County Durham and Darlington

Noted (AI summary) Durham County Council refers to its written submission to the inquest and reaffirms its commitment to suicide prevention, but provides no new information.

Noted (AI summary) The Department for Transport explains that there is no legal requirement to hold a driving licence to register a vehicle, or to become the keeper of an already registered vehicle, and outlines circumstances where this might occur.

Noted (AI summary) Humankind has implemented a standard operating procedure for prescription deliveries, including mandatory witnessed delivery and recording in the service user's notes. They have also established a contact procedure and contingency plan for failed deliveries, and record failed deliveries as incidents in their management system. Boots UK acknowledges the concerns raised and states the gravitas is duly noted.

Noted (AI summary) NICE acknowledges the correspondence but states that responsibility for the content of the BNF lies with the publishers, BMJ Group and Pharmaceutical Press, and therefore NICE cannot comment on the concerns raised. The Royal Pharmaceutical Society will add additional information regarding acute pulmonary reactions to the nitrofurantoin monograph in the BNF, specifically highlighting it in an additional section of the side-effects information, and will also add information on the importance of counselling patients on the possible symptoms of acute pulmonary reactions and the necessity of promptly reporting such symptoms. The medical group has emailed prescribing clinicians about nitrofurantoin side effects, will discuss the matter at a Significant Event Analysis Meeting, plans to provide written information to patients, and will contact the Local Medicine Management Team to suggest changes to local guidelines. The MHRA will request that Marketing Authorisation Holders strengthen the wording in the UK Summary of Product Information (SmPC) and Patient Information Leaflet (PIL) regarding pulmonary reactions to nitrofurantoin. The MHRA will also communicate any SmPC and PIL updates, to the BNF, and will communicate to UK healthcare professionals to inform them of these updates via the Drug Safety Update.

Noted (AI summary) The Department for Health and Social Care acknowledges the concerns and outlines existing NICE guidance and CQC recommendations regarding the safe use and management of controlled drugs. They highlight the need for regular monitoring of patients before repeat prescriptions are issued.

Noted (AI summary) Oxleas NHS Foundation Trust states they no longer have any involvement in the authorship or editing of the Maudsley Prescribing Guidelines since April 2015. Tees Esk & Wear Valley NHS Foundation Trust is developing a Medication Safety Series document regarding prescribing resources and sources of patient information, aiming to have a draft ready for approval on 24th September 2020 and complete dissemination by 2nd October 2020. NICE has passed the concerns regarding lamotrigine to the BNF publishers and will consider moving a footnote about the risk of suicidal thoughts and behaviour into the recommendation of their guideline on epilepsies, currently being updated. BNF Publications will add suicidal ideation as a side effect to the lamotrigine monograph and the important safety section of the lamotrigine monograph in the BNF.