Integrated Care Protocols (ICPs)

The medicines listed below are designated within the Trust formulary as requiring Specialist initiation, and subsequent prescribing in accordance with an ICP – Integrated Care Protocol. These drugs are coded within the Formulary as amber.

Specialist initiation might be required because of complex assessment and diagnostic criteria for the disease being treated, or the medication used might be unfamiliar to GPs. As the prescriber of a medication legally assumes responsibility for the drug additional prescribing support might be required for continued prescribing.

An Integrated Care Protocol can assist in the seamless transfer of patient treatment from secondary care to general practice, as it provides information on the drug, together with guidance on the prescribing and monitoring responsibilities.

The timing of the transfer of prescribing responsibility for each medication is described in its specific ICP, but, as a principle, prescribing should be retained by the specialist until the dose is stable between hospital visits.

ICPs in place within the trust and agreed with our local ICBs are shown below. Additional ICPs may be found on Shropshire, Telford and Wrekin website Home – NHS Shropshire, Telford and Wrekin (shropshiretelfordandwrekin.nhs.uk) .

Copies of the agreement should be printed for each party – Specialist and GP – to agree, sign and retain.

Drug Name Indication ICB Review Date
Amiodarone Severe Rhythm Disorders Telford & Wrekin
Shropshire
09/18
11/17
Atomoxetine ADHD Telford & Wrekin 10/17
Azathioprine Gastroenterology (Shropshire CCG only), Dermatology Telford & Wrekin
Shropshire
09/16
09/17
Azathioprine Rheumatology Telford & Wrekin
Shropshire
03/18
09/16
Ciclosporin Dermatology, Rheumatology Telford & Wrekin 
Shropshire
01/17
09/17
Ciclosporin Osteoporosis Shropshire 03/18
Denosumab Osteoporosis Telford & Wrekin 10/16
Dronedarone AF Telford & Wrekin
Shropshire
09/18
11/17
Fluoxetine Depression in Children and Adolescents Telford & Wrekin 10/17
Growth Hormone Children Growth Hormone Deficiency Telford & Wrekin 03/18
Growth Hormone Adult Growth Hormone Deficiency Telford & Wrekin 03/18
Hydroxychloroquine Dermatology/Rheumatology Telford & Wrekin 06/16
Leflunomide Rheumatology Telford & Wrekin
Shropshire
07/17
03/18
Lisdexamfetamine ADHD Telford & Wrekin 12/16
Mercaptopurine Gastroenterology, Rheumatology, Dermatology Telford & Wrekin 12/18
Methotrexate Gastroenterology, Rheumatology, Dermatology Telford & Wrekin
Shropshire
09/17
09/17
Methotrexate Rheumatology Shropshire 03/18
Methylphenidate ADHD Telford & Wrekin 05/18
Penicillamine Rheumatology Telford & Wrekin 11/18
Riluzole ALS and MND Telford & Wrekin
Shropshire
12/18
11/15
Sodium Aurothiomalate Rheumatoid Arthritis Telford & Wrekin
Shropshire
09/18
03/18
Sulfasalazine Gastroenterology, Rheumatology, Dermatology Telford & Wrekin
Shropshire
09/16
09/16
Sulfasalazine Gastroenterology Shropshire 09/17
Pimecrolimus Mild, Moderate or Severe Atopic Eczema Telford & Wrekin
Shropshire
Under review
Under review

Out of date documents  are under review, but can continue to be used until a replacement ICP is agreed and adopted.

Prescribing Information documents outline the prescribing responsibilities between the specialist and the GP. The information provided within these documents are there to support and guide the GP through the treatment leading to safe management of the drug in primary care. If the GP feels that such prescribing is outside their area of expertise or has clinical concerns then, he or she is under no obligation to do so. If a specialist asks the GP to prescribe but the GP is not happy to continue prescribing, they must inform the specialist within 2 weeks of receiving the request.

The aim of these documents is to provide sufficient information for the GP to enable them to prescribe medicines that can be continued in primary care.

To provide all essential information to the GP and a link between primary and secondary care if the GP has further questions, clinicians within SaTH must print and complete the information within this document and send to the GP in the same manner as an ESCA.

Drug Name Indication                                                                         Prescribing Information Review Date
Fexofenadine Urticaria in Adults Prescribing Information 11/17
Glycopyronium- Hypersalivation Hypersalivation in Children & Young Adults with Neurological conditions Prescribing Information 01/18
Melatonin Sleeping Disorders in Children Prescribing Information 01/17
Rifaximin Hepatic Encephalopathy Prescribing Information 09/17
Sacubitril/Valsartan Symptomatic Chronic Heart Failure Prescribing Information 05/19
Ulipristal Uterine Fibroids Prescribing Information 09/17

Decisions about the NHS provision of Drugs and other Treatments.

As per s34(2)(a) of The National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 the Trust is compliant with the NICE recommendations in relation to the commissioning of drugs and treatments (More Information).

The NICE recommendations for any particular drug can be found on their website at: https://www.nice.org.uk/guidance

However, do you not have access to the internet and wish to come in and view these, you can contact the Trust and arrange an appointment to come in.