2019
Consultation on the draft position statement has closed. A final draft was circulated prior to the June meeting of RMOC South and the committee were asked for final comments prior to submission for publication. Final amendments are being made and publication is planned imminently.
30/09/2021
Melatonin for sleep disorders in children and adults with neurodevelopmental disorders 29/08/2018 RMOC work programme topic North
A NICE evidence summary covering use of melatonin is planned, based on a scope worked up by the RMOC system.
RMOC determination of shared care suitability for new and existing medicines 21/08/2018 RMOC work programme topic North 01/11/2018
National revision of standardised & quality assured shared care templates through RMOC shared care programme of work 21/08/2018 RMOC work programme topic North 01/11/2018
A template for shared care protocols has been published. Production of shared care protocols for medicines included in the guidance is underway, and a work plan is available.
31/12/2021
National shared care guidelines for immunosupressants from Tertiary Referral Centres 02/08/2018 RMOC work programme topic North 01/11/2018
Guidance published March 2021: Shared Care for Medicines Guidance – A Standard Approach, including a template for shared care protocols. Production of shared care protocols for medicines included in the guidance is underway, and a work plan is available.
Carbetocin for use in NHS ambulance services 05/07/2018 RMOC work programme topic London
This topic is currently on hold as the product has not yet launched in the UK. Anticipated launch is 2020 and the topic will be revisited at this time.
Proposal to establish and oversee a national ‘do once’ system for organisational medicines governance 04/07/2018 RMOC work programme topic South 27/09/2018
The RMOC system is to endorse and give oversight to a national "do once" system for patient group directions. At the May 19 meeting of RMOC South PGDs for administration of flumazenil and tranexamic acid for use by the ambulance trusts were approved. The PGDs have now been published on the SPS website.
PIL explaining Prescribing responsibilities between primary & secondary/tertiary care 22/06/2018 RMOC work programme topic North 01/11/2018
Guidance published March 2021: Shared Care for Medicines Guidance – A Standard Approach. Patient information will now be developed.
30/09/2021
Primary care monitoring of drugs that fall under specialised comissioning 07/06/2018 RMOC work programme topic North 01/11/2018
Guidance published March 2021: Shared Care for Medicines Guidance – A Standard Approach, including a template for shared care protocols. Production of shared care protocols for medicines included in the guidance is underway, and a work plan is available.
Melatonin for sleep disorders in children 29/05/2018 RMOC work programme topic North
A NICE evidence summary covering use of melatonin is planned, based on a scope worked up by the RMOC system.
Drug decision making for tertiary and super specialist centres 29/05/2018 RMOC work programme topic North 01/11/2018
Guidance published March 2021: Shared Care for Medicines Guidance – A Standard Approach, including a template for shared care protocol. Production of shared care protocols for medicines included in the guidance is underway, and a work plan is available . Specialised commissioning and tertiary care will be addressed in future phases of this work.
Prior Approval BlueTeq Standardisation 16/05/2018 RMOC work programme topic South 25/01/2019

Guidance published - January 2020


The RMOC has produced standard principles for medicines prior approval forms. The document provides advice on the application of the Blueteq prior approval system, as this is the current system used in the NHS but the principles should be applied if an alternative prior approval system is utilised. Principles to aid consistency are outlined in the document, so should be viewed as generic requirements. These are based upon processes adopted by NHS England Specialised Commissioning.

Patient Information to explain prescribing responsibilities 14/05/2018 RMOC work programme topic North 01/11/2018
Guidance published March 2021: Shared Care for Medicines Guidance – A Standard Approach. Patient information will now be developed.
30/09/2021
Cost Comparator Tool to Optimise Best Value Biologic 03/05/2018 RMOC work programme topic South 27/09/2018
The RMOC has previously discussed and recommended further development of the ‘Best Value Biological Calculator’, an innovation from North Bristol NHS trust. NHS strategic finance support has not been available, but an update at the June 21 RMOC South meeting highlighted this is now being taken forward with proof of concept funding in the South West.
Learning Disabilities Mortality Review (LeDeR) 10/04/2018 RMOC work programme topic North

This topic is being considered under the STOMP work stream.

Evidence for the use of heparinised saline for maintaining patency of intravascular catheters 03/04/2018 RMOC work programme topic London 04/07/2018

Guidance published - February 2019


Sodium Oxybate 14/03/2018 RMOC work programme topic Midlands and East 08/08/2018

Guidance published - October 2019


The RMOC (Midlands and East) has reviewed issues around the prescribing and commissioning of sodium oxybate in adult patients with narcolepsy with cataplexy. The document aims to facilitate local decisions by a CCG on whether to commission sodium oxybate for use in all adult patients. It suggests a framework by which a CCG can ensure that sodium oxybate is used appropriately and safely under the strict criteria set out within this statement. This statement does not stipulate that sodium oxybate must be commissioned, but aims to assist this decision making process and improve consistency.

Evidence based recommendation for use of Botox 13/03/2018 RMOC work programme topic South 27/09/2018
A short life working group of the South RMOC have shared evidence reviews and estimated cohort sizes for a range of botulinum toxin unlicensed indications. RMOC South have agreed an interim statement detailing current progress and this will be shared with the other RMOCs for comment before publication.
31/08/2021
Shared care agreements 09/03/2018 RMOC work programme topic North 03/05/2018
Guidance published March 2021: Shared Care for Medicines Guidance – A Standard Approach, including a template for shared care protocols Production of shared care protocols for medicines included in the guidance is underway, and a work plan is available .
31/12/2021
Regional availability of rarely used and emergency medicines 25/01/2018 RMOC work programme topic London 01/03/2018

Guidance published - May 2018
Update published - December 2018


London RMOC supports a proposed service specification for pan-regional storage of antidotes. A national antidote storage audit has been conducted and results will be published in 2019. A position statement on rarely used urgent medicines is being produced.

Rationalisation of Insulin Products 16/01/2018 RMOC work programme topic Midlands and East 18/04/2018

Guidance published - June 2018


The RMOC system has now issued guidance to formulary committees and area prescribing committees on issues pertaining to safety considerations when adopting any insulin preparation onto a local formulary.

STOMP (Stopping over­medication of people with a learning disability) 16/01/2018 RMOC work programme topic North 28/06/2018

Guidance published - November 2018


The STOMP programme was developed as part of the national response to the Winterbourne View Hospital report. It aims to ensure that people with learning difficulties, or autism, or both, are not over-medicated. The North RMOC leads this work as part of the polypharmacy work stream, on behalf of all RMOCs. It has worked with STOMP colleagues to provide a resource pack on the SPS website which can used locally to inform local policies. The RMOC will also work with STOMP colleagues to facilitate the development of prescribing guidance and prescribing indicators that can be utilised locally.

National standardisation for medicines agreements over the interface (shared care) 16/01/2018 RMOC work programme topic North 03/05/2018
A template for shared care protocols has been published. Production of shared care protocols for medicines included in the guidance is underway, and a work plan is available.
31/12/2021
Shared Care Protocols & Traffic Light Drugs lists 16/01/2018 RMOC work programme topic North 01/11/2018
Topic transferred from South RMOC to North RMOC to be considered as part of Shared Care Programme. Guidance published March 2021: Shared Care for Medicines Guidance – A Standard Approach , including a template for shared care protocols Production of shared care protocols for medicines included in the guidance is underway, and a work plan is available.
31/12/2021
Compassionate care and free of charge medicines guidance 15/01/2018 RMOC work programme topic South 20/01/2018

Updated guidance published - January 2020


Advice ratified by the Regional Medicines Optimisation Committee (principles drafted by the Medicines Optimisation Clinical Reference Group) has been updated concerning what should be in place for local policies on compassionate use / free of charge medicines.

Shared care new EL: primary and secondary care responsibilities 15/01/2018 RMOC work programme topic North 30/01/2018
Topic transferred from South RMOC to North RMOC to be considered as part of Shared Care Programme. Guidance published March 2021: Shared Care for Medicines Guidance – A Standard Approach , including a template for shared care protocols Production of shared care protocols for medicines included in the guidance is underway, and a work plan is available.
31/12/2021
Liothyronine 15/01/2018 RMOC work programme topic South 03/05/2018

Updated guidance published - 15th July 2019


Homely remedies 15/01/2018 RMOC work programme topic Midlands and East 05/12/2017
A position paper and template policy have been published and are available here.
Standardised strengths of high risk, unlicensed oral liquid formulations for anti-TB medicines 15/01/2018 RMOC work programme topic North

Guidance published - April 2018


RMOC (North) endorsed the approach put forward by the NHS Pharmaceutical Quality Assurance Committee Sub-Group on Unlicensed Medicines to standardise the strengths of high risk unlicensed oral liquids for anti- TB medicines.

Polypharmacy 15/01/2018 RMOC work programme topic London 04/07/2018
This piece of work is being pursued by London RMOC in conjunction with other partners. The Specialist Pharmacy Service produced a report in July 2018 to support discussions about medicines optimisation review, it is available here for interested parties .
Anti-microbial resistance 15/01/2018 RMOC work programme topic Midlands and East 31/08/2017
Midland and East RMOC is leading on this on-going topic as part of the Medicines Value Programme.
Best Value Medicines 15/01/2018 RMOC work programme topic South 14/09/2017
South RMOC is leading on this on-going topic as part of the Medicines Value Programme. A number of briefings and a toolkit have been published under the RMOC recommendations and resources section of the SPS website.