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Schedule 2 Part A Service Specification
Service Specification No.
Monitoring of Disease Modifying Antirheumatic Drugs
(DMARDs) Gold injections
Commissioner Lead
Alastair Mew/Dr Richard Oliver
Provider Lead
April 2014 – March 2015
Date of Review
December 2014
Population Needs
1.1 National/local context and evidence base
The treatment of several diseases, particularly in rheumatology, is increasingly reliant on disease modifying
agents including Gold injections. These will be initiated by secondary care teams and once the patient has been
stabilised on treatment will be subject to transfer for primary care monitoring and prescribing. This LCS is to
cover the monitoring of the safe use of these drugs with the express aim of detecting and acting on side effects
which may occur with their use. The monitoring of the clinical aspects of the disease remain with secondary care
NHS Outcomes Framework Domains & Indicators
Domain 1
Domain 2
Domain 3
Domain 4
Domain 5
Preventing people from dying prematurely
Enhancing quality of life for people with long-term
Helping people to recover from episodes of ill-health or
following injury
Ensuring people have a positive experience of care
Treating and caring for people in safe environment and
protecting them from avoidable harm
2.2 Local defined outcomes
Demonstrated by
Patient care closer to home
Patients receiving treatment at a local GP practice to
Patient has the option to be seen at a local GP practice
to them.
Patients managed jointly treated in the community
where appropriate.
Improved patient choice
Reduction in secondary care activity.
Aims and objectives of service
This service to provide Gold injections in primary care is designed to be one in which:
Treatment is initiated in secondary care for recognised indications for specified lengths of time;
Maintenance of patients first stabilised by secondary care and discharged to primary care governed
by a shared care protocol;
iii. The service to the patient is convenient;
iv. The need for continued therapy is reviewed regularly by secondary care and discontinued when
The use of resources by the National Health Service is efficient.
Service description/care pathway
This local commissioned service will fund:
A Drug Administration Service in respect of all the following specified drugs:
Gold (as sodium aurothiomalate or myocrisin)
Production and maintenance of a register of all patients prescribed Gold. The consultation record
will include:
The patient’s name and date of birth;
The indication for and likely duration of treatment;
Computerised linkage of medication to indication for treatment;
Which drug is being used;
Read code diagnosis;
The responsible consultant;
Relevant clinical history, examination findings and test results;
Follow up arrangements.
iii. Call and recall of patients on the register to monitor the effects of medication and to ensure regular
review is taking place by STHFT;
iv. Re-referral to STHFT where the patients’ symptoms or other complications require specialist advice;
Record keeping relating to the service, including all known information relating to any significant
events – i.e. deaths – of which the practice has been notified;
vi. Training/Accreditation. The GP must ensure that he or she has the information and knowledge to
understand the therapeutic issues relating to the patient’s clinical condition and that all staff involved
in providing any aspect of care under this scheme has the necessary training and skills to do so.
Those doctors who have previously provided services similar to the proposed LCS and have such
medical experience, training and competence as is necessary to enable them to contract for the LCS
shall be deemed professionally qualified to do so.
vii. Clinical Audit All practices must undertake an annual clinical audit as detailed in schedule 4 part c. A
standard data collection form for the clinical audit will be distributed to providers and this must be
completed and returned to the Clinical Audit & Effectiveness team at Sheffield CCG. The timescales
and process for forwarding audit results will be notified to the provider by the commissioner.
Outcomes of audits may be discussed with practices.
Practices are expected to use best practice when recording data. Please address any data quality
queries to the Data Quality Team at Sheffield CCG.
Inter Practice Referrals. Where the service is provided by someone other than the patient’s
own practice, the provider must ensure that the patients registered GP is given this information, after
obtaining explicit consent from the patient.
Population covered
This service will be available to every patient in Sheffield eligible for primary care monitoring of Monitoring of
Disease Modifying Antirheumatic Drugs (DMARDs) Gold.
Any acceptance and exclusion criteria and thresholds
Please see protocol by following link
Interdependence with other services/providers
Clinicians at Sheffield Teaching Hospital Rheumatology departments.
Applicable Service Standards
Applicable national standards (e.g. NICE)
Applicable standards set out in Guidance and/or issued by a competent body (e.g. Royal Colleges)
Applicable local standards
Location of Provider Premises
The Provider’s premises are located at:
Individual GP practices