By ADSHGIn July 2016, the ADSHG made a submission to the Scottish Medicines Consortium to make the case for Plenadren to be approved for NHS prescription within Scotland for the treatment of adrenal insufficiency. Plenadren is a once-daily hydrocortisone modified release tablet that is designed to release its active ingredient slowly over 10 hours after swallowing.
By ADSHGNever Events framework 2015 does not include omission of steroids.
In 2014 the ADSHG prepared a submission to the NHS England consultation on Never Events, categories of hospital error which are supposed to be prevented by routine hospital procedure and safety checks.
In this submission, we asked the task force to add omission of steroids alongside overdose of insulin, as a reportable Never Event that is potentially fatal.
By ADSHGIn its 2008 submission to the Darzi healthcare review, 'Our NHS, our future', the ADSHG recommended the establishment of regional (tertiary) centres of expertise in adrenal medicine and effective partnerships between tertiary centres and local GPs.
Regional (tertiary) centres of expertise in adrenal medicine, able to offer:
1. Optimisation of steroid replacement therapy by monitoring:
Mineralcorticoid replacement (plasma renin, serum electrolytes) Glucocorticoid replacement (hydrocortisone day curve) DHEA replacement (DHEA-S, testosterone and oestrogen) Calcium and other indicators of bone turnover.
2. Life-long monitoring for the anticipated development of associated conditions. Frequently:
Hypothyroidism or Graves disease Diabetes Vitamin B12 deficiency Coeliac disease or other autoimmune conditions.
3. Patient education in prevention and treatment of adrenal emergencies, including training in self-injection.
4. Guidance to the patient’s other medical specialists regarding steroid cover for surgical and dental procedures
5. Effective partnerships between tertiary centres and local GPs
By ADSHGIn its submission to the government's 2009 review of prescription charges (the Gilmore review), the ADSHG recommended that prescription charges could be phased out in a cost-neutral way by placing patients with long-term medication dependencies on three to six month repeat prescriptions, as appropriate. This could generate savings on pharmacy dispensing fees and associated costs estimated at potentially £450 million per annum.
Summary of main points
Prescription charges and length of repeat prescriptions for patients with long-term medication dependencies are two issues that must be reformed in tandem, because of inevitable concerns over the potential for increased medicines wastage where medication is a 'free good' and because restricting patients to just 28-days’ supply at a time unnecessarily and artificially limits the medical benefit. The current main mechanism for wastage prevention, 28-day rationing, is inefficient when applied to drugs with a stable, long-term dependency. It is costing the NHS hundreds of millions of pounds in additional expenditure in pharmacy costs. Our estimates suggest it would be possible to phase out prescription charges for the entire UK population on a cost-neutral basis, through a one-third reduction of the current spending on pharmacy dispensing fees and associated charges. The prescription charge brings in around £450 million pounds in revenue, which is about one-third of the £1.36 billion spent on pharmacy costs. A cost-neutral phasing out of the prescription charge could be achieved by extending the length of repeat prescriptions for patients with a stable, long-term medication dependency from the current 28 days to between three and six months, as appropriate.
Download the following
Letter to Professor Ian Gilmore
Reforming prescription charges (letter 6 April 2009)
Background information for the Gilmore review
Monitoring the impact of 28-day repeat prescribing: do the benefits outweigh the costs?
Supplementary information to the Gilmore review on prescription charges.
Medicines wastage: how big is the problem?
By ADSHGHealth select committee, inquiry into priorities for health and social care in the negotiations on the UK’s withdrawal from the European Union, 2016