Download SWL CE Bulletin Issue 20 Nov 2012

Primary Care Clinical Effectiveness Bulletin
Edition No. 20: November 2012
Welcome to your South West London digest of
best practice relevant to primary care. This
information is collated each month from
national and local sources, with hyperlinks to
the more detailed guidance within each
section – simply [control + click] within the
sections to follow the links to websites.
AND
 Consideration will be given to patients with
significant asymmetry.
(Significant
asymmetry will be defined as a difference
of at least 2 full cup sizes*) to the extent
that they cannot get a bra to fit;
* AA, A, B, C, D, DD, E, F, FF, G, GG, H, HH, J,
JJ, K, L
Contents (Ctrl+Click to go straight to section)
1. South West London Effective
If the patient does not fulfill the criteria laid
out above, but the applicant feels that there
are other exceptional circumstances that
would justify funding, a request stating these
additional reasons can be made in the form of
an
IFR
(Individual
Funding
Request)
/exceptional circumstances application.
Commissioning Initiative (SWLECI)

Augmentation/Mammoplasty ( breast
Enlargement
2. NICE Clinical & Public Health
Guidelines


Walking and Cycling
Obesity – Working with local
communities
2. NICE Clinical Guidelines & Public
Health Guidelines
Walking and cycling: Local measures to
promote walking and cycling as forms of
travel or recreation (PH41) Applicable to
3. NICE Technology Appraisals and IPGs


Mannitol powder for cystic fibrosis
Ivabradine for chronic heart failure
primary, secondary care services & local
government
4. Other news
This guidance sets out how people can be
encouraged to increase the amount they walk
or cycle for travel or recreation purposes. This
will help meet public health and other goals,
for instance, to reduce traffic congestion, air
pollution and greenhouse gas emissions.
1. South West London Effective
Commissioning Initiative (ECI)
The SW London Effective Commissioning
Initiative (ECI), is driven by the need to
ensure that NHS funded treatments are
effective, evidence-based, provide value for
money, and that access to them is equitable
across the cluster. This month’s featured
criteria are from the current 2012/13 ECI list.
Encouraging and enabling people to walk or
cycle requires action on many fronts – and by
many different sectors. A range of issues have
to be addressed, including environmental,
social, financial and personal factors. The
recommendations cover:
 local programmes
 policy and planning
 schools, workplaces and the NHS.
Augmentation/Mammoplasty (Breast
enlargement)
Other measures are needed to tackle the
wider influences on walking or cycling. This
includes
reducing
road
dangers
and
reallocating road space to create a more
supportive environment.
This procedure is not routinely funded by the
NHS but may be funded through the prior
approval process in the following situation:
 The patient should be 18 or over at the time
of application
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Primary Care Clinical Effectiveness Bulletin
Edition No. 20: November 2012
Obesity - working with local
communities (PH42) Applicable to primary,
and

whose lung function is rapidly declining
(forced expiratory volume in 1 second
[FEV1] decline greater than 2% annually)
and
community, secondary care services & local
government
This guidance aims to support effective,
sustainable and community-wide action to
prevent obesity. It sets out how local
communities, with support from local
organisations and networks, can achieve this.
This guidance focuses on the prevention of
overweight and obesity. The recommendations
may also help people who are already
overweight or obese to lose weight, or to
prevent them from gaining further weight. It
does not cover clinical management for people
who are already overweight or obese. The 14
recommendations cover:
 developing a sustainable, community-wide
approach to obesity
 strategic leadership
 supporting leadership at all levels
 coordinating local action
 communication
 involving the community
 integrated commissioning
 involving local businesses and social
enterprises operating in the local area
 local authorities and the NHS as exemplars
of good practice
 planning systems for monitoring and
evaluation
 implementing monitoring and evaluation
functions
 cost effectiveness
 organisational development and training
 scrutiny and accountability.

1.2 People currently receiving mannitol whose
cystic fibrosis does not meet the criteria in 1.1
should be able to continue treatment until they
and their clinician consider it appropriate to
stop.
Chronic heart failure - ivabradine
(TA267) Applicable to primary, secondary &
tertiary care services
1.1 Ivabradine is recommended as an option
for treating chronic heart failure for people:
 with New York Heart Association (NYHA)
class II to IV stable chronic heart failure
with systolic dysfunction and
 who are in sinus rhythm with a heart rate
of 75 beats per minute (bpm) or more and
 who are given ivabradine in combination
with
standard
therapy
including
betablocker
therapy,
angiotensinconverting enzyme (ACE) inhibitors and
aldosterone antagonists, or when betablocker therapy is contraindicated or not
tolerated and
 with a left ventricular ejection fraction of
35% or less.
1.2 Ivabradine should only be initiated after a
stabilisation period of 4 weeks on optimised
standard therapy with ACE inhibitors, betablockers and aldosterone antagonists.
3. NICE TAs and IPGs
Cystic fibrosis - mannitol dry powder for
inhalation (TA266) Applicable to secondary
1.3 Ivabradine should be initiated by a heart
failure
specialist
with
access
to
a
multidisciplinary heart failure team. Dose
titration and monitoring should be carried out
by a heart failure specialist, or in primary care
by either a GP with a special interest in heart
failure or a heart failure specialist nurse.
care services
1.1 Mannitol dry powder for inhalation is
recommended as an option for treating cystic
fibrosis in adults:

for whom other osmotic agents are not
considered appropriate.
who cannot use rhDNase because of
ineligibility, intolerance or inadequate
response to rhDNase
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Primary Care Clinical Effectiveness Bulletin
Edition No. 20: November 2012
4. Other news
’Eyes on Evidence’ (NHS Evidence)
This monthly newsletter covers major new
evidence as it emerges, with an explanation
about what it means for current practice.
For other NICE publications please click
on titles below:
New Evidence Updates on NICE guidance
Guidance is continually under review in the
light of new scientific evidence. Recent
evidence updates have included lung cancer
and peritoneal dialysis.
Interventional Procedure Guidance
Diagnostic Guidance
Medical Technologies Guidance
Quality Standards
NICE 'will ensure consistent care in
commissioning landscape'
Practical support for general practice
NICE provide a collection of resources to
enable general practice professionals to
improve outcomes for their patients by
ensuring that their practice is up to date with
current recommendations from NICE on
clinical practice, public health, social care and
support for GP led commissioning.
NICE guidance and quality standards will help
provide consistent care for patients within the
new NHS commissioning landscape, say
experts. As a result of the changes to the
system, CCGs can expect a range of
challenges and opportunities as they take on
their new role, such as ensuring the care they
provide is comparable with that in other areas.
Experts on a recent NICE webinar on
commissioning agreed that NICE has an
important role to play in the commissioning
landscape, working with the Outcomes
Framework to help ensure that there is no
regional variation in care.
Editorial team
Thank you to those who have fed back on the
usefulness of this bulletin and made
suggestions for improvement. All comments
are helpful to continually improve it. Contact
details for your borough leads are:
NICE Pathways - NICE Pathways brings
together all related NICE guidance and
associated products in a set of interactive
topic-based flowcharts. A total of 75 pathways
have been produced so far and can be
browsed A to Z or by topic.
Usman Khan, Richmond Borough Team,
[email protected]
Tracy Steadman, Croydon Borough Team,
[email protected]
Alastair Johnston, Wandsworth Borough Team,
[email protected]
Livia Royle, Kingston Borough Team,
[email protected]
Jacqueline Lindo, S&M Borough Team,
[email protected]
PRODIGY (formerly CKS)
Is a reliable source of evidence-based
information and practical 'know how' about the
common conditions managed in primary care.
See new and updated topics
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