Friday Letter 12/04/2019

Friday 12th April 2019

NEL Self-Assessment survey

Following our email during the week, thank you to all those who have promptly responded to our short self asessment survey.

If you have not done so already, and follow the link below. Your response will take no longer than 2-3 minutes to complete and will enable your LPC to provide you with more relevant and personalised support.

Self-assessment link:


Levomepromazine 25mg/ml injection supply issue

Please read through the following message from DHSC regarding a supply issue with levomepromazine 25mg/mL injection.

URGENT-Levomepromazine 25mg/ml injection supply issue – information for Primary Care

Overview of Supply

  • Sanofi informed NHS England and DHSC on 5th April 2019 that they are going out of stock this week of levomepromazine 25mg/ml injection and new stock is expected to be available from the end of April.
  • The supply issue is due to a quality deviation experienced at their Italian factory and is not linked to EU exit.
  • The only other UK supplier, Wockhardt, have informed us that due to the unexpected increase in demand, they will also go out of stock of levomepromazine injection and their next delivery has been delayed with further stock expected at the end of April.
  • Wockhardt have confirmed the remaining levomepromazine 25mg/mL injection stock which is held at Alliance will be ring-fenced for primary care use only. Stock at Alliance is limited and will not last until the end of April.
  • Existing stocks are likely to be exhausted by end of this week and no new supplies are expected until end of April.
  • GPs, palliative care networks and community pharmacies should consider the following advice and work together during this period to ensure patients can be managed appropriately.

Alternative agents

  • UK Medicines Information with support of national clinical specialists have developed the following clinical information to help support the management of patients  who may be affected by this issue.
  • Please follow the link to view this guidance:
  • All the suppliers of the following medicines have  been made aware of this supply issue and have confirmed they can support an increase in demand should this be required.
  • Haloperidol 5mg/1ml solution for injection ampoules (DrugsRUs)
  • Midazolam 10mg/2ml solution for injection ampoules (Hameln, Accord, Roche)
  • Cyclizine 50mg/ml solution for injection ampoules (Advanz)
  • Metoclopramide 10mg/2ml solution for injection ampoules (Hameln, Ennogen)

Management Plan – GPs, Palliative Care Networks and Community Pharmacies to review and action immediately

  1. During the period of shortage, new patients should only be started on levomepromazine if other treatment options have been exhausted. This is to try to avoid disrupting existing treatment regimens where possible whilst acknowledging that for some new patients levomepromazine may be the only option available.
  2. Community pharmacies who require stock for existing patients should order Wockhardt stock from Alliance.
  3. Community pharmacies having difficulty obtaining stock should contact their local secondary care trusts as they have been asked to support primary care and hospices where possible, to understand if they have stock that can be made available to allow the continuation of treatment in existing patients.
  4. Some specialist importers have identified stock they can bring into the UK. Lead times vary between 7-21 days. If community pharmacies are considering ordering unlicensed imports, the community pharmacist will need to inform the prescribing doctor the product being supplied to the patients is an unlicensed product. Please consider placing orders now for 1-2 weeks of stock based on forecasted demand. We are currently aware that Clinigen, Waymade, Alium and Mawdsleys have sourced unlicensed supplies from abroad.
  5. Community pharmacies unable to obtain levomepromazine injection should liaise with the prescriber to discuss using an alternative product as outlined in the memo above.


Meeting the challenge of reducing stress and building resilience in the NHS workforce | Health Education England

Health Education England has launched a new framework to help health and social care employers improve the mental wellbeing of their employees.

The document encourages employers to take a closer look at the systems they currently  have in place for managing staff wellbeing,  it challenges them to give greater consideration to the impact  workforce stress has on staff and look at the role they can play in providing better support to staff who may need It.


Ongoing issue: FP10s for eye drops /ointments

There have been local issues of drops being dispensed where ointment has been prescribed by the ophthalmologist on the hospital FP10.

If you receive a prescription and are unsure, please check. if ointment form is prescribed by an ophthalmologist it cannot be changed to drops withour agreement from the prescriber.

If you have any comments or are experiencing similar issues, please contact the LPC office.


MAS Supply Issue- Outer London pads

The Outer London Pads for Barking and Dagenham, Redbridge and Waltham Forest are currently out of stock.

If you are in these boroughs, please continue to order as your order will be added to a backlog which will be cleared when the stock is replenished in the coming weeks.

MAS Pad order page:


NHS England has launched a new monthly podcast on primary care networks.

In this episode (39 mins), a GP talks about her passion for primary care networks and how she is supporting the development of networks in her own area, as part of the work across Surrey Heartlands Integrated Care System.


CPD: Respiratory and Allergy

You may want to join healthcare professionals for the MIMS Workshops Respiratory and Allergy Learning Series taking place across the UK in 2019. The programme will be delivered by expert speakers and is aimed at GPs, nurses and other healthcare professionals, with the opportunity to earn 4 hours of CPD credits.



Help Us Help You- Evaluation of Campaign

Following the February 2019 Pharmacy Advice Help Us Help You Before it gets worse campaign, PHE are asking for the completion of a short survey to give feedback regarding their campaign support materials.

All pharmacies should have pariticpated in this mandatory campaign, your response is appreciated and will support the improvement of furtre campaign materials produced by PHE.

Please click here to complete the short survey


Blood pressure management

Please see the new 30 minute CPD module on Blood Pressure Management from Pharmacy Magazines website.

Click here to view.


Community pharmacists and rheumatoid arthritis

Local Medicines adviser, Sarah Wood, is currently undertaking her PhD in the pharmacological management of rheumatoid arthritis .

If you work in a pharmacy at least one day a week, please kindly lend your support by completing this short survey?

Thank you in advance for your time, please share with your pharmacy networks and encourage them to support.


CPD: A digital framework for allied health professionals.

Please see the following link for the above CPD. Although not pharmacy specific, the information contained is very helpful and informative.

Click here to view

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