RMOC work programme

Title Submitted Action Committee Committee meeting Further details Expected guidance
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.

Shared Care agreement for Amiodarone and dronedarone 21/08/2019 RMOC work programme topic North
At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
Prescribing of preventative medicines in pregnancy 17/07/2019 RMOC work programme topic London 20/11/2019
This topic will be discussed at the November meeting of London RMOC. More information coming soon.
Vitamin B supplementation in alcoholism 15/05/2019 RMOC work programme topic North 06/11/2019
A draft recommendation was considered by RMOC North at their November meeting, this will now be shared to the wider RMOC for comment prior to publication
31/03/2020
Insulin Quantity Review Policy 07/05/2019 RMOC work programme topic South
This topic will be discussed at the January 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 will be discussed at the January meeting of South RMOC. More information coming soon.
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.
18/07/2019
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.
18/07/2019
Optimisation of injectable depot buprenorphine (Buvidal) into substance misuse care pathways 03/04/2019 RMOC work programme topic South
This topic will be discussed at the January meeting of South RMOC. More information coming soon.
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
Topic requires further work up at RMOC to link in with evidence base. More information coming soon.
ARK Antibiotic Review Kit 21/02/2019 RMOC work programme topic Midlands and East 08/08/2019
More information coming soon
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.

05/07/2019
Biosimilar insulin 28/12/2018 RMOC work programme topic South 31/05/2019
It is the intention of the RMOC to set up a subgroup to investigate the potential for increasing uptake of biosimilar insulins.
Melatonin for treatment of insomnia in children with neurodevelopmental disorders and neurogenetic diseases: new medicines review 28/12/2018 RMOC work programme topic North
Following publication of the revised operating model, NHS England Medicines and Diagnostic Policy team are exploring options for taking this topic forward. More information coming soon.
Hydrocortisone granules in capsules for opening (Alkindi) 28/12/2018 RMOC work programme topic London 06/03/2019
Following publication of the revised operating model, NHS England Medicines and Diagnostic Policy team are exploring options for taking this topic forward. More information coming soon.
Sequential use of biologics 17/09/2018 RMOC work programme topic South 25/01/2019

Update published - August 2019


The RMOC has been asked to provide advice on the sequential use of biologic therapy. Evidence is lacking in this area and it is a difficult topic to provide general advice. Following the RMOC meeting legal advice has been sought and will form the basis of RMOC advice.

Screening for retinopathy associated with taking hydroxychloroquine or chloroquine 13/09/2018 RMOC work programme topic South 13/09/2019
To be discussed at the next meeting of RMOC South. More information coming soon.
Sodium docusate 10/09/2018 RMOC work programme topic North 07/03/2019

Update published - June 2019


The committee reviewed a request for RMOC to advise APCs to remove docusate sodium from formularies on the basis of lack of efficacy and evidence of harm. Use of docusate sodium is particularly high in the north, however the group also noted that use of all laxatives is high in the region, as is opioid use. The committee was not able to identify any evidence to support the application, and found there was not a case to desprescribe docusate sodium. It was noted that higher levels of use in some areas may be appropriate, depending on context (e.g. disease prevalence), and that review of formularies to bring them in line with NICE guidance may result in a reduction in variation. The group proposed to establish links with Public Health England and controlled drug accountable officers in the North, to establish what work has already been done locally, and seek engagement.

Melatonin for sleep disorders in children and adults with neurodevelopmental disorders 29/08/2018 RMOC work programme topic South
Following publication of the revised operating model, NHS England Medicines and Diagnostic Policy team are exploring options for taking this topic forward. More information coming soon.
RMOC determination of shared care suitability for new and existing medicines 21/08/2018 RMOC work programme topic North 01/11/2018
At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
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
At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
GLP1 choice in those with CVD 15/08/2018 RMOC work programme topic Midlands and East 05/12/2018
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 01/11/2018
To be considered as part of the overarching North RMOC Shared Care Programme. Guidance on repatriation would be required as part of the ask of this topic. Regional pharmacists are to first explore the extent of the issue across English tertiary referral centres and feed into considerations for this topic.
31/03/2020
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

Update published - May 2019


The RMOC system is to endorse and give oversight to a national "do once" system for patient group directions. At the May meeting of RMOC South PGDs for administration of flumazenil and tranexamic acid for use by the ambulance trusts were approved. The PGDs will be published on the SPS website. These two initial PGDs are only for use by ambulance trusts. There was a discussion that adaption and adoption of the PGDs would be beneficial, where clinically appropriate. This is to be discussed further with SPS, but it was agreed that useful content can be copied by organisations.

PIL explaining Prescribing responsibilities between primary & secondary/tertiary care 22/06/2018 RMOC work programme topic North 01/11/2018
At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
Multi Compartment Compliance Aids 14/06/2018 RMOC work programme topic London 28/11/2018
A project proposal, available here, for achieving a gold standard approach to Multi-Compartment Compliance Aids (MCCAs) in England has been produced and submitted to 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 01/11/2018
At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
Melatonin for sleep disorders in children 29/05/2018 RMOC work programme topic South
Following publication of the revised operating model, NHS England Medicines and Diagnostic Policy team are exploring options for taking this topic forward. More information coming soon.
Drug decision making for tertiary and super specialist centres 29/05/2018 RMOC work programme topic North 01/11/2018
At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
Prior Approval BlueTeq Standardisation 16/05/2018 RMOC work programme topic South 25/01/2019

Update published - August 2019


It had been agreed that the RMOC would work on producing a set of principles regarding the use of Blueteq to provide greater clarity and reduce current variation in the system. The NHSE Specialised Commissioning rules could be adapted, and the RMOC will work with the Kent, Surrey and Sussex (KSS) team who are developing a template fora region wide common approach. RMOC guidance will provide an example template.

Patient Information to explain prescribing responsibilities 14/05/2018 RMOC work programme topic North 01/11/2018
At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
Cost Comparator Tool to Optimise Best Value Biologic 03/05/2018 RMOC work programme topic South 27/09/2018
The RMOC have considered the cost comparator tool, which is used in a number of Trusts in Bristol. The tool supports selecting the best value biologic at the point of a clinician selecting therapy. It does not replace clinical judgement or patient preference, but supports optimising the patient's therapy. Discussion is ongoing with the AHSN network and the NHSE Medicines Value Programme regarding funding the best value biological cost comparator tool.

Stopping medication 23/04/2018 RMOC work programme topic London 28/11/2018
A guideline production plan, available here, for evidence-based deprescribing across England has been produced and submitted to NHS England Medicines and Diagnostic Policy team.
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


31/01/2019
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.

31/12/2019
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.
01/01/2020
Shared care agreements 09/03/2018 RMOC work programme topic North 03/05/2018
Topic transferred from South RMOC to North RMOC to be considered as part of Shared Care Programme. At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
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.

22/05/2018
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.

22/06/2018
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.

19/11/2018
National standardisation for medicines agreements over the interface (shared care) 16/01/2018 RMOC work programme topic North 03/05/2018
Topic transferred from South RMOC to North RMOC to be considered as part of Shared Care Programme. At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
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. At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
Antidepressant prescribing in primary/secondary care 16/01/2018 RMOC work programme topic South 03/05/2018

Update published - January 2019


Deprescribing of antidepressants is a wider issue than solely a pharmacological approach. In February 2020 NICE will be publishing their updated guideline on Depression which will include non-pharmacological methods. Public Health England is undertaking a review on dependence on, and withdrawal from, prescribed medicines - including antidepressants with intended publication in 2019. The principles around polypharmacy and deprescribing are being overseen by the London RMOC. In view of these activities the South RMOC will not progress this topic any further .

Compassionate care and free of charge medicines guidance 15/01/2018 RMOC work programme topic South 20/01/2018

Guidance published - 28th July 2018

Since publication, a number of comments on the document have been received. These comments have been discussed at RMOC level and have also been addressed by a Medicines Optimisation Clinical Reference Subgroup. The draft is currently being adapted to provide a better undertanding of the NHS expectations for the pharmaceutical industry.

31/01/2020
Shared care new EL: primary and secondary care responsibilities 15/01/2018 RMOC work programme topic North 30/01/2018
RMOC discussed draft guidance and fed back comments to NHS England. Topic has since transferred from South RMOC to North RMOC. At the November meeting the RMOC considered a definition of shared care, a draft shared care policy, a shared care template and a list of agents identified as being suitable for shared care. Amendments were suggested and the revised versions will be shared with all RMOC members in the near future.
31/03/2020
Liothyronine 15/01/2018 RMOC work programme topic South 03/05/2018

Updated guidance published - 15th July 2019


07/11/2018
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.
13/11/2018
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.

FreeStyle Libre Flash monitoring system 15/01/2018 RMOC fast-track topic North
Guidance produced and published by the RMOC has now been superseded by NHS England flash glucose monitoring guidelines for CCGs. NHS England guidance is available here.
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 South 14/09/2017
Midland & East RMOC is leading on this area and have identified a number of potential areas to focus on.
Anti-microbial resistance 15/01/2018 RMOC work programme topic London 19/07/2017

The RMOC (London) Antimicobial Resistance / Stewardship Subgroup is a network that brings together multi-disciplinary practitioners and other network leads with an interest in AMR and improvement across London. Its aims are to: reduce anti-microbial prescribing overall, reduce rates of gram negative infections and increase good practice in prescribing. Its particular areas of current focus include UTI prevention, diagnosis, and treatment in the elderly; optimising use of antibiotics in urgent care settings; and working with STPs to map and understand their priorities. Information about the work programme can be found here

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.
Anti-microbial resistance 15/01/2018 RMOC work programme topic North 28/06/2017
Midland & East RMOC is leading on this area and have identified a number of potential areas to focus on.
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.
Best Value Medicines 15/01/2018 RMOC work programme topic London 19/07/2017
The NHS England Medicines Value Programme (MVP) has been set up to improve health outcomes from medicines and ensure we are getting the best value from the NHS medicines expenditure. The Best Value Medicines Implementation group in London has been established to support the regional health economy to implement strategies that enable realisation of the MVP. This will include working with Regional Pharmacists and STP Senior Leadership to identify and implement programmes of work that contribute to efficient use of medicines. Information about the work programme can be found here.
Best Value Medicines 15/01/2018 RMOC work programme topic Midlands and East 31/08/2017
South RMOC is leading on this area and have identified a number of potential areas to focus on.
Best Value Medicines 15/01/2018 RMOC work programme topic North 28/06/2017
South RMOC is leading on this area and have identified a number of potential areas to focus on.