All Guidance

This protocol only applies to the unlicensed indications listed below. Transplant protocols should be followed for licensed indications.

Unlicensed: Severe rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, connective tissue diseases with severe / organ-threatening manifestations, interstitial lung disease (not to be used in idiopathic pulmonary fibrosis IPF), vasculitidies, as maintenance post cyclophosphamide in patients for whom azathioprine is contra-indicated or is inappropriate.

For Nebulisation in Adult Patients with Non-Cystic Fibrosis Bronchiectasis

• Age related Macular Degeneration   

• Diabetic Macular Oedema 

• Macular Oedema secondary to Central Retinal Vein Occlusion

• Macular Oedema secondary to Branch Retinal Vein Occlusion

• CNV associated with pathological myopia

• Vitreomacular Traction

The purpose of oral nutritional supplementation (ONS) is to supplement food intake, not replace it and their use does not remove the need to manage the underlying condition responsible for the patient’s poor appetite. It is important to ensure that prescribing is both appropriate for the patient and that the treatment length is such that waste is minimised.

Last updated on LSCMMG January 2023

Prescribing request from out-of-area specialists to Lancashire GPs where there is an inconsistency with the recommended local and out-of-area colour classification

In developing local commissioning policies, the CCG will commission treatments or services which accord with all of the following principles:

• Appropriateness
• Effectiveness
• Cost-effectiveness
• Ethics
• Affordability

A number of treatments which should be considered a LOW PRIORITY are detailed within this policy

Guidance on consensus approaches to managing Palliative Care Symptoms

Licensed: Severe active rheumatoid arthritis, including juvenile forms, Wilson's disease (hepatolenticular degeneration) in adults and children (0 to 18 years).

The purpose of this guidance is to outline recommendations for prescribing within primary care in Lancashire and South Cumbria. It is intended to provide information on current best practice including providing advice on prescribing situations which are not always clear so as to ensure a consistent approach by primary care prescribers across Lancashire and South Cumbria. All prescribers are encouraged to follow this guide.

Adapted from NICE guideline 112

Please note: GPs and other primary care prescribers are under no obligation to act upon the advice issued by a private specialist. If the NHS prescriber receiving the request does not believe they have the competence to initiate or continue the recommended intervention a referral to an appropriate NHS specialist should be made. Patients are entitled to receive additional private care if this is provided separately from NHS care.

The purpose of these guidelines is to provide a quick reference guide for use in primary care summarising information on the diagnosis and management of RLS in primary care. This guidance covers the management of RLS in primary care and gives information about when to refer to secondary care.