Integrated Medicines Optimisation Board (IMOB)

Black Country IMOB October 2025:

The final minutes from 31.07.25 have been shared 

The key summaries of 2^nd October 2025 IMOB meeting are set below. 

1. COVID-19 Medicines Delivery Unit (CMDU) Update

• Service continues to deliver antiviral treatments effectively with positive patient outcomes.
• High patient satisfaction, multilingual outreach, and strong system collaboration noted.

• Awaiting ICB decision on future service model beyond October 2025.

2. Primary Care Medicines Optimisation Priorities

• Progress reported on carbon-neutral inhalers, valproate safety, antimicrobial stewardship, and blood glucose test strips.
• ICB performing above average in most metrics; carbon emissions remain challenging.

• Ethical prescribing challenges in deprived areas acknowledged.

3. Antimicrobial Resistance (AMR) Update – Secondary Care

• ICB meeting or exceeding most national AMR targets.
• Ongoing focus on IV-to-oral switch and managing TB drug shortages.
• Communication systems effective across primary and secondary care.

4. Joint Formulary & Shared Care Updates

• Discussion on:
  • Private use of Mounjaro (tirzepatide) and non-commissioned drugs in inpatients.
  • Shared Care Group membership and review of drugs requiring shared care.
  • Communication gaps around ESCA processes and clinician education.

 Medicines Optimisation Group (MOG)

Black Country MOG October 2025 Key Summaries:

Final MOG minutes 26.08.25 approved  

The key summaries include:  

Primary Care Efficiencies 2024/25

• Cost efficiency target exceeded by £3.2m.
• Savings from prescribing support, Optimise Rx, and targeted workstreams.
• Programme improved patient safety and supported financial targets

Medicines Optimisation Workplan 2024/25

• Place-based teams delivering prescribing improvement and safety audits.
  Polypharmacy reviews and care home support ongoing.
  Focus on equity, workforce optimisation, and digital solutions for 2026/27.

Prescribing Incentive Scheme (PIS) Evaluation

• Direct financial savings and high practice engagement.
• Reduced antibiotic prescribing, improved diabetes and lipid management.
• Recommendations for refining scheme design and outcome measurement.

Optimising SGLT2 Inhibitors (Dapagliflozin)

• Generic dapagliflozin now recommended for T2DM and heart failure.
• Significant national and local savings expected.
• Systems to update pathways and support switching; supply chain confirmed.
  Action: Update on dapagliflozin switch plan/timeline to be provided at December MOG.

Insulin Discontinuation Update
- Several insulin products discontinued between 2025–2026.
- System-wide searches and guidance in place for safe patient switching.
- Ongoing monitoring and support for practices.

Community Pharmacy Weight Management Pilot

• £50k grant for pharmacy-led weight management pilot (5–10 patients).
• Clear eligibility criteria and wraparound care.
• Collaboration with BSOL for future funding; equity and competition concerns noted at the meeting.

Patient-Led Ordering Policy

• Policy empowers patients to order repeat prescriptions directly.
• Exceptions for vulnerable and digitally excluded patients.
• Joint implementation by GP practices and pharmacies; robust communication plan required.

Antimicrobial Stewardship (AMS) Update

• AMS event held; focus on paediatric RTIs and back-up prescriptions.
• Prescribing rates monitored; campaigns and resources promoted.
• National safety alert for TB antimicrobials; dashboard and resources available

Standing Items Updates: 

• Community Pharmacy Services, Finance, JFG, MORAG, NICE TA, IMOB, MSN, PST updates noted (refer to enclosures).
• COVID-19 treatments, concession prices, and medicines safety discussed.
• Black Country respiratory documents to be adopted regionally.

AOB & Consultations

• Members reminded to review and feedback on consultations for pharmacy flexibilities and optometrist prescribing (links provided):
  Consultation 1  
  Enabling pharmacist flexibilities when dispensing medicines - GOV.UK  

Consultation 2 
Extend medicines for optometrists and contact lens opticians - consultation document - GOV.UK 

• Brand to generic SOPs x 3 – virtually approved 30^th September 2025 
• Updated Repeat Prescribing Policy – virtually approved 19th August 2025 
  (refer to this document for current best practice, including updates on 7-day prescribing, eRD, care home processes, high-risk medicines, and expanded appendices.)
• BCICB Emollient Good Practice Guidance  

Produced by the BC ICB Medicines Management Care Home Group – shared for Virtual/Meeting approval 20th October 2025
Approved by Quorate vote at MOG 28th October 2025 

Next BCICB MOG 16th December 2025

Please share/provide comments changes to the draft minutes of 28.10.25 by 17^th November 2025.

Formulary Update

Formulary Update

Doxylamine succinate and pyridoxine hydrochloride (Xonvea®)

The Black Country Joint Formulary Group approved Doxylamine succinate and pyridoxine hydrochloride (Xonvea®) as GREEN

Lidocaine 4% adrenaline 0.1% and tetracaine 0.5% gel

The Black Country Joint Formulary Group approved Lidocaine 4% adrenaline 0.1% and tetracaine 0.5% gel as RED.

Trifarotene (Aklief®)

The Black Country Joint Formulary Group approved Trifarotene (Aklief®) as GREEN

NICE TA drugs

The JFG approved the following NICE TA recommendations and RAG statuses 

• Ribociclib with an aromatase inhibitor for adjuvant treatment of hormone receptor-positive HER2-negative early breast cancer at high risk of recurrence [TA 1086] RED
• Durvalumab with tremelimumab for untreated advanced or unresectable hepatocellular carcinoma [TA1090] RED
• Tarlatamab for extensive-stage small-cell lung cancer after 2 or more treatments [TA1091] BLACK
• Pembrolizumab with carboplatin and paclitaxel for untreated primary advanced or recurrent endometrial cancer [TA1092] RED
• Idebenone for treating visual impairment in Leber’s hereditary optic neuropathy in people 12 years and over [TA1093] RED
• Benralizumab for treating relapsing or refractory eosinophilic granulomatosis with polyangiitis [TA1096] RED
• Enfortumab vedotin with pembrolizumab for untreated unresectable or metastatic urothelial cancer when platinum-based chemotherapy is suitable [TA1097] RED
• Isatuximab in combination for untreated multiple myeloma when a stem cell transplant is unsuitable [TA1098] RED
• Betula verrucosa for treating moderate to severe allergic rhinitis or conjunctivitis caused by tree pollen [TA1087] GREY
• Guselkumab for treating moderately to severely active ulcerative colitis [TA1094] RED
• Guselkumab for treating moderately to severely active Crohn’s disease [TA1095] RED
• Latanoprost–netarsudil (Rolanda) as AMBER RECOMMENDED

Change of RAG status for Parkinson’s medications

• The Black Country Joint Formulary Group approved the change of RAG status for the following Parkinsons medication from AMBER INITIATION to AMBER RECOMMENDED.

• Amantadine
• Safinamide
• Opicapone
• Entacapone
• Co-caredopa +Entacapone(brands include Stanek, Stalevo and Sastrav)

Malignant Chapter additional drug lines 

The Black Country Joint Formulary Group approved the following RAG status for additional drugs in the Malignant Chapter

• Canakinumab for treating gouty arthritis attacks and reducing the frequency of subsequent attacks (terminated appraisal) [TA 281] BLACK
• Dactinomycin -For Paediatric Systemic Anti-cancer therapy (SACT) RED
• Dimethyl fumarate for treating relapsing‑remitting multiple sclerosis [TA 320] RED
• Glatiramer acetate for treating multiple sclerosis [TA 527] RED
• Interferon beta (Avonex) for treating multiple sclerosis [TA 527] RED
• Interferon beta (Betaferon) for treating multiple sclerosis [TA 527] RED
• Interferon beta (Proleukin) BLACK
• Interferon beta (Rebif) for treating multiple sclerosis [TA 527] RED
• Ofatumumab for treating relapsing multiple sclerosis [TA 699] RED
• Peginterferon alfa(Pegasys)  and ribavirin for the treatment of chronic hepatitis C[TA 200] RED
• Peginterferon beta-1a(Plegridy)  for treating relapsing–remitting multiple sclerosis[TA 624] RED
• Sarilumab for moderate to severe rheumatoid arthritis[TA 485] RED
• Siponimod for treating secondary progressive multiple sclerosis [TA 656] RED
• Sirolimus-BLACK
• Teriflunomide for treating relapsing–remitting multiple sclerosis[TA 303]RED

Substance misuse section in Central Nervous System(CNS) Chapter 

The Black Country Joint Formulary Group approved the substance misuse section of CNS

The section will be published on the Black Country formulary website in due course.

Local News

Discontinuation of Exenatide (Bydureon BCise) 2mg/0.85ml prolonged-release suspension for injection pre-filled pen

Exenatide (Bydureon® BCise®) 2mg/0.85ml prolonged-release suspension for injection pre-filled pens have been discontinued with supplies now exhausted. Clinicians should:

• not initiate new patients on Bydureon BCise;
• review existing patients and consider switching to an alternative once weekly parenteral GLP-1 RA which can fully support increased demand;

When switching to an alternative agent, ensure patients are not intolerant to any of the excipients, and are counselled on the new treatment, the reason for the switch, dosing regimen, and how to administer it (refer to product SPC).

Semaglutide (Ozempic) and dulaglutide (Trulicity) are alternative once weekly GLP-1 RAs which remain available and can support increased demand. If these GLP-1 RAs are not appropriate, GIP/GLP-1 RA tirzepatide (Mounjaro) is available and can support the increased demand. Consider dose reductions for those on concomitant insulin or sulfonylureas when switching to tirzepatide (Mounjaro) to avoid the risk of hypoglycaemia.

If the above options are not considered appropriate, advice should be sought from the diabetes team on alternative management options.

Consider when switching from Bydureon BCise to alternative GLP-1 RA or GLP-1 RA/GIP: 

• Initiation of semaglutide, dulaglutide, or tirzepatide should occur two weeks after the final dose of Bydureon BCise, due to the approximate half-life of Bydrureon BCise. Ensure patients are advised appropriately on potential side effects.
• Due to limited data on switching between GLP-1 RAs or GLP-1 RA/GIP, it is recommended to follow the licensed initiation protocol for each agent.

See SPS Medicines Supply Tool for further information and updates.

Levemir discontinuation: start reviewing patients to avoid disruptions in treatment

Levemir (insulin detemir) is being discontinued in December 2026. No new patients should be started on any Levemir product, and all existing patients should be switched to an alternative before September 2026 to avoid disruptions in treatment, as recommended by NHS England. The products affected are Levemir FlexPen 100units/ml solution for injection 3ml pre-filled pens, and Levemir Penfill 100units/ml solution for injection 3ml cartridges.

Clinicians should take a planned approach aiming for a steady decline in patient numbers over the coming 12 months, particularly where specialist input is required so that clinical services are not overwhelmed. Practices should review patients in primary care using the following advice where able to do so. Patients already under specialist teams should be reviewed at their next routine appointment. 

 Prioritise high risk patients for review:

• Impaired awareness of hypoglyacemia
• History of severe hypoglycaemia
• Frailty, renal impairment or high glucose variability
• Paediatrics and young people

 Key switching steps:

1. Identify patients: run clinical system searches and prioritise high risk patients 
2. Assess individual needs:  Consider patient preference, dexterity, other insulins and co-morbidities, renal condition, frailty, hypoglycaemia.
3. Select alternative: Insulin glargine (Semglee/Lantus, Toujeo), insulin degludec (Tresiba cartridges only) or human isophane insulin (Humulin I supply cannot currently support uplift in demand). Diversifying choice of insulin helps prevent other supply shortages. Link to local formulary options here.
4. Adjust dosage: start new insulin with 20% dose reduction from Levemir to reduce risk of hypoglycemia, and titrate with glucose monitoring
5. Patient education: train patient on new insulin device and injection technique, share manufacturers videos and support materials
6. Supply ancillaries: prescribe needles, pen devices and blood glucose monitoring equipment
7. Monitor closely: ensure frequent glucose checks post-switch and follow up the patient to assess safety and efficacy

To avoid medicines wastage, patients should not discard their remaining Levemir stocks but can use them up until their review and switch to an alternative has occurred. 

Useful resources:

• National clinical guidance from Association British Clinical Association and Primary Care Diabetes & Obesity Society
• Specialist Pharmacy Service Medicines Supply Tool for more info and current supply position of alternative insulins (log in required)
• Local prescribing data and advice is available from the ICB Medicines Optimisation Team upon request

National supplies of alternative insulins (as of August 2025)

Safety Update

Please click here for a full summary of SPC updates in October.

Paracetamol and pregnancy - reminder that taking paracetamol during pregnancy remains safe

23^rd October 2025

MHRA reiterates there is no evidence that taking paracetamol during pregnancy causes autism in children. Pregnant women should continue to follow existing NHS guidance. Untreated pain/fever can pose risks to unborn baby so patients should continue to use recommended treatment.

Isotretinoin – updates to prescribing guidance and survey of services

27th October 2025

The Commission on Human Medicines (CHM) has endorsed changes to isotretinoin prescribing guidance. In addition, CHM is seeking further information from dermatology services who prescribe isotretinoin to inform any future changes to current risk minimisation measures.

Prescribing News

NICE Guidance - October 2025

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of October 2025. This month there is one technology appraisal and one guideline that impacts upon primary care.

The Mirabegron for treating neurogenic detrusor overactivity in people 3 to 17 years technology appraisal has been terminated. NICE is unable to make a recommendation for this indication because the company did not provide an evidence submission.

The HIV testing: increasing uptake among people who may have undiagnosed HIV guideline has been updated. The update recommends using the UK Health Security Agency's annual surveillance data on HIV to help establish local prevalence.

The information in the Prescribing News section has been adapted from the Prescribing Advice for GPs blog  

This section has been adapted from www.prescriber.org.uk 

CKS October 2025 

During October 2025 Clinical Knowledge Summaries were published or updated in the following areas. 

• Anticoagulation - oral
• Contraception - progestogen-only methods
• Diabetes - type 1
• Earwax
• HIV infection and AIDS
• Mental health in students
• Osgood-Schlatter disease
• Tennis elbow

All of the topics have been reviewed and updated with minor structural and layout changes. The Contraception - progestogen-only methods topic has been updated to align the recommendations with updated guidance from the College of Sexual and Reproductive Healthcare (formerly known as the Faculty of Sexual and Reproductive Healthcare). The Diabetes - type 1 topic has been updated in line with evidence in current literature, including the use of diabetes-specific autoantibody testing in adults at diagnosis, and when to suspect hypoglycaemia.

Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice. 

The information in the Prescribing News section has been adapted from the Prescribing Advice for GPs blog  

This section has been adapted from www.prescriber.org.uk 

Drug Availability

Medicines Supply Issue Update for Primary and Secondary Care

Registered users can use the medicines supply tool to get the most up-to-date information on medicine supply issues, actions to take, alternative medicines to use, and expected resolution dates for primary and secondary care.

Free registration with an NHS email address is required for access.

Drug Tariff Price Change

Drug tariff price changes are summarised as the top 10 price reductions and top 10 price increases since last month, the top 25 increases and decreases compared to three months ago, and the top 50 changes since last year.

Drug tariff in price changes in November

Antimicrobial Update

Please click here to find SPC updates and other news in October.

Patient Group Direction for the supply of nitrofurantoin capsules/tablets for the treatment of Urinary Tract Infection (UTI): Version 2.0 

Version 2.0 of this PGD template, valid from Jan 2026, has been published to allow organisations to undertake local governance processes in a timely manner. Version 1.4 of this PGD template remains currently valid and will be removed from this page on its expiry (31st Dec 2025).

Patient Group Direction for the supply of trimethoprim tablets for the treatment of Urinary Tract Infection (UTI): Version 2.0 

Version 2.0 of this PGD template, valid from Jan 2026, has been published to allow organisations to undertake local governance processes in a timely manner. Version 1.2 of this PGD template remains currently valid and will be removed from this page on its expiry (31st Dec 2025).

How to keep antibiotics working
As part of World Antimicrobial Resistance Awareness Week from 17 November to 30 November 2025, we are encouraging practices to share materials to raise awareness of how to keep antibiotics working.
 
Please share the assets attached from 17 November onwards. Further assets are available on the Campaign Resource Centre.

Please also share the super bodies campaign for children too. The materials have been developed by NHS Birmingham and Solihull ICB. 

Please note that the information in this newsletter is correct at the time of publication.
Clinicians should always refer to the most up to date information.

hitesh.patel15@nhs.net

tahera.fardous@nhs.net, sarah-louise.walton@nhs.net

medicines.walsallccg@nhs.net

arti.punn@nhs.net

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