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GPs should not alter liothyronine prescriptions without oversight, says NHS



NHS England has released new advice for prescribing liothyronine, clarifying its position after some CCGs ‘wrongly’ used official guidance to tell GPs to stop prescribing the drug.

The new advice has clarified that GPs should not change existing prescriptions – or administer new ones – without the oversight of an NHS consultant endocrinologist.

It follows guidance originally published in 2017, which set out how to reduce prescriptions for a number of routinely prescribed items in primary care – and after a period in which the price of liothyronine rose dramatically.

When NHS England issued the guideline at the end of 2017 the document said: ‘In most circumstances, the primary care prescribing of liothyronine is not supported for any patient.

‘Initiation for patients with hypothyroidism should only be undertaken by consultant NHS endocrinologists.’

However, CCGs were incorrectly using the guidance to tell GPs to end prescriptions for the drug, according to former BMA GP Committee prescribing lead Dr Andrew Green.

The cost of liothyronine increased by almost 6,000% in a decade – from £4.46 in 2007 to £258.19 by July 2017, as revealed in an investigation by the Competition and Markets Authority.

Dr Green said: ‘Some CCGs were wrongly using the guidance to tell GPs to stop these prescriptions, whereas the correct action for GPs is to refer back into NHS endocrinology services for assessment.

‘Equally, patients cannot use opinions received from non-NHS sources to pressurise GPs to provide liothyronine prescriptions.’

In the new advice published last month by NHS England, the document states: ‘The prescribing of liothyronine is only supported if initiated by, or considered appropriate following a review by, an NHS consultant endocrinologist.

‘The withdrawal or adjustment of liothyronine treatment should also only be undertaken by, or with the oversight of, an NHS consultant endocrinologist.’

It added: ‘Where GPs are involved in such treatment changes this should be with NHS consultant endocrinologist support.

‘This applies to both liothyronine monotherapy and combination therapy with levothyroxine.’

Dr Green welcomed the new advice, which he said makes clear the position for GPs.

He said: ‘This is welcome guidance as it clarifies what was the intention of last year’s guidance from NHS England’s Low Priority Prescribing Clinical Working Group.

‘It confirms that decisions regarding the care of patients who believe they need liothyronine should be made by an NHS endocrinologist, who would also be responsible for prescribing until stability is achieved.’

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