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Medicine Pathways, Guidelines & Position Statements

The following documents have been developed for clinicians working within NCL. Documents which have passed their review date should be viewed as an archived document for information only. If you have any queries, please email admin.ncl-mon@nhs.net.

Cardiovascular system (inc. anticoagulation)
Direct Oral Anticoagulants (DOACs)

VTE: Choice of DOAC (Position Statement)
NVAF: Choice of DOAC (Position Statement)

The documents below should be used to refer patients to their local anticoagulation clinic for initiation of anticoagulation. Where appropriate, local anticoagulation clinics should add their own contact details on the relevant paperwork (i.e. referral proformas, notification and transfer of care forms). Please note that these documents may be updated intermittently. Users are also reminded that the prescribing guidance is not definitive and that other sources such as the electronic medicines compendium (SPCs) should be used for the most recent drug information. This can be found at the following link: https://www.medicines.org.uk/emc

DOAC Anticoagulation Referral
DOAC Counselling Checklist
DOAC GP Communication
DOAC Prescribing Support

Other

Summary of Antiplatelet Options in Cardiovascular Disease
Lipid management – medicines optimisation pathways
Stable angina prescribing guideline
Omega-3 Fatty Acids Position Statement
Guidance for the review of Omega-3 fatty acids
Guidance for the management of hypertriglyceridaemia
Low Molecular Weight Heparin (LMWH) prescribing guideline

Respiratory system

Adult asthma inhaler choice – Full guideline
Adult asthma inhaler choice – Quick reference guide

The NCL Acute and Chronic Management of COPD treatment guideline is approved by the NCL JFC as an interim measure, pending publication of the Pan-London COPD pathway.

NCL Acute and Chronic Management of COPD

Central nervous system

Lidocaine 5% Patch Position Statement
Co-proxamol Tablets Position Statement
Clozapine management for patients admitted to acute hospitals guidance
Cannabis-based medicinal products Position Statement 
Cannabis-based medicinal products Patient Information
Valproate risk minimisation guideline

The “Adult ADHD: Additional information for prescribing in adults in primary care” document has been endorsed by C&I and BEH Mental Health Trust DTCs, and has been created to provide additional information to GPs when they consider requests to continue prescriptions for adult patients receiving stable doses for whom treatment was started by ADHD specialists working outside the NCL commissioned services (e.g., private organisations or overseas specialists).

The document can be found on the NCL GP website via the link below (note: you must login to view this page):

Adult ADHD: Additional information for prescribing in adults in primary care

Infections

NICE and UK Health Security Agency (UK HSA) have brought together their information on managing common infections into a summary table. The North Central London Medicines Optimisation Board (NCL MOB) support the use of the: Antimicrobial prescribing table (rcgp.org.uk).

Fluoroquinolones safe prescribing Position Statement
Treatment of Infections due to Multi-Drug Resistant Gram Negative Pathogens

From 1 June, the Health Services Laboratories (HSL) microbiology laboratory will apply new antimicrobial susceptibility result definitions recommended by the European Committee on Antimicrobial Susceptibility (EUCAST). While the letters ‘S’, ‘I’ and ‘R’ are retained, the definitions for the letters ‘S’ and ‘I’ have changed.
Communication to clinicians: Changes to antibiotic susceptibility reporting
Standard and High Dose Antibiotic Dosing Regimens

High consequence infectious diseases (HCID) centres in England have produced prescribing information for oral tecovirimat. This is hosted on the NCL MON website to support local clinicians and has been adapted to include supply information within NCL.
Tecovirimat prescribing information

Endocrine system – Flash glucose monitoring

Use of Flash Glucose Monitoring in North Central London (includes FSL2)

Position Statement
Implementation Guide (Based On LPP/LDCN Recommendations)

Forms – for use by diabetes specialists (includes FSL2)

Blueteq Forms for NCL patients (login required)
Patient-Prescriber Agreement (complete after training session)

Information sheets – for patients and primary care (FSL only)

Patient Frequently Asked Questions (FAQ)
Primary Care Information Sheet

Training materials (FSL only)

Training Pack For Health Care Professionals & Patients