COVID-19 Prescribing Advice

We will endeavour to offer specific prescribing advice and support via this dedicated page regarding COVID-19.  Please check back regularly for updates.

4th June 2020 Prescribing & Medicines Optimisation Guidance 

Latest bulletin can be accessed here. Content includes NICE Rapid evidence summaries, Valproate Pregnancy Prevention Programme: temporary advice for management during coronavirus (COVID-19), Supply Disruption Alert: Zyban® (bupropion hydrochloride) 150mg prolonged release tablets, Danazol 100mg and 200mg capsules discontinued, 

4th June 2020 - Dealing with patient returned medicines during COVID-19

NPA COVID-19: Guidance on dealing with patient-returned / unwanted medicines (England)

Appendix 1: checklist on pharmacy considerations for accepting unwanted medicines

Managing patient returned medicines during the COVID-19 pandemic - flowchart

27th May 2020 - Prescribing & Medicines Optimisation Guidance 

Latest bulletin can be accessed here. Content includes vitamin D in COVID-19, fluoxetine 40mg serious shortage,  Patient level RECALL: Emerade (adrenaline) auto injector 500microgram, PrescQipp- free access now available, Ranitidine- Ongoing supply issues, Influenza Season 2019/20: ending the prescribing and supply of antiviral medicines in primary care, COVID-19: Guidance for commissioners and providers of services for people who use drugs or alcohol. 

26th May 2020 - NHS Diabetes Advice Helpline

NHS Diabetes Advice is provided by NHS England and NHS Improvement in response to disruption to normal services due to the COVID-19 pandemic and response. The service is for adults living with diabetes who use insulin to manage their condition and require immediate advice from a team of clinical advisors. Whether they or a member of their household have caught the virus, or routine care has been disrupted, the helpline can provide clinical advice to help them understand how to effectively manage their diabetes.  Full details can be found here

19th May 2020 Prescribing & Medicines Optimisation Guidance 

Latest bulletin can be accessed here. Content includes Contingency controlled drugs legislation, Vitamin D: A rapid review of the evidence for the treatment or prevention in COVID-19, Supply Issues- Sytron oral solution, NICE rapid guidelines, National flu immunisation programme 2020/21.

12th May 2020 - Prescribing & Medicines Optimisation Guidance 

Latest bulletin can be accessed here. Content includes valproate pregnancy prevention, vitamin B12 update, routine vaccination schedule, adverse effects - coronavirus tests and treatment, inhaled beclomethasone.

6th May 2020 - Guidance for initiation of valproate in female patients and for annual review and pregnancy testing to support adherence to pregnancy prevention requirements during the coronavirus pandemic

Please see MHRA advice here

6th May 2020 - Dealing with patient returned/unwanted medicines during COVID-19

Please see the NPA Guidance here

4th May 2020 - Prescribing & Medicines Optimisation Guidance 

Latest bulletin can be accessed here. Content includes urgent prescriptions, secondary care requests to prescribe, triptorelin, supply problems and NICE guidance.

30th April 2020 Prescribing & Medicines Optimisation Guidance

Latest bulletin can be accessed here. Content includes medicines re-use in a care home or hospice setting, sexual health contraception, vitamin D supplementation, Ramadan and diabetes.

28th April 2020 - Accepting medication returns at community Pharmacies

For both the service specification 2018-20, and the new service specification 2020-22, there are several requirements to meet to claim payment under the CCG commissioned Just in Case - Palliative Care Medicines Service. In addition to the requirement to stock the essential medicines, there is also the requirement to accept patient returns by family or carers for destruction, and have the appropriate training and SOPs in place to provide a safe and effective service.

Patient returns enables the removal of controlled drugs from the community and it is important to avoid misuse or diversion, and protects people in our community from harm. Misuse and diversion is an increased risk at the moment when normal supply routes and prices of "street" drugs have been affected by the COVID-19 pandemic and Hampshire is seeing an increased incidence of drug related overdoses and deaths.

  • All returned medicines from patients should be treated as if they are contaminated with the COVID19 virus and we recommend;
  • Taking steps to maintain a 2- metre distance from the person returning the medicines
  • Where possible, do not physically handle the returned medicines and ask the person returning to:
  • Separate controlled drugs from other medicines and put in separate bag
  • Offer new carrier bags to the person returning the medicines
  • Ask for the medicines to be placed into the carrier bag, and double-bagged into another, tied, and directly placed into the waste medicines container
  • Repeat for controlled drugs, and quarantine for 5 days in the CD cabinet before processing as normal. If there is no space, quarantine in a secure location in the pharmacy
  • Wearing the appropriate PPE, especially gloves (single use) when handling the waste medicines and containers. If you have physically handled the returned medicines, be careful not to touch your face and wash your hands immediately after handling. See section on Protecting your team in the pharmacy
  • Clean and disinfect all surfaces which have been used during this process

For the period of the pandemic we recommend that no further processing by pharmacy staff is undertaken e.g. removal of packaging, labels or segregation (unless it is a CD that has been identified from the beginning). Please discuss with the patient/representative that this does pose some risk to patient data as you will not be able to remove names and addresses from the return. Further information can be found here 

22nd April 2020 Venous Leg Ulcers - Self Care Support Resources beneficial during social distancing

This link gives direct access to all of L&R’s key resources to watch or download including measuring forms, ordering code lists, application posters and measuring & application videos. Self help videos for patients taking care of their wound at home are also available on the site. We hope this gives you the resources you need to support your venous leg ulceration patients in these unprecedented times and whilst we socially distance ourselves from face to face support.

22nd April 2020 - Accessing Sexual Health Services

We would like to inform you that from the 1 April 2020 Solent NHS Trust have been commissioned by Isle of Wight Council to provide Sexual Health Services on the Isle of Wight. The service will run from the same clinic at St. Mary’s Hospital and the current Isle of Wight NHS Trust staff will transfer to the new service.  Further details about accessing services can be found here 

21st April 2020 - New Isle of Wight COVID website

Community Action have developed the following informative website specific to the Isle of Wight and COVID-19

20th April 2020 - Acute use of non-steroidal anti-inflammatory drugs (NSAIDs) in people with or at risk of COVID-19

In response to the public health emergency posed by COVID-19, NHS England has established a rapid policy development process to aid clinicians in offering best care and advice to patients with or at risk of COVID-19. This document sets out the clinical policy for the acute use of non-steroidal anti-inflammatory drugs (NSAIDs) in people with or at risk of COVID-19. The chronic use of NSAIDs is outside of the scope of this policy with a separate review to take place.

20th April 2020 - 4th Community Pharmacy Preparedness Letter

20th April 2020 - Dietician Referral

Dietitians may not have the capacity to individually assess each patient due to the high numbers, current referral criteria is:

  • BMI <16
  • MUST 3+
  • new coeliac
  • uncontrolled IBD
  • High output stoma
  • New Type 1 diabetes
  • Wound healing
  • Dysphagia
  • Type 2 diabetes with poor control / on low carb diet in order to prevent admission / GP/ Nurse contact

Therefore, in order to reduce malnutrition and support favourable clinical outcomes, HCPs in the community can use the letter template to request ONS if they have identified a patient as being at risk of malnutrition, it includes ONS rationale and recommendations. A copy could be sent to the GP for approval and also the dietitians so that if there is a chance for dietitians to review the patient we would be able to do so.

20th April 2020 - PPE Ordering 

HWIOW PPE Order Form

HWIOW PPE Stock Ordering Process

PPE Guide

NSDR Ordering Information

10th April 2020 - Prescribing & Medicines Optimisation Guidance

Latest bulletin can be accessed here. Content includes Nutrition for the End of Life, Respiratory Inhalers, Drug monitoring advice (Near patient testing), Care homes- Good practice guide, Tissue Viability Advice Line – extended hours, Emerade (adrenaline)autoinjector 300microgram, Omeprazole soluble and liquid formulations, UK citizens “caught “overseas".

9th April 2020 - Nutritional Support for Care Home Patients - COVID-19

Nutrition plays a vital role on helping people stay healthy and recover from illness. This document has been provided to help care homes with residents who require nutrition support during the COVID-19 pandemic. This Information has been collated and adapted from resources by the Medicine Optimisation Specialist Dietitian for North and Mid Hampshire and the Dietitians on the Isle of Wight. 

6th April 2020 - Prescribing & Medicines Optimisation Guidance

Latest bulletin can be accessed here. Content includes Covid-19 rapid guideline: managing suspected or confirmed pneumonia in adults in the community (NG165) 3 rd April 2020, Covid-19 rapid guideline: managing symptoms (including at the end of life) in the community NG163 3 rd April 2020, COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders NG167 3 rd April 2020, Hydroxychloroquine and Chloroquine, Easter Opening Hours for Community Pharmacy.

1st April 2020 - Temporary approval of home use for both stages of early medical abortion

The Secretary of State for Health and Social Care has approved 2 temporary measures in England to limit the transmission of coronavirus (COVID-19) and ensure continued access to early medical abortion services:

  • women and girls will be able to take both pills for early medical abortion up to 10 weeks in their own homes, without the need to first attend a hospital or clinic
  • registered medical practitioners (doctors) will be able to prescribe both pills for the treatment of early medical abortion up to 10 weeks from their own homes

This must be carried out in line with the criteria set out in this document.

1st April 2020 - Prescribing and Medicines Optimisation Guidance

Latest bulletin can be accessed here. Content includes update to eRD during Covid, Increased awareness around Controlled Drugs, Wessex LMC letter, Medicines Advice line via SMAS.

1st April 2020 - New Website area for practice and community nurses

A new page has been created on the MOT area of the CCG website to support practice and community nurses. The page currently has information to support reduced unnecessary patient contact for dressing changes during the current pandemic.  The page can be accessed here 

31st March 2020 - Prescribing and Medicines Optimisation Guidance

30th March 2020 - Wessex Local Medical Committees 

Letter regarding Pharmacy opening hours and duties during the pandemic can be found here

27th March 2020 Guidance for the safe switching of warfarin to direct oral anticoagulants (DOACs) for patients with non-valvular AF and venous thromboembolism (DVT / PE) during the coronavirus pandemic

Guidance can be downloaded here

27th March 2020 - Community Pharmacy Buddy List

Please download the "Buddy List" here. It applies if the pharmacy is closed/ has had to close for more than the allowed 2.5 hours of their working day. i.e. if they were closed during the core hours as stated in the COVID SOP to maintain access to pharmaceutical services in the event of a temporary closure.

27th March 2020 - Community Pharmacy PPE 

We are trying to organise PPE kit for you all to keep your staff as safe as possible.

Please could you complete the online form here with the quantity of kit you think you will need over the next 72 hours. We will be in contact again to discuss ongoing supplies beyond that. Please remember we have finite stock so only request the amount that you need and give consideration to what type of mask is needed for staff that are customer facing and high risk vs. those that may be less customer facing, behind a screen, etc.

26th March 2020 - Isle of Wight Council Wellbeing Service Update

Due to COVID-19 all face-to-face clinics will now transfer to telephone support until further notice. All patients new and existing will be offered this support.

Self-referrals for stop smoking can be made through the normal route:

The patient should call 01983 823670 or email: You will be asked to leave name and contact details (this can be phone number or email address) and for the best time to contact. We will get back to to the patient within 5 working days to discuss how we can help

Referrals for weight management must be made by a health professional or Jobcentre+/DWP by completing the attached referral.

Please note physical activity referrals and health walks have been suspended until further notice.


In light of the increased demand on community pharmacy we have made some changes to the pharmacotherapy process.

NRT: Usually in total the Wellbeing Advisor’s submit up to 6 requests for NRT – 1 request per week for a period of 6 weeks. Until further notice the Wellbeing Advisor will submit two requests for two weeks worth of NRT which can be collected together at one visit.

The Wellbeing Advisor will add the following to the Pharmoutcomes comments box: 

“If there are any problems with the products availability or if you would like to provide instructions for collection at a certain time please contact the client directly on telephone number provided.”

The Wellbeing Advisor will inform the client that they have submitted the above comment directly to the pharmacy and if the client has any problems to call the Wellbeing Advisor.

This format will be followed at each stage during the NRT cycle. If client is in at risk group and they have no support to access to collect medication Wellbeing Advisor to provide the following Isle of Wight Council number to them: 01983 823600 open 9 until 5.


The Wellbeing Advisor will add the following to the comments box 

“Please call the client on the telephone number provided. The client has been informed that the pharmacy will call them directly.”

The Wellbeing Advisor will inform the client that they have submitted the above comment directly to the pharmacy and if the client has any problems or has not had a response within three working days from the pharmacy to call the Wellbeing Advisor. The Wellbeing Advisor will then contact the pharmacy directly.

This format will be followed at each stage during the Champix cycle. If client is in at risk group and they have no support to access to collect medication Wellbeing Advisor to provide the following Isle of Wight Council number to them: 01983 823600 open 9 until 5.


If you have any questions, please do not hesitate to contact me on the details below.

Thank you for all your support at this difficult time. 

Lauren Stott

Senior Public Health Practitioner

UKPHR Registered Public Health Practitioner: Registration No: PRO171

Public Health Team | Isle of Wight Council| Jubilee Stores | The Quay | Newport |Isle of Wight |PO30 2EH

Direct telephone line: 01983 821000 extension 6978 Email:

25th March 2020 - NICE Rapid guidelines for COVID-19

Can be accessed here

25th March 2020 - Helpline set up to support the most vulnerable residents affected by self-isolation measures

Isle of Wight Council and voluntary networks have worked together to provide this helpline to ensure those that need assistance are supported.

You can call 01983 823 600 between 9am and 5pm, 7 days a week. A poster for display can be downloaded here

This helpline is for anyone;

  • who needs help because of self-isolation
  • who is alone and needs support
  • who feels vulnerable

24th March 2020 - Increase to Community stock holding of Just In Case medications

We envisage using the following for people unable to receive SC drugs;

  • Fentanyl 12 size patches. If these become unavailable, we’ll then use 25 size patches cut in half (i.e. would need to be a matrix formulation, not a reservoir)
  • Scopolamine 1mg patches
  • Olanzapine oro-dispersible 5mg size tablets
  • Lorazepam
  • Hyoscine hydrobromide 300 microgram size tablets (e.g. Kwells)

Please can we increase the community stock holding from 1 box of everything (typically 10 ampules) to 3/5 boxes of key lines. Some patients may require relatively low dose opioids, antipsychotics and antimuscarinics for breathlessness, agitation and chest secretions and the route will vary according to the circumstances (e.g. SC injection or oro-dispersible preparations with some use of patches) 

The stock that currently has availability issues is not a big concern:

  • Morphine 30mg/1ml - back in stock
  • Levomepromazine - unavailable

24th March 2020 - Community Pharmacy Palliative Care Stock Check

We appreciate that you are all very busy, but are you able to complete a quick stock check of the palliative care medicines that you have in stock this week? A form has been developed onPharmOutcomes to make this as quick and easy as possible to do. The audit is ready and you are all accredited, you'll find the audit under Palliative Care on the Services tab withinPharmOutcomes. We will then have an idea of the capacity within the system and if we need to change anything at this stage to be able to support our community better over the next few weeks. Remember you'll be paid quarterly for the audits, paid for any new stock and any that goes out of date.

Many thanks, Caroline Allen. 

23rd March 2020 - NHS England and NHS Improvement Novel Coronavirus (COVID-19) standard operating procedure - Community Pharmacy

Available for download here 

20th March 2020 - Due to the current situation with COVID-19, please could I ask that any patient that currently requires vitamin B12 injections be converted to tablets.

A small cohort with the co-factor will not be able to absorb tablets (other than a small amount of passive absorption), however, it take up to 12 months for levels to deplete, and so we’d recommend testing in 6-12months once this COVID-19 pandemic has passed. This practice is in line with the CCG current guidance. The vitamin formulary can be found here and a B12 algorithm here and patient information leaflet here.

20th March 2020Is there is anything that the CCG can help you with, to keep patients safe and healthy, and pharmacies dispensing medicines?

We’ll do whatever we can to help.

  • We’ve extended the urgent supply service to avoid the need for repeat prescriptions.
  • We’ve extended the palliative medicines services to support patients and families/cares at what may be a distressing time.
  • We’ll be batching repeats for patients at Grove House and Argyll, so if the patients use your pharmacy, please support them with the changes to the prescription process. We have leaflets and information sheets to support you with this.

We are holding daily SIT REPs (situation reports) with the general practices in primary care to keep on top of any issues arising. Would a daily pharmacy SIT REP be useful? You could telephone in for a few minutes at a set time each day. Would 1pm work?

For teleconference Dial: 0333 0110 614   Room number: 96157007 #    PIN: 9173 #

Let’s ensure that we all keep communicating and supporting each other where we can. 


20th March 2020 - Early use of antibiotics in older adults

Rapidly managing pneumonia in older people during a pandemic

Non-response to initial antimicrobial therapy increases mortality, and so the initial selection of antimicrobials is critical. According to NICE, to cover atypical and multiple pathogens in older patients with pneumonia and at risk of severe complications, the recommended choices of antibiotics in the community are:

Amoxicillin with  500mg three times a day (higher doses can be used - see BNF) for 5 days
Clarithromycin 500mg twice a day for 5 days
Alternative oral antibiotics for penicillin allergy, if the pneumonia is of moderate intensity; treatment should be guided by microbial results when available

Doxycycline OR 200mg on the first day, then 100mg once a day for a further 4 days (5 day course in total)
Clarithromycin 500mg twice a day for 5 days

Mel Stevens, IOW NHS Trust Anti-Microbial Pharmacist and Emily McNaughton, Microbiologist support this advice. We recommend that you review your stock holding of these items, if possible.

20th March 2020 - Letter to DMARDs Patients and advice on monitoring during COVID-19

Letter to DMARDs patients regarding monitoring during the pandemic is available to download in the "Downloads" section below.

The following pragmatic guidance has been agreed withrheumatology at St Mary’s. Basically we encourage patients to keep taking their treatment including prednisolone and biologics as long as they are well. If they become unwell we advise stopping DMARDs and biologics for a couple of weeks. Prednisolone should be continued and may need to be increased. Patients on these drugs should consider themselves at high risk.

This applies to patients who are stable on their DMARDs.

Those patients who have recently started DMARDs and those with recent deranged blood results which require more frequent monitoring, should continue with more frequent monitoring.


Current monitoring interval

Monitoring internval during COVID19


8 weekly U&E, FLT, FBC

 3 to 4 monthly


3 monthly LFT, FBC

6 monthly U&E

5 to 6 monthly U&E, LFT, FBC


U&E monthly

BP monthly

FBC, LFT 3 monthly

Lipids annual

U&E, LFT, FBC, BP 2 to 3 monthly


LFT, FBC 2 monthly

BP & weight at visits

LFT, FBC, BP & weight 3 to 4 monthly

Lefunomide  and at least 1 other immunosuppressive

LFT, FBC monthly

BP & weight at visits

2 monthly  LFT, FBC, BP & weight


FBC, LFT 3 monthly

U&E 6 monthly

U&E, LFT, FBC 6 monthly

Mercaptopurine in heterozygous TMTP patients

FBC, LFT monthly

U&E 6 monthly

FBC, LFT 2 to 3 monthly

U&E 6 monthly


FBC monthly

FBC 2 to 3 monthly


U&E, urinalysis monthly

FBC, urinalysis

2 monthly

Penicillamine & renal dysfunction

U&E, urinalysis 2 weekly

U&E, urinalysis

2 weekly

Sulfasalazine in first year of treatment

LFT, FBC 3 monthly

6 monthly (in the first 2 years of stable treatment)

20th March 2020 - Daiichi-Sankyo confirm extra allocation across Hampshire STP of Edoxaban.  This supports the ongoing supply of the first line choice for NVAF. 

David France is working on which warfarin patients (probably the unstable patients) can switch to DOACs/NOACs and using edoxaban as first line DOAC where appropriate (depending on clinical indication). The community pharmacies don’t seem to have supply issues but it may be worth notifying them as they don’t currently hold much stock. Avoid rivaroxaban where possible as it’s subject to supply quotas. See the anticoagulation decision aid flowchart for more information.

20th March 2020 - As the COVID-19 situation escalates, more and more of the national groups for specific medical conditions will put out statements to support their patient groups. This is not an exhaustive list, but it’s a start and will no doubt grow over the next few weeks.  









Patient advice on ibuprofen

See NHS website (and all other relevant pages)

20th March 2020 - NICE is developing a series of rapid guidelines on the active management of COVID-19 infection.

The first 3 guidelines will cover the management of patients in critical care, the management of patients who are having kidney dialysis and the management of patients who are receiving systemic anticancer treatments.

Further guidelines, to be announced in due course, are likely to include: symptom management; patients receiving radiotherapy; and patients with rheumatoid arthritis.

NICE will be making the guidelines available to healthcare providers around the world on its website, so they can see the approach the UK is taking.

For the latest news on the development of COVID-19 guidelines visit our website.

20th March 2020 - As part of the island emergency response planning for the Isle of Wight, we have decided to EXTEND the JUST-IN-CASE PALLIATIVE CARE MEDICINES SERVICE.

This will cover:

  • All pharmacies.
  • Please hold the full stock list
  • The CCG/EMH may suggest that pharmacies prepare quick grab bags, to facilitate supply for specific patient groups – a list will be provided in due course.
  • The EMH Palliative Care Nurses may be prescribing under a PGD.
  • Please let me know of any supply issues and I’ll ask for stock availability.
  • The CCG will continue to pay every pharmacy who places a claim £60/quarter, and to order any stock required to hold the full list at this stage, or any stock that goes out of date afterwards.
  • All associated training, whilst encouraged is not obligatory for participation




Cyclizine (50mg/1ml) Ampoules


10 amps

Dexamethasone (3.3mg/1ml) Ampoules


10 amps

Fentanyl (100 micrograms/2ml) Ampoules


10 amps

Haloperidol 5mg/1ml Ampoules


10 amps

Hyoscine butylbromide 20mg/1ml Ampoules


10 amps

Levomepromazine (25mg/1ml) Ampoules


10 amps

Lorazepam 1mg tablets (rapidly dispersible – e.g. Thornton & Ross or Genus brands)


28 tabs

Metoclopramine (10mg/2ml) Ampoules


10 amps

Midazolam (10mg/2ml)  Ampoules


10 amps

Morphine Sulphate (10mg/1ml) Ampoules


10 amps

Morphine Sulphate (30mg/1ml) Ampoules


10 amps

Oramorph 10mg/5ml Oral Solution (one 300ml bottle)



Oxycodone (10mg/1ml) Ampoules


10 amps

Water for Injections 20ml size Ampoules


10 amps

Methadone (10mg/1ml) Ampoules for injection


10 amps

Ondansetron (4mg/2ml) Ampoules for injection


10 amps

Phenobarbitol (200mg/1ml) Ampoules for injection


10 amps

Ranitidine (50mg/2ml) Ampoules for injection


10 amps

Supporting families and carers with CD returns and destruction is an important part of this process to avoid misuse in the community.

Please do not under estimate how important your support during this COVID-19 pandemic may be, and we would like every pharmacy to provide this service for their community at what could be a distressing time for patients and families.

19th March 2020 - Inclusion Community Hub

Due to updated guidance around Covid 19. We will be relaxing our current prescribing regimes.  We hope to start this from Tuesday 24th March 2020. This means that the majority of our clients will be given TWO WEEKS medication to take home. The medication we prescribe is OST (Opiate Substitute Treatment).  This includes. Physeptone (methadone), Buprenorphine (Subutex) and Espranor. This may increase the risk of potential overdoses although we are doing everything we can to minimise this risk.  We will try to ensure that all of our clients are provided with at least one Naloxone pen and a lock box to help reduce risk. It may be helpful if you could check your stocks of Naloxone in case of emergency.

Inclusion Community Hub, Carisbrooke Road, Newport, 01983 526654,

13th March 2020 - In light of the latest COVID advice from the Government, NHSE and Public Health England, we have decided to EXTEND the URGENT SUPLY SERVICE with immediate effect.

This will cover:
* All patients with a UK GP
* Any day of the week
* Any time of the day.

Any questions, please contact myself or the PharmOutcomes help-desk. This will support 111 and the general practices who are likely to be busy dealing with symptomatic patients. We will be changing the Urgent Supply service to align with the national CPCS and PURMs service, once things are back to normal.

Caroline Allen, 

Deputy Head of Medicines Optimisation, Isle of Wight CCG.

Hampshire and Isle of Wight Partnership of Clinical Commissioning Groups

Telephone: 01983 534271 Email: Building A, The Apex St Cross Business Park, Newport, Isle of Wight, PO30 5XW