You may be aware that a coalition of thyroid organisations, including the British Thyroid Association (BTA), worked together on a Dossier for the Lord O’Shaughnessy in respect of the harm being done to patients in respect of the NHS England guidance on liothyronine.
After the publication of the Dossier, the Regional Medicines Optimisation Committee (South) (RMOC) published their own guidance which was felt by all the thyroid patient organisations to not be in line with the NHS England guidance. This guidance was then available for all CCGs in their area to use. Since then the patient organisations and the BTA have been talking with NHS England, the outcome of which was that they agreed to clarify the RMOC guidance.
We know that many patients are still having their liothyronine withdrawn or not being referred to endocrinologists for a trial and this is not acceptable. However, we are also hearing, at long last, that some CCGs are recognising the need for liothyronine by some patients.
Hopefully, the clarification of the RMOC guidance will enable patients to have their liothyronine reinstated and trials to be given to patients who do not resolve all of their symptoms with levothyroxine.
The RMOC have published a small article in their March 2019 Newsletter as follows and we look forward to giving feedback to the draft. We will keep you informed of progress.
The RMOC guidance concerning the prescribing of liothyronine was published in November 2018 in order to provide advice to CCGs regarding the application of the national NHS England and NHS Clinical Commissioners’ guidance: ‘Items which should not routinely be prescribed in primary care: Guidance for CCGs’ which had been published in November 2017 which you can find here.
Following the publication of the RMOC guidance, variation in practice was documented in the House of Lords dossier entitled ‘Case Details with Clear Evidence that NHS England Guidance on Prescription of Liothyronine is not Being Followed by CCGs; Evidence in Response to a request from The Lord O’Shaughnessy, Parliamentary Under-Secretary of State for Health and Social Care’. You can download this dossier here.
The RMOC guidance was discussed with key individuals including senior clinical and academic representation from the British Thyroid Association. The reduction in variation of practice as a result of implementing the RMOC guidance was welcomed, but clarification was requested concerning some of the statements in the RMOC document. The document is being considered in light of the House of Lords dossier, with the aim of providing clarification rather than a change in guidance A draft revision of the published RMOC guidance, with clarification of the wording, has been discussed at the South RMOC and is currently being circulated to the South RMOC for review. This will then be circulated to other RMOCs for comment.