RMOC work programme

Title Submitted Action Committee Committee meeting Further details Expected guidance
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
More information coming soon
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
More information coming soon
Biosimilar to biosimilar switching 28/12/2018 RMOC work programme topic South

Update published - March 2019


Following adalimumab biosimilar implementation, the RMOC considered the action to be taken if a patient does not tolerate the transition to a biosimilar. A position will be included in the next national adalimumab briefing note, but with a lack of evidence to support such switching, this is primarily a clinical decision.

Biosimilar insulin guidance 28/12/2018 RMOC work programme topic South

Update published - March 2019


Biosimilar insulins has been prioritised as the next topic for the RMOC BVB group to look at. It was thought that the NHS can achieve better value for money from insulins by increasing the uptake of biosimilars. This may increase the entry of new biosimilar insulin products into the NHS. The Commissioning Support Unit are providing support for this project and will report to the next South RMOC meeting in May

Melatonin for treatment of insomnia in children with neurodevelopmental disorders and neurogenetic diseases: new medicines review 28/12/2018 RMOC work programme topic North
The product was identified through SPS horizon scanning mechanisms and has been agreed for review through the RMOC system. It has recently been approved by EU licensing authorities. See www.sps.nhs.uk/medicines/melatonin/ for more details.
Hydrocortisone granules in capsules for opening (Alkindi) 28/12/2018 RMOC work programme topic London 06/03/2019

Update published - April 2019


Alkindi was discussed by the RMOC in March with a view to providing advice on whether this formulation represents an efficacious, safe and cost effective option for replacement therapy of adrenal insufficiency in children. The committee was unable to provide advice on this topic and it has been referred back to the May MOPP.

Levodopa (inhaled) – adjunctive to oral levodopa for “off episodes” in the management of Parkinson’s disease: new medicines review 28/12/2018 RMOC work programme topic North
The product was identified through SPS horizon scanning mechanisms and has been agreed for review through the RMOC system. It is currently undergoing review by the EU licensing authorities. See www.sps.nhs.uk/medicines/levodopa/ .
for more details
rivaroxaban 2.5mg for PAD/CAD 20/12/2018 RMOC work programme topic North 07/03/2019

More information coming soon

Doxylamine/pyridoxine (Xonvea) oral for treatment of nausea and vomiting of pregnancy: new medicines review 18/12/2018 RMOC work programme topic North
This product is a fixed-dose combination modified-release tablet containing a histamine H1 receptor antagonist (doxylamine 10mg) and vitamin B6 (pyridoxine 10mg). Its anticipated use is for nausea and vomiting in pregnancy (NVP) in women who do not respond to conservative management. The product was identified through SPS horizon scanning mechanisms and has subsequently been identified as requiring review through the RMOCs.
Sequential use of biologics 17/09/2018 RMOC work programme topic South

Update published - March 2019


The RMOC has been asked to provide evidence for sequential biologic therapy. This issue concerns the number of cycles of biologicals used before use is limited. This is a difficult area with a limited evidence base. Limited sequential use of biologics has been covered to varying degrees in NICE guidance although no definitive answer reached due mainly to the lack of evidence. The RMOC will explore the evidence base in this area.

Sodium docusate 10/09/2018 RMOC work programme topic North 07/03/2019

More information coming soon

Melatonin for sleep disorders in children and adults with neurodevelopmental disorders 29/08/2018 RMOC work programme topic South
More information coming soon
RMOC determination of shared care suitability for new and existing medicines 21/08/2018 RMOC work programme topic North

More information coming soon

National revision of standardised & quality assured shared care templates through RMOC shared care programme of work 21/08/2018 RMOC work programme topic North

More information coming soon

GLP1 choice in those with CVD 15/08/2018 RMOC work programme topic Midlands and East 05/12/2018

Update May 2019


This topic was discussed at a previous meeting, however the RMOCs are currently awaiting publication of the updated operating model from NHS England which affects which topics are discussed. In the interim The Specialist Pharmacy Service have published a review of GLP-1 mimetics and CVD.

National shared care guidelines for immunosupressants from Tertiary Referral Centres 02/08/2018 RMOC work programme topic North

More information coming soon

Carbetocin for use in NHS ambulance services 05/07/2018 RMOC work programme topic London

More information coming soon

Proposal to establish and oversee a national ‘do once’ system for organisational medicines governance 04/07/2018 RMOC work programme topic South

Update published - November 2018


The RMOC system is to endorse and give oversight to a national "do once" system for patient group directions.

PIL explaining Prescribing responsibilities between primary & secondary/tertiary care 22/06/2018 RMOC work programme topic North

More information coming soon

Multi Compartment Compliance Aids 14/06/2018 RMOC work programme topic London

Update published - April 2019


A Summary of Guidance and Evidence for use of Multi-Compartment Compliance Aids (MCCAs) was presented to the RMOC. The published evidence strongly suggests that all patients with medication adherence issues undergo an assessment to identify the best adherence aid, and that the impact of MCCAs on medication adherence is unknown with no consensus on the type/features of the MCCAs to supply. The paper was well received by the RMOC and will be published on the SPS website. The RMOC agreed there is a need for a standard tool for reviewing patients with adherence problems and this should be scoped. An update to this will be brought to the next London RMOC in July 2019.


The project proposal: Achieving a gold standard approach to MCCAs in England was presented to the RMOC. A project initiation document will now be presented to the London RMOC in July 2019 for submission to the NHS England Medicines and Diagnostic policy team.

Primary care monitoring of drugs that fall under specialised comissioning 07/06/2018 RMOC work programme topic North

More information coming soon

Melatonin for sleep disorders in children 29/05/2018 RMOC work programme topic South
More information coming soon
Drug decision making for tertiary and super specialist centres 29/05/2018 RMOC work programme topic North

More information coming soon

Prior Approval BlueTeq Standardisation 16/05/2018 RMOC work programme topic South

Update published - March 2019


The RMOC considered a proposal for standardised BlueTeq templates to be adopted by CCGs to provide greater clarity and reduced variation in the system. This arose since prescribers in acute trusts have different templates to complete for different CCGs which add complexity and potentially inequity to the system. On behalf of the RMOC, SPS had surveyed APCs/CCGs within the South England region to identify the degree of uptake of BlueTeq. The survey confirmed wide variation on the use of BlueTeq between CCGs, and the medicines it is used for. It was agreed that producing national standard templates would be a major undertaking and therefore the RMOC would work on producing a set of principles to follow regarding use of BlueTeq.

Patient Information to explain prescribing responsibilities 14/05/2018 RMOC work programme topic North

More information coming soon

Biosimilar switching programmes – ‘nocebo vs. meaningful differences between products’ 14/05/2018 RMOC work programme topic South

More information coming soon

Cost Comparator Tool to Optimise Best Value Biologic 03/05/2018 RMOC work programme topic South

Update published - March 2019


The RMOC considered the cost comparator tool, which is used in a number of Trusts in Bristol. The tool supports selecting the best value biological at the point of a clinician selecting a therapy. It does not replace clinical judgement or patient preference, but supports optimising the patients’ therapy. The RMOC supported further exploration of how the tool could be used more widely in the NHS.

Stopping medication 23/04/2018 RMOC work programme topic London

Update published - April 2019


A project plan for evidence-based deprescribing guidelines across England was presented to the RMOC, using similar methodology developed by the Bruyere Research Institute in Canada. The RMOC agreed to the project proposal and NHS England Medicines and Diagnostic Policy team have been informed to consider the commissioning of the deprescribing guidelines. The RMOC are consulting with APC members across England on which topics should be prioritised for development.

Prescribing of insulin in frail and elderly who are being managed at home 17/04/2018 RMOC work programme topic Midlands and East

More information coming soon

Learning Disabilities Mortality Review (LeDeR) 10/04/2018 RMOC work programme topic North

This topic is being considered under the STOMP work stream.