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 23/05/2019

PGD published - July 2019


The RMOC system is to endorse and give oversight to a national "do once" system for patient group directions. A PGD for administration of tranexamic acid injection by registered Paramedics and Nurses for treatment of severe haemorrhage was submitted to the RMOC for noting prior to release and is now available via the link above on the SPS website.

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

PGD published - July 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 was approved.

Biosimilar Rapid Acting Analogue Insulin 20/03/2019 RMOC work programme topic South 23/05/2019

Update publishedAugust 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 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 guidance 28/12/2018 RMOC work programme topic South 31/05/2019

Update publishedAugust 2019


The RMOC is investigating the potential for increasing uptake of biosimilar insulins. The Commissioning Support Unit presented their report to the RMOC which provides a stocktake of the current situation and future opportunities. There was positive support on the principles and potential benefits of biosimilar insulins but caution around the complexity and challenges of this transition. It was agreed that the potential for further work on delivery will be explored and, if appropriate, a sub group would be set up.

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
Topic currently on hold - await revised RMOC Operating Model.
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
Topic will not be progressed by RMOCs. Await publication of 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 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
Topic currently on hold - await revised RMOC Operating Model
RMOC determination of shared care suitability for new and existing medicines 21/08/2018 RMOC work programme topic North 01/11/2018
To be considered as part of the overarching North RMOC Shared Care Programme.
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
To be considered as part of the overarching North RMOC Shared Care Programme. Scoping of this topic is required as part of wider programme.
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 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.
Carbetocin for use in NHS ambulance services 05/07/2018 RMOC work programme topic London
Topic currently on hold - await revised RMOC Operating Model
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
To be considered as part of the overarching North RMOC Shared Care Programme.
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 01/11/2018
To be considered as part of the overarching North RMOC Shared Care Programme.
Melatonin for sleep disorders in children 29/05/2018 RMOC work programme topic South
Topic currently on hold - await revised RMOC Operating Model
Drug decision making for tertiary and super specialist centres 29/05/2018 RMOC work programme topic North 01/11/2018
To be considered as part of the overarching North RMOC Shared Care Programme.
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
To be considered as part of the overarching North RMOC Shared Care Programme.
Biosimilar switching programmes – ‘nocebo vs. meaningful differences between products’ 14/05/2018 RMOC work programme topic South 27/09/2018
Considered as part of adalimumab switch programme. See adalimumab briefings published under RMOC recommendations and resources on the SPS website for details.
Cost Comparator Tool to Optimise Best Value Biologic 03/05/2018 RMOC work programme topic South 27/09/2018

Update published - August 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. 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

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
Topic not progressed on advice of National Clinical Director for diabetes - await GP QOF targets. It is anticipated that many of the issues highlighted by this topic submission will be resolved with the QOF.
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

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 27/09/2018

Update published - August 2019


The short life working group shared the work they had done concerning the use of botulinum toxin in a range of unlicensed indications. Evidence reviews and estimated cohort sizes were produced. It was agreed that an interim statement detailing current progress will be prepared and shared with the three other RMOCs.

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.
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.
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.
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

Update published - August 2019


Since publication a number of comments on the document have been received. Some of these were discussed at the January RMOC meeting. They were also addressed by a Medicines Optimisation Clinical Reference Group subgroup. The draft is being adapted to provide a better understanding of the NHS expectations for the pharmaceutical industry. Once received it will be sent to the South RMOC for approval.

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 to be considered as part of Shared Care Programme.
Low clinical value medicines 15/01/2018 RMOC work programme topic South 03/05/2018

Updated guidance published - 15th July 2019


This topic has been updated following feedback from the January South RMOC meeting, RMOC South consultation and Thyroid Trust.

07/11/2018
Medication Safety tools in primary care 15/01/2018 RMOC work programme topic South 30/01/2018
Topic no longer active - superseded by Medicines Safety Programme.
08/11/2018
Homely remedies 15/01/2018 RMOC work programme topic Midlands and East 05/12/2017

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
Not an active RMOC topic. To be progressed as discrete topics if they are submitted and under more overarching themes such as polypharmacy, homely medicines etc.
Medicines use in Care Homes 15/01/2018 RMOC work programme topic London
Not an active RMOC topic. To be progressed as discrete topics if they are submitted and under more overarching themes such as polypharmacy, homely medicines etc.
Polypharmacy 15/01/2018 RMOC work programme topic South 03/05/2018
London RMOC is leading on this area and have identified a number of potential areas to focus on.
Polypharmacy 15/01/2018 RMOC work programme topic London 04/07/2018
London RMOC is leading on this on-going topic as part of the Medicines Value Programme. A subgroup has been established, jointly chaired by Professors Nina Barnett and Emma Baker.
Polypharmacy 15/01/2018 RMOC work programme topic Midlands and East
London RMOC is leading on this area and have identified a number of potential areas to focus on.
Polypharmacy 15/01/2018 RMOC work programme topic North 28/06/2017
London 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 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
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 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.
Biosimilar 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 have been published under RMOC recommendations and resources section of SPS website.
Biosimilar medicines 15/01/2018 RMOC work programme topic London 19/07/2017
South RMOC is leading on this area and have identified a number of potential areas to focus on.
Biosimilar 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.
Biosimilar 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.