Case Summary No: 1451
Trust / Providers concerned: Somerset Clinical Commissioning Group
Date Closed: 27 July 2015
Outcome: Not Upheld
A patient complained as they were advised by their secondary care specialist that they could no longer receive prescriptions of liothyronine (T3) as a result of changes to the Somerset Clinical Commissioning Group’ s (CCG) prescribing formulary guidance for Somerset.
What we found
The prescribing formulary is developed based on National Institute for Health and Care Excellence (NICE) guidance and best practice, with the engagement of Somerset GPs. The CCG has historically commissioned the use of liothyronine in acute trusts as a short term rescue therapy for patients with severe hypothyroid episodes, due to its the rapid response. However, the CCG has never approved the use of liothyronine as a long term maintenance therapy, a position which was agreed with local specialists.
This position was recently reviewed and reiterated that the CCG did not commission long term maintenance therapy with liothyronine, as it was not deemed to be a safe and a cost effective use of NHS resources. GP practices and secondary care colleagues were reminded of this, with the expectation that specialist doctors working in secondary care would review patients and convert their treatment over to levothyroxine and also not initiate any new patients on liothyronine. No guidance was given to cease treatment.
Putting it right
The complainant was given assurance that as with any drug, doctors in Somerset retain their clinical freedom. Where the CCG does not consider the specialist recommendation to be a cost effective use of NHS resources then the CCG would not normally support the commissioning of the drug and doctors would be supported in making a different prescribing choice to the specialist recommendation. Somerset CCG is fully supportive of doctors addressing clinical need and specialist clinicians working in acute trusts may make applications for individual funding in exceptional circumstances for drugs not formally commissioned.