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

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 the PGD for administration of tranexamic acid injection by registered Paramedics and Nurses for treatment of severe haemorrhage was approved. The PGD is due to be published on the SPS website shortly. Whilst this PGD is only for use by ambulance trusts. There was a discussion that adaption and adoption for wider use in other settings would be beneficial, where clinically appropriate. Further discussion is required, but it was agreed that useful content can be copied by organisations.

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

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 the PGD for administration of flumazenil injection by registered Paramedics and Nurses for the complete or partial reversal of the central sedative effects of midazolam used for conscious sedation. The PGD is due to be published on the SPS website shortly. Whilst this PGD is only for use by ambulance trusts. There was a discussion that adaption and adoption for wider use in other settings would be beneficial, where clinically appropriate. Further discussion is required, but it was agreed that useful content can be copied by organisations.

Biosimilar Rapid Acting Analogue Insulin 20/03/2019 RMOC work programme topic South

Update publishedMay 2019


Individual products are not considered as separate items but this topic is being considered under the broader Best Value Biologics work stream. See biosimilar insulin guidance for an update of current discussions.

Antibiotic pack sizes 28/02/2019 RMOC work programme topic Midlands and East
ARK Antibiotic Review Kit 21/02/2019 RMOC work programme topic Midlands and East
Biosimilar to biosimilar switching 28/12/2018 RMOC work programme topic South

Briefing published - July 2019


A statement on biosimilar switching has been incorporated into the July RMOC briefing on adalimumab.

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

Update publishedMay 2019


Further discussions on this topic took place at the May meeting of RMOC South (see approved minutes for details). Actions from the meeting include discussions with NHSE Commercial Medicines Lead before setting up a subgroup of the RMOC (including a diabetic nurse specialist).

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 RMOC New Medicines workstream is currently under review. The product was identified through SPS horizon scanning mechanisms.
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 RMOC New Medicines workstream is currently under review. The product was identified through SPS horizon scanning mechanisms. 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

Await NICE Guidance

Doxylamine/pyridoxine (Xonvea) oral for treatment of nausea and vomiting of pregnancy: new medicines review 18/12/2018 RMOC work programme topic North
The RMOC New Medicines workstream is currently under review. The product was identified through SPS horizon scanning mechanisms. 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. See www.sps.nhs.uk/medicines/doxylamine-pyridoxine/ for more details.
Sequential use of biologics 17/09/2018 RMOC work programme topic South

Update published - May 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. For the most. For the most recent discussions on this topic please see approved minutes.

Screening for retinopathy associated with taking hydroxychloroquine or chloroquine 13/09/2018 RMOC work programme topic South
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
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 - 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

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 - May 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. At the May meeting it was noted that the Blueteq lead for NHSE Specialised commissioning has shared his standard template, SOPs and set of rules which could be adapted for CCG use.

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 - May 2019


The RMOC have previously 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. At the May meeting of the South RMOC an action was set to identify funding and an organisation to adapt and spread the tool. See approved minutes for full details.

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.

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 05/12/2018

Update published - May 2019


NHSE commission sodium oxybate in children up until their 19th Birthday. After this point commissioning responsibility falls to an individual CCG. The RMOC have previously discussed this topic and held further discussions at the April meeting. The committee agreed that a framework to help CCGs make commissioning decisions would be useful. A draft document drawn up with input from specialists from adult sleep services and NHS England specialised commissioning was discussed and will be published after completing the consultation process. Additionally, NHSE specialised commissioning will work with specialists in the treatment of narcolepsy in adults and children to produce a document to facilitate the transition of paediatric patients to adult services.

Evidence based recommendation for use of Botox 13/03/2018 RMOC work programme topic South

Update published - May 2019


An update from the short life working group was given at the May meeting of South RMOC. Actions were set to draft an interim statement which is to be shared with other RMOCs and discussed with the MOOG. See approved minutes for full details.

Shared care agreements 09/03/2018 RMOC work programme topic South 03/05/2018

Update published - November 2018


RMOC South discussed guidance from NHS England (Responsibility for prescribing between Primary & Secondary/Tertiary Care), focusing on how RMOCs can achieve their expectations as set out in section 6 of this guidance. A survey was sent across the South region to identify the types of issues that organisations have with shared care.

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 South 03/05/2018

Update published - November 2018


This is a large piece of work which needs an agreed mechanism of delivery to ensure it is addressed appropriately across England. This is currently being discussed within the RMOC governance structure. An update will be provided once a decision is reached.

Shared Care Protocols & Traffic Light Drugs lists 16/01/2018 RMOC work programme topic South

More information coming soon

Antidepressant prescribing in primary/secondary care 16/01/2018 RMOC work programme topic South 03/05/2018

Update published - November 2018


RMOC South is leading on this as part of the Polypharmacy workstream on behalf of all RMOCs. The RMOC will work with clinical specialists to produce a resource pack to publish on the SPS website. It intends to identify signposting opportunities to help health care professionals and practitioners.

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

Guidance published - 28th July 2018

Update published - May 2019


Comments on this guideline have been reviewed and discussed at the latest meeting of the South RMOC. A revised draft is to be circulated for approval following receipt of comments from MOCRG sub group. See approved minutes for further details.

Shared care new EL: primary and secondary care responsibilities 15/01/2018 RMOC work programme topic South 30/01/2018
RMOC discussed draft guidance and fed back comments to NHS England.
Low clinical value medicines 15/01/2018 RMOC work programme topic South 03/05/2018

Guidance published - 7th November 2018


This topic focuses on prescribing of liothyronine. RMOC South has worked with endocrinology clinical specialists to produce guidance on prescribing of liothyronine.

07/11/2018
Medication Safety tools in primary care 15/01/2018 RMOC work programme topic South 30/01/2018

Update published - November 2018


RMOC South will work with the AHSNs to produce guidance on the following areas:

1. Introduction to PINCER

2. Cost-effectiveness review of available tools

3. Best practice guidance

4. Checklist for self-assessment when using medication safety tools

5. Signposting to support implementation.

08/11/2018
Homely remedies 15/01/2018 RMOC work programme topic Midlands and East 08/08/2018

Update published - May 2019


Guidance published - 13th November 2018


Guidance has been published. At the May RMOC meeting the committee discussed a query raised about the guidance. The committee noted that as the publishe document was a template policy for homely remedies, it could be adapted for local use as desired.

13/11/2018
Medicines use in Care Homes 15/01/2018 RMOC work programme topic Midlands and East
Medicines use in Care Homes 15/01/2018 RMOC work programme topic London
Polypharmacy 15/01/2018 RMOC work programme topic South 03/05/2018

Update published - November 2018


This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme. Polypharmacy will continue to be discussed on the South RMOC agenda, with a focus on deprescribing and polypharmacy in care homes. Work will be joined up with organisations such as AHSNs.

Polypharmacy 15/01/2018 RMOC work programme topic London 04/07/2018

Update published - July 2018


This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme. The London RMOC has established a polypharmacy subgroup, jointly chaired by Professors Nina Barnett and Emma Baker.


The subgroup has undertaken an analysis of the existing patient pathway that precipitates polypharmacy, both longitudinally and cross-sectionally; it has also undertaken a forces analysis of the factors causing inappropriate polypharmacy.


The subgroup will focus on how medicines optimisation review can be used effectively to avoid inappropriate polypharmacy.

Polypharmacy 15/01/2018 RMOC work programme topic Midlands and East

Update published - September 2018


This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme.

Polypharmacy 15/01/2018 RMOC work programme topic North 28/06/2018
This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme. The North RMOC has identified STOMP as an important programme of work to focus on.
Anti-microbial resistance 15/01/2018 RMOC work programme topic South 03/05/2018

Update published - November 2018


This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme. The South RMOC will identify ways in which it can support the AMR stewardship agenda through:

o Reducing inappropriate antibiotic prescribing in primary care; implementing new NICE common infections guidance.

o Asking acute Trusts what strategies are in place to promote an increase in IV to PO antibiotic administration.

o Enabling development of a local whole health economy approach & use of networks to drive AMR improvement including infection prevention and control.

Anti-microbial resistance 15/01/2018 RMOC work programme topic London 04/07/2018

Update published - July 2018


This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme. The London RMOC has established a subgroup with a remit to focus its attention on three areas:

1. Sharing best practice on UTI prevention, diagnosis and treatment in the elderly;

2. Use of antibiotics in the urgent care setting;

3. Working with STPs to map current antimicrobial stewardship activity.

Anti-microbial resistance 15/01/2018 RMOC work programme topic Midlands and East

Update published - September 2018


This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme.

Anti-microbial resistance 15/01/2018 RMOC work programme topic North 28/06/2018
This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme. The RMOC has discussed the data and information presented relating to antimicrobial resistance and agreed to follow up various actions around these data with CCGs and Trusts not meeting targets within the north region.
Biosimilar medicines 15/01/2018 RMOC work programme topic South 03/05/2018
This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme. The South RMOC has established a subgroup to provide recommendations on uptake of Best Value Biological Medicines across the sector. The subgroup will report back at subsequent RMOC meetings.
Biosimilar medicines 15/01/2018 RMOC work programme topic London 04/07/2018
This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme. The London RMOC has established a subgroup which will report back at subsequent meetings.
Biosimilar medicines 15/01/2018 RMOC work programme topic Midlands and East 08/08/2018
This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme. The Midlands & East RMOC has established a subgroup to provide recommendations on uptake of Best Value Biological Medicines across the sector. The subgroup will report back at subsequent RMOC meetings.
Biosimilar medicines 15/01/2018 RMOC work programme topic North 28/06/2018
This is an on-going topic for discussion at RMOCs as part of the Medicines Value Programme. An update and discussion to ensure the RMOC is informed about the national and regional picture for Best Value Biological Medicines use has been happened.