Happy to prescribe

If you are asked to continue treatment for a specific condition for which a shared care guideline is available and you are happy to prescribe in accordance with the guidance then take over the agreed responsibilities, including prescribing. Please obtain a copy of the SCG from secondary care or via the link below. 

Unhappy to prescribe

If sufficient information has not been provided and if you do not feel happy to continue to prescribe then it is advisable to refer the patient back to the specialist clinic. Please complete an inappropriate request communication form and send this as soon as possible to the contact provided in the form. 

• Shared Care Guidelines
• Inappropriate request communication form

This medicine is recommended for use at Homerton Healthcare NHS Foundation Trust provided it is used specifically in accordance with the relevant current NICE Technology Appraisal(s).

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) can be initiated in primary care provided that the prescriber has the appropriate knowledge to do so. 

Empagliflozin is the first line SGLT2 inhibitor.

Combination formulations containing metformin are not approved for prescribing (please prescribe metformin separately where appropriate).

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) can be initiated in primary care provided that the prescriber has the appropriate knowledge to do so. 

Empagliflozin is the first line SGLT2 inhibitor.

Combination formulations containing metformin are not approved for prescribing (please prescribe metformin separately where appropriate).

This medicine is recommended for use at Homerton Healthcare NHS Foundation Trust provided it is used specifically in accordance with the relevant current NICE Technology Appraisal(s).

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) can be initiated in primary care provided that the prescriber has the appropriate knowledge to do so. 

Empagliflozin is the first line SGLT2 inhibitor.

Combination formulations containing metformin are not approved for prescribing (please prescribe metformin separately where appropriate).

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) can be initiated in primary care provided that the prescriber has the appropriate knowledge to do so. 

Empagliflozin is the first line SGLT2 inhibitor.

Combination formulations containing metformin are not approved for prescribing (please prescribe metformin separately where appropriate).

This medicine is recommended for use at Homerton Healthcare NHS Foundation Trust provided it is used specifically in accordance with the relevant current NICE Technology Appraisal(s).

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) can be initiated in primary care provided that the prescriber has the appropriate knowledge to do so. 

Empagliflozin is the first line SGLT2 inhibitor.

Combination formulations containing metformin are not approved for prescribing (please prescribe metformin separately where appropriate).

SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin) can be initiated in primary care provided that the prescriber has the appropriate knowledge to do so. 

Empagliflozin is the first line SGLT2 inhibitor.

Combination formulations containing metformin are not approved for prescribing (please prescribe metformin separately where appropriate).

This medicine is recommended for use at Homerton Healthcare NHS Foundation Trust provided it is used specifically in accordance with the relevant current NICE Technology Appraisal(s).

Exenatide (Byetta® and Bydureon®) is not approved for prescribing in patients who newly require a GLP-1 receptor agonist. Patients who are established on exenatide should continue on this treatment and reviewed according to the patient management plan.

The JPG has approved Abasaglar® as brand of choice for patients newly initiated on insulin glargine. Abasaglar is a biosimilar insulin glargine.

April 2022 - The JPG agreed to remove Lyxumia® (lixisenatide) from the joint formulary. Lixisenatide is not approved for prescribing in patients who newly require a GLP-1 receptor agonist. Patients who are established on lixisenatide can continue on this treatment and reviewed according to the patient management plan. Existing patients can also be referred to the diabetes specialist nurses for consideration of an alternative GLP-1 agonist that have favourable cardiovascular data. 

Jan 2023 - The North East London Formulary & Pathways Group (FPG) approved Metformin 500mg oral powder sachets sugar free as the preferred formulation for those with dysphagia or are receiving tube-feeding.

• Patients needing metfomin 500mg or 1000mg (1g) doses should be prescribed Metformin 500mg oral powder sachets sugar free instead of Metformin 500mg/5ml or 1g/5mL oral solution sugar free. The powder must be mixed with water to produce a solution prior to administration.
• Patients taking 850mg doses should continue to be prescribed Metformin 850mg/5ml oral solution sugar free.

Formulary status - Hospital Only

Subcutaenous Semaglutide should not be prescribed by primary care prescribers for the management of obesity. This medication should only be prescribed by specialist weight management service (Tier 3 or equivalent) and within set criteria as specified by the NICE TA875. Only Wegovy brand is licensed for the management of obesity. Ozempic brand is only licensed for diabetes and should not be prescribed for the management of obesity. 

Subcutaneous semaglutide should be prescribed diabetes management wherever possible as this has shown greater efficacy and proven CV benefit. Oral semaglutide should only be considered for patients who are unable to receive GLP-1 in an injectable form. Refer to the North East London guidelines for the management of type 2 diabetes for further information on prescribing GLP-1. 

Tirzepatide should only be initiated either:
• by or on recommendation of a specialist
• by primary care prescriber with specialist knowledge and/or has received training to prescribe this medicine

Clonidine for the management of ADHD should only be prescribed in secondary care.

December 2023 - The North East London Formulary & Pathways Group (FPG) approved the use of dienogest for treatment of endometriosis. This medicine should only be initiatiated by a specialist and GP can continue prescribing in primary care following the first prescription from the specialist. Patient to be reviewed at 1 month and at 6 months by the specialist. 

April 2018 - The JPG agreed to approve the addition of utrogestan (oral) 100mg micronised capsules to the formulary for hormone replacement therapy (HRT), provided that it is prescribed either: 

• For HRT only in women with high risk for breast cancer, venous thromboembolism or cardiovascular disease.
• As a second line progestogen for HRT in women who are unable to tolerate the side effects of synthetic progestogens.

Please note utrogestan (vaginal) 200mg micronised capsules are not formulary-approved and should not be prescribed.

Not approved for prescribing

TA 160, raloxifene is not recommended as a treatment option in postmenopausal women for primary prevention of osteoporotic fractures.

Specialist knowledge/initiation

TA 161, raloxifene is recommended as an alternative treatment option for the secondary prevention of osteoporotic fragility fractures in postmenopausal women:

Clomiphene may initiated in primary care prior to the patient being reviewed in the fertility clinic. Clomiphene should be commenced on day 2 of the menstruation cycle and given for five days. Patient would require a hysterosalpingogram scan between day 9 and day 11. 

GP will need to contact the fertility clinic to arrange an appointment for the patient. 

• HUHFT fertility centre
• City and Hackney clomiphene pathway

This medicine is recommended for use at Homerton Healthcare NHS Foundation Trust provided it is used specifically in accordance with the relevant current NICE Technology Appraisal(s).

Adults who have been prescribed zoledronic acid for 3 years and alendronate, ibandronate or risedronate for 5 years should have a drug holiday unless they have a high fracture risk. Please see the guidance below for further information. 

• Click for guidance

This medicine is recommended for use at Homerton Healthcare NHS Foundation Trust provided it is used specifically in accordance with the relevant current NICE Technology Appraisal(s).

Adults who have been prescribed zoledronic acid for 3 years and alendronate, ibandronate or risedronate for 5 years should have a drug holiday unless they have a high fracture risk. Please see the guidance below for further information. 

• Click for guidance

The JPG agreed to approve this medicine for use at Homerton University Hospital Foundation Trust provided that it is used specifically in accordance with NICE Technology Appraisal(s).

Specialist knowledge/initiation - Ibandronic acid tablets 150mg for the treatment of osteoporosis in adults

Hospital only - Ibandronic acid 3mg solution for injection for the treatment of osteoporosis in adults

Non-formulary at HUHFT. Hospital only for providers that have this on their formulary - Ibandronic acid is not approved for secondary bone metastases and hypercalcaemia

Not approved for prescribing

TA 160, raloxifene is not recommended as a treatment option in postmenopausal women for primary prevention of osteoporotic fractures.

Specialist knowledge/initiation

TA 161, raloxifene is recommended as an alternative treatment option for the secondary prevention of osteoporotic fragility fractures in postmenopausal women:

• Risedronate sodium 30mg tablets should only be prescribed in secondary care by or under the explicit direction of a specialist.
• Risedronate sodium 5mg tablets are not approved for prescribing

Adults who have been prescribed zoledronic acid for 3 years and alendronate, ibandronate or risedronate for 5 years should have a drug holiday unless they have a high fracture risk. Please see the guidance below for further information. 

• Click for guidance

This medicine is recommended for use at Homerton Healthcare NHS Foundation Trust provided it is used specifically in accordance with the relevant current NICE Technology Appraisal(s).

This medicine is recommended for use at Homerton Healthcare NHS Foundation Trust provided it is used specifically in accordance with the relevant current NICE Technology Appraisal(s).

Adults who have been prescribed zoledronic acid for 3 years and alendronate, ibandronate or risedronate for 5 years should have a drug holiday unless they have a high fracture risk. Please see the guidance below for further information. 

• Click for guidance

The injection/infusion formulation of this medicine is not recommended for prescribing in primary care (i.e. hospital only prescribing).

This medicine is not recommended for use at Homerton Healthcare NHS Foundation Trust as the trust does not provide this specialist service. Note that this medicine may be prescribed by other provider trusts that are accredited to provide this specialist service.

Use restricted to:

1. Levothyroxine failure
2. Thyroid cancer, in preparation for radioiodine ablation, iodine scanning, or stimulated thyroglobulin test

Only to be initiated in secondary/ tertiary care

Refer patient to endocrinology team for review. If the patient is to continue with treatment after review or treatment is initiated by an endocrinologist for restricted indications then the rationale for this should be clearly documented in the clinic letter. Prescribing can be continued in primary care provided that there is a clear rationale for prescribing (i.e. as per the list of restricted indications). The rationale is should be clearly documented in the patient's EMIS record.

The injection/infusion formulation of this medicine is not recommended for prescribing in primary care (i.e. hospital only prescribing).

Happy to prescribe

If you are asked to continue treatment for a specific condition for which a shared care guideline is available and you are happy to prescribe in accordance with the guidance then take over the agreed responsibilities, including prescribing. Please obtain a copy of the SCG from secondary care or via the link below. 

Unhappy to prescribe

If sufficient information has not been provided and if you do not feel happy to continue to prescribe then it is advisable to refer the patient back to the specialist clinic. Please complete an inappropriate request communication form and send this as soon as possible to the contact provided in the form. 

• Shared Care Guidelines
• Inappropriate request communication form

Happy to prescribe

If you are asked to continue treatment for a specific condition for which a shared care guideline is available and you are happy to prescribe in accordance with the guidance then take over the agreed responsibilities, including prescribing. Please obtain a copy of the SCG from secondary care or via the link below. 

Unhappy to prescribe

If sufficient information has not been provided and if you do not feel happy to continue to prescribe then it is advisable to refer the patient back to the specialist clinic. Please complete an inappropriate request communication form and send this as soon as possible to the contact provided in the form. 

• Shared Care Guidelines
• Inappropriate request communication form

January 2023 - The North East London Formulary & Pathways Group (FPG) recommended the use of this medicine provided that it is used in accordance with NICE TA832 (Relugolix–estradiol–norethisterone acetate for treating moderate to severe symptoms of uterine fibroids). 

Formulary status: Blue (hospital only)

Formulary status to be reviewed once a primary care treatment pathway is agreed for NEL.

Happy to prescribe

If you are asked to continue treatment for a specific condition for which a shared care guideline is available and you are happy to prescribe in accordance with the guidance then take over the agreed responsibilities, including prescribing. Please obtain a copy of the SCG from secondary care or via the link below. 

Unhappy to prescribe

If sufficient information has not been provided and if you do not feel happy to continue to prescribe then it is advisable to refer the patient back to the specialist clinic. Please complete an inappropriate request communication form and send this as soon as possible to the contact provided in the form. 

• Shared Care Guidelines
• Inappropriate request communication form