NHS Ipswich and East Suffolk Clinical Commissioning Group
NHS West Suffolk Clinical Commissioning Group
Contents:
Catheter, Stoma &
Skincare
Formulary Version 12
July 2019
Catheter products
Stoma accessories
Skin care products
Community nurses/district nurses: Items not listed in this formulary are non-formulary. If needed for a particular patient, an exception
reporting form should be completed (available on SCH website).
Catheters
Initial catheterisation: the catheters listed in this formulary can be ordered by community
nurses through NHS Supply Chain for initial use only.
Long term catheter use: a prescription should be requested from GP practice.
Bowel Irrigation Anal and Ostomy irrigation: irrigation system products – specialist recommendation only
Stoma and skin care products
Stoma products: request a prescription from GP practice.
Skin care products: (excluding stoma skin care products) patients to be advised to purchase
skin care products
GP practice staff
Wherever possible formulary items should be prescribed. If a non-formulary item is required,
an exception reporting form should be completed (available on WSCCG & IESCCG website)
Prescribing Indicator
First Line
Second Line
Special Consideration
Catheter Products
Intermittent Catheters
1. Single-use Intermittent Catheters (single use)
Intermittent catheterisation allows patients to empty their bladder when the normal functioning of the
bladder is impaired. A single use catheter is inserted into the bladder by the patient to drain the bladder and
is then removed. The frequency of use will depend on the patients’ clinical need and in normal
circumstances may be up to 5 times daily for bladder emptying.
*In certain circumstances some patients may require more frequent bladder emptying, including those with
neurological and spinal conditions. This cohort of patients, following assessment by a qualified nurse in this
field, may require bladder draining every 3 hours or up to 10 catheters per day*
Appliance Product
details
Gauge/ CH
size
Cost per pack
(pack size) Comments
Usual
quantity to
order
First Line
Teleflex Flocath Quick
Male
40cm 8-18
£36.95 (30)
Integral saline solution
Protective sleeve for
touch free application
Approx. use in
normal
circumstances
4-5 catheters per
day / 4-5 packs per
month
Female
20cm 8-14
Teleflex Liquick Base
Male 10-16
£85.24 (60)
Higher Quantity Pack
For patients requiring a
more flexible
catheter
Approx. use
4-5 catheters per
day / 2-3 packs per
month
Female 6-14
Paediatric 8-10
Second Line
Coloplast Speedicath
Male
8-16 £45.54 (30)
Quantities may be higher
for patients with
neurological /
spinal conditions Approx. use
4-5 catheters per
day /
4-5 packs per
month
Female
Wellspect Healthcare
LoFric Primo
Male 10-18 £46.80 (30)
For patient self-
catheterisation Female
15cm/20cm 10-14 £48.12 (30)
Paediatric 6-10 £48.12 (30)
Compact Option
Speedicath Compact
Male 12-18 £54.99 Compact size for rapid
use when mobile/out of
home OR poor dexterity
Pre Lubricated
May be a 2nd
product at lower
quantities on
repeat Female 8-14 £47.10
Pathway considerations for Intermittent catheterisation
Patients may be assessed and commenced on intermittent catheterisation from the following settings:
Acute: Ipswich Hospital / West Suffolk Hospital
- Urology Clinic
- Urogynaecology Clinic
Community: Suffolk GP Federation
- Bladder and Bowel Community Service
When considering patient appliance overuse or changes in patient clinical need, patients should be assessed by
their GP and if required referred back to the service which commenced the treatment.
Relevant contacts:
Suffolk GP Federation Bladder and Bowel Service: 0300 123 2425
Ipswich Hospital central number: 01473 712233
- Urology dept. 01473 703689
West Suffolk Hospital central number: 01284 713000
- West Suffolk Hospital website: https://www.wsh.nhs.uk/Services-A-Z/Services.aspx
- WSH Urology contacts link: https://www.wsh.nhs.uk/Services-A-Z/Urology/Urology.aspx
Indwelling Catheters and Accessories
Appliance Product
details
Gauge/ CH
size
Cost per pack
(pack size) Comments
Usual
quantity to
order
2. Long-term indwelling catheters (use for up to 12 weeks)
First Line
Rüsch Sympacath AquaFlate
Hydrogel Coated Latex
with prefilled syringe
Male
12-18 £6.27 (1) 1st Line
*Contains LATEX*
1 catheter every
4-12 weeks
In normal
circumstances 1
catheter can last
12 weeks
Suprapubic
catheters or
complex
conditions may
require more
frequent changes
Female
L.I.N.C All-Silicone catheter
with prefilled syringe and
Lidocaine Gel
Male 12-18
£5.57 (1)
2nd choice or
patients with latex
allergy
*Includes lidocaine gel
with pack* Female 12-16
Second Line
Rüsch Brillant AquaFlate
All-Silicone catheter
With prefilled syringe
Male 12-18
£6.11 (1)
2nd line choice or
patients with latex
allergy Female 12-16
Paediatric use only
Bard Biocath Hydrogel
Coated
Paediatric
5ml 8-10 £8.54 (1) Paediatric only
*Contains LATEX*
3. Catheter maintenance solutions
Sodium chloride 0.9%
OptiFlo S Bard 50ml £3.42 Used to unblock a
catheter
Usually not on
repeat unless
requiring regular
bladder wash outs Uro-Tainer NaCl 0.9% Braun 50ml £3.45
Solution G
OptiFlo G (Suby G) Bard 50ml £3.54
(50ml sachet) For patients prone to
encrustation.
Used as regular
maintenance to prevent
blockage
Usually not on
repeat unless
requiring regular
bladder wash outs Uro-Tainer Twin
(Suby G) Braun
2x30ml
sachets
£4.85
(2 x 30ml sachets)
4. Catheter lubricating gel
Cathejel Lidocain
Female 8.5g £1.10 For catheter insertion
Contains Lidocaine
*Not required for
LINC catheters that
include Lidocaine gel
PRN for use at
each
catheterisation Male 12.5g £1.15
5. Catheter valves (change every 7 days)
Care Flo catheter valve L.I.N.C Lever tap £7.59 (5)
Alternative to leg bag
*Assessment of bladder
function is necessary
before using this
product*
4 valves per Month
Incontinence Sheaths and Accessories
Appliance Product details Gauge/ CH
size
Cost per pack
(pack size) Comments Usual
6. Incontinence Sheaths (External Catheter)
First Line
Prosys Flofit
Self Adhesive Silicone
Sheath
Standard 24mm
28mm
31mm
35mm
40mm
£46.20 (30)
Use 1 sheath per 24 hours
*Ensure patient is correctly
measured prior to use*
Approx. use – 1
sheath per day /
1 pack per
month
Pop-on
Wide Band
Second Line
Jade Ultra Flex Extra Clear
Sheath
Small
25mm
29mm
32mm
36mm
41mm
£47.16 (30)
Medium
Intermediate
Large
Extra large
7. Sheath Accessories
Barrier Film Wipes
Coloplast Conveen Prep
Wipes 1st Line
Contains Alcohol
Sheath prep
wipes Box of 54 £10.81
1 wipe used at each sheath
change
Approx. every 24 hours
High Quantity Pack
2 boxes every 3
months Smith & Nephew
Secura Barrier Film Wipes
(Alcohol-free)
Barrier film
Wipes Box of 50 £23.68
Adhesive Remover
Great Bear
GB Soft Skin No Sting
Medical Adhesive
Remover Spray
Aerosol Spray 50ml £9.32
To aid sheath removal
when required
1 can of spray
per month
Great Bear
GB Soft Skin No Sting
Medical Adhesive
Remover Wipes
Wipes Pack of 30 £15.11 1 box of wipes
per month
Drainage Bags and Accessories
Appliance Product details Gauge/ CH
size
Cost per pack
(pack size) Comments
Usual quantity
to order
8. Leg Drainage Bags
First Line
LINC Medical Systems
LINC Flo Leg Bag
Use for 5-7 days
350ml
T tap only
Direct £20.72 (10)
Each box comes with 10
pairs of leg bag straps
To maintain a closed
system overnight leave the
leg bag connected and
connect a night bag to the
leg bag
Approx. 1 box
every 2-3 months
10cm tube
500ml
Lever tap /
T-tap
Direct
£22.27 - £22.31 (10) 10cm tube
30cm tube
750ml
T-tap only
Direct
£22.28 (10) 10cm tube
30cm tube
Second Line
Teleflex
Rusch Leg Bag
Use for 5-7 days
*Choice of lever tap or slide
tap*
350ml 10cm tube
£21.90 (10) Each bag comes with 2 leg
bag straps
To maintain a closed
system overnight leave the
leg bag connected and
connect a night bag to the
leg bag
Approx. 1 box
every other
month
30cm tube
500ml 10cm tube
£23.94 (10) 30cm tube
750ml 10cm tube
£23.94 (10) 30cm tube
9. Belly bag® (use for up to 28 days)
Teleflex Rusch Belly Bag
B1000
*Patient must have functioning
bladder musculature to use
product*
1 litre Twist tap £10.78 (1)
For patients where a leg
bag cannot be
Connected
*Not suitable for external
catheters or nephrostomy
tubing*
1-2 bags per
month
Appliance Product details Gauge/ CH
size
Cost per pack
(pack size) Comments
Usual quantity
to order
10. Disposable Single Use Night Drainage Bags
First Line
Linc-Flo
Non-sterile
Single use bags
2 litre 100cm tube £2.13 (10) First choice single use
Twist off tap
1 bag per night
3 boxes per
month
Second Line
Teleflex
Non-sterile
Single use bags with slide
tap outlet
120cm kink
resistant tube
£9.55 (30)
*higher quantity*
Single use bag with slide
tap outlet
Includes 1 x bed hanger per
pack
1box
every month
11. Reusable Night Drainage Bags
First Line
Linc-Flo drainage bag with
tap outlet
Use for 5-7 days
2 litre
lever tap /
T-tap
120cm anti-
kink tube £9.52 (10) Change every 5-7 days
1 box every
2-3 months
*If patient using
bags more
frequently –
consider daily
single use bags
as alternative*
Second Line – Reusable Drainage Bag
Teleflex
Rusch night drainage bag
2 Litre
lever /
slide tap
120cm kink
resistant tube £10.78 (10)
Change every 5-7 days
Each bag has integral bed
hanger
1 box every
2-3 months
12. Accessories
Leg bag holders
Clinisupplies Prosys sleeves
Small 24-40cm
£7.61 (4)
Washable
PRN use
Approx. every
4-6 months
Medium 36-50cm
Large 40-65cm
Clinisupplies Prosys
Leg bag straps P10LS £12.88 (10)
G-strap
Clinisupplies Prosys Retainer
Strap
Adult £12.27 (5)
Washable
PRN use
Approx. every
4-6 months Abdominal £13.54 (5)
Long term catheters, drainage bags and accessories
For support in ordering and advice with the catheter and drainage bag products on formulary please see useful
contact details below:
Linc Medical:
- Urology Product Specialist: Alison Naeem [email protected]
- LINC customer services 01572 717515
Teleflex:
- Urology product advisor: Ketan Vyas [email protected]
- Teleflex customer services 01494 532761
A catheter ordering list has been developed to assist healthcare professionals with ordering and prescribing of these
products – To access this with further guidance and information, please see the Continence section on Ipswich & East
Suffolk and West Suffolk CCG websites:
East:http://www.ipswichandeastsuffolkccg.nhs.uk/GPpracticememberarea/Clinicalarea/Medicinesmanagement/CCGF
ormularies/Woundcareandstoma.aspx
West: https://www.westsuffolkccg.nhs.uk/clinical-area/prescribing-and-medicines-management/dressings-and-stoma/
Bowel Irrigation and Accessories
Product Quantity and
code Price Comments
Usual quantity to
order
1. Anal Plugs
These are initiated after specialist recommendation ONLY and not to manage diarrhoea or constipation.
Patients can use 1-2 per day, depending on patient need. They should be left in place for no more than 12
hours.
Renew Insert Anal Plug Pack of 30
Regular: FG730
Large: FG731
£66.87
For management of bowel
incontinence to prevent leakage
Variable quantities
according on individual
patient need
Approx. 30-60 per month Coloplast Peristeen Anal Plug
Pack of 20
Small: 1450
Large: 1451
£47.51
£46.54
2. Anal Irrigation Systems – Peristeen unit, accessory pack and Qufora system
Anal Irrigation is a highly specialist treatment requiring assessment and initiation by a consultant/colorectal/stoma
nurse ONLY. This system can be used as a treatment in the management of bowel disorders i.e. chronic constipation,
bowel incontinence and/or neurogenic bowel dysfunction. This should only be considered where other less invasive
options have been unsuccessful. Comprehensive training for patients and carers, prior to initiating treatment is
essential to ensure safe and effective irrigation technique is undertaken.
Prescribing quantities should be based on individual patient need and take into consideration recommended quantities
for prescribing. If quantities ordered exceed those listed without good reason refer to stoma specialist.
Peristeen System and Accessories: To be prescribed under the recommendation of a specialist
Peristeen System
Includes:
1 control unit (pump and tubes) 2
rectal catheters (single use)
1 water bag (lasting 15 uses)
2 straps (to secure unit)
1 system
Standard:29121
Small: 29196
£77.53 System also available in
smaller size
1 unit every 3-6 months
depending on daily or
alternate day use.
90 uses per unit.
Peristeen Rectal Catheters
Includes:
10 rectal catheters
1 pack
Standard:21923
Small: 21928
£86.39 Available in smaller size
May need additional catheters
Approx. 30 per month if
using one per day.
Single use item
Peristeen Accessory Unit
Includes:
15 rectal catheters (single use)
1 water bag (lasting 15 uses)
1 unit
Standard:29122
Small: 29127
£135.12 System also available in
smaller size
1-2 per month depending on
frequency
Peristeen Tubes Pack of 2
Code: 21925 £7.75
As required in addition to the
Unit PRN
Qufora IrriSedo Mini System
Base set – mini system 15 I hand pump
I cone bag
15 Hydrophilic cones
Waste bags
(15 irrigations)
1 system
Code: 53601-015 £59.00
effective for the low anterior
resection syndrome patients and
those who have incomplete
evacuation issues
1-2 per month
Base set – mini system 30 1 hand pump
1 cone bag
30 Hydrophilic cones
(30 irrigations)
1 system
Code: 53601-030 £118.00
Helps patients in the
management of their bowels 1 per month
Qufora IrriSedo Extension Tube
(15 irrigations)
1 pack
Code: 52715-015 £45.00
For elderly patients with weaker
hands these extension tubes help
manage the system
1-2 per month
Qufora IrriSedo Balloon System
Base set:
1 control unit
1 water bag
2 rectal balloon catheters
1 system
Small: 58102-002
Regular: 58101-002
£70 Available in two different sizes. 6 monthly
Accessory set:
1 water bag
15 rectal balloon catheters
1 set
Small: 58202-015
Regular: 58201-015
£115.00 water bag 15 uses
catheter are single use Monthly
Rectal catheters x 10
1 pack
Small: 58302-010
Regular: 58301-010
£79.00 For an additional supply of
catheters Ad-Hoc
3. Ostomy Irrigation Systems – For Stoma Patients
Stoma manual irrigation system: This is for active independent patients requiring irrigation to maintain normal
bowel function. Both are first line systems following assessment and initiation from a specialist or stoma nurse ONLY,
which must be reviewed and monitored.
All requests for repeat prescriptions should be initiated by the patient; the preferred route is direct to the GP practice,
to enable a robust audit trail as per CCG recommendations.
Coloplast Assura Irrigation system
Irrigation bag (Coloplast)
Pack of 1
1 pack
Code: 1511
£14.86 Replace 2 to 4 times a year
Colotip (Coloplast)
Pack of 1
1 pack
Code: 1110 £7.85 Replace 2 to 4 times a year
Assura Irrigation Supporting
Plate
Pack of 5
1 Pack of 5
Code: 12820 £36.53 Replace 1 to 2 times a year
Brava Belt (Coloplast)
Pack of 1
1 pack
Standard: 0421 *please check correct
product with code*
£7.02 Replace 1 to 2 times a year.
Has a larger size if required (0422)
Assura Irrigation sleeve
Pack of 30
1 pack of 30
Code 60mm: 12836
40mm: 12834
£40.43 Maximum 1 per a month. Use once every 1-2 days
Dansac Irrigation System:
Water container (Dansac)
Pack of 1
1 pack
Code:95200-0000 £21.44 Replace 4 to 6 times a year
Clamp (Dansac)
Pack of 1
1 pack
Code:95210-0000 £9.28 Replace 2 to 4 times a year
Cone with tubing (Dansac)
Pack of 1
1 pack
Code:95205-0000 £13.78 Replace 2 to 4 times a year
Brush (Dansac)
Pack of 1
1 pack
Code:95220-0000 £2.34 Replace yearly
Tube (Dansac)
Pack of 1
1 pack
Code: 95215-0000 £1.64 Will require 2 per year
Irri-Drain with Ring Holder for
Silicone Ring
Pack of 20
1 pack
Code: 950-20 £27.41 Prescribe 1 to 2 a month
Irri-Drain Adhesive
Pack of 20
1 pack
Code: 950-35 £26.74 Prescribe 1 to 2 a month
Silicone ring (Dansac)
Pack of 1
1 pack
Code: 09547-0000 £5.50 Prescribe 1 to 2 a year
Restricted Products: Electronic pumps (e.g. Navina Smart Unit/Braun IryPump) are only to be issued following
specialist recommendation. This is for patients with poor dexterity or for specific patients groups where manual pumps
are unsuccessful or clinically inappropriate. Requests for prescriptions should only be accepted from a stoma specialist
nurse, hospital ward staff if a prior agreement has been made with the GP. This is usually a long term treatment.
Pathway considerations for Bowel and Ostomy Irrigation
Patients may be assessed and commenced on an irrigation system from the following settings:
Acute: Ipswich Hospital / West Suffolk Hospital
- Stoma Nurse Team
- Colorectal Clinic
When considering patient appliance overuse or changes in patient clinical need, patients should be assessed by their
GP and if required referred back to the clinic which commenced the treatment.
Useful Contacts:
Ipswich Hospital Trust Stoma Nurses Sharon Stopher, Sally Power 01473 703301
West Suffolk Hospital Stoma Nurses Katie Lloyd, Ann Hubble 01284 712697
East Suffolk GP Federation Community Stoma Nurses: Debbie Cooper, Sarah Skingley 01473 242168
West Suffolk Community Stoma Nurse: Bernadette Ambrose 07739 321369
Stoma Accessories
Product Quantity Price Comments Usual quantity to order
1. Barrier films (used with each bag/flange change)
3m Health Care Cavilon No
Sting Barrier Film Pump Spray 28ml £5.79
Used on skin that is broken,
sore or weepy to promote
healing.
For selected patients only
(diabetics, palliative patients
and difficult stomas)
1 box/bottle per month
StoCare Protect No-Sting
Protect Barrier Film Spray
*Higher Quantity*
50ml £7.90
StoCare Protect Barrier Wipes 30 £12.95
Salts Barrier Film Wipes 2nd Line 30 £16.17
2. Skin fillers
Hollister Adapt Paste
(contains alcohol) 60g £3.89
Used as a sealant for creases
and crevices 1-3 per month
Dansac Soft Paste
(contains alcohol) 50g £3.77
Oakmed Paste 2nd Line 56g £7.75
3. Sore Skin Accessories
Orabase paste S103 30g £2.17 Used to heal around stoma Not for regular use
Coloplast Brava Powder 25g £2.47
For wet skin, short term use
1-3 per month
Higher quantity tubes may
last longer
Convatec Orahesive Powder 25g £2.53
OstoMart OstoSEAL
Protective Powder
*Higher Quantity*
50g £4.96
Ilex Skin Protectant 2nd Line 57g £8.26
4. Discharge solidifying agents
Bullen Absorbian Sachets 30
sachets £7.88
Absorbs effluent Mainly for
ileostomies 1 per month
Opus Deogel 200ml £8.11
Opus Deogel Sachets
2nd Line
50
sachets £31.13
Respond Ostosorb 150
sachets £42.16 *Higher Quantity Option*
5. Flange extenders
Salts Flange Extender - Aloe 30 £13.52
Extends adhesion of bag.
Especially if patient has a
hernia
1-2 boxes per month
Coloplast Brava Elastic Tape 20 £13.29
UltraFrame Flange Extenders
*ultra-thin transparent film 20 £13.56
Dansac X-tra Strips 2nd line 30 £19.21
Ostomart Astoa 2nd line 30 £19.44
Product Quantity Price Comments Usual quantity to order
6. Mouldable washers
Salts Mouldable Seals
Thin/Aloe 30 £51.74 /
£51.32
Used on problem
stomas An adhesive
sealant to fill
creases/crevices around
stoma
1-3 box per month
Higher amount of packs may
be required when prescribing
lower quantity packs
Salts Mouldable Seals
Standard/Aloe 30 £52.56 /
£52.13
Hollister Adapt Barrier Rings 48mm 10 £18.34
Pelican Cohesive Slims Small 2nd Line 30 £58.55
Pelican Cohesive Seals Small 2nd Line 30 £59.69
Dansac TRE Seal 30mm 2nd Line 30 £68.22
7. Adhesive Removers (Sprays/Wipes) (used with each bag/flange change)
Peak Medical Offmate
Adhesive Remover Spray 50ml £5,10
Used each time
stoma bag is changed
Sprays are more cost
effective than wipes
1-3 cans per month
(depending on frequency
of bag changes)
StoCare Remove Adhesive
Remover Spray 50ml £5.60
Opus Lift Plus 360 /
with Citrus 360 50ml £5.99
Dansac Easy Spray
Adhesive Remover Spray 2nd Line
50ml £6.67
StoCare Remove Non-sting
Adhesive Remover Wipes 30 wipes £8.60
Salts Adhesive Remover
Wipes 2nd Line 30 wipes £8.72
8) Belts and Support
Coloplast Brava Belt (standard –
XL size) 1 belt
£7.02
Use to secure and support
ostomy pouches in position
Maximum quantity 3 per year Oakmed Adjustable Ostomy Belt
100cm £7.82
Restrictions
Stoma support garments and clothing - Level 3 Following specialist recommendation only (Level 1
and 2 garments are OTC items)
Deodourants, cleansers and soaps are not clinically necessary and prescribing of these products will not
be supported in Suffolk.
Please refer to CCG Website for ‘Ostomy Accessories List - Prescribing Indictor’ for further
prescribing guidance
Contacts:
Ipswich & East: Suffolk GP Federation Community Stoma Nurses:
Debbie Cooper, Sarah Skingley 01473 242168
West Suffolk Community Stoma Nurse: Bernadette Ambrose 07739 321369 Ipswich
Hospital Trust Stoma Nurses Sharon Stopher, Sally Power 01473 703301
West Suffolk Hospital Stoma Nurses Katie Lloyd, Ann Hubble 01284 712697
Skincare
(OTC) = Item is available for patients to purchase over the counter
Product
1. Soap Substitute
Emulsifying ointment (OTC)
Epimax®(OTC)
Zero AQS cream (OTC)
Dermol 500 Lotion (OTC) Only if infection present or frequent complication
2. Emollients (Leave on preparations)
Where required in Primary Care for patients with chronic skin conditions
e.g. psoriasis or eczema, prescribe larger tubs i.e. 450/500G only. Where use is intermittent, smaller packs are required
or simply dry skin - these are available to purchase.
Lanolin based products e.g. E45® or Exocream® are not routinely recommended for chronic skin conditions due to
allergy risk
First Line
Epimax®(OTC) This is equivalent to Diprobase® Cream. Can be used as a soap substitute.
Low fire risk
lsomol® gel (OTC) This is equivalent to Doublebase®. Low fire risk.
Zeroderm® ointment This is equivalent to Hydromol® ointment (lanolin free) and Epaderm®
ointment. High fire risk
White soft paraffin 50% / liquid
paraffin 50% ointment (OTC) High fire risk
Second Line
Ultrabase® cream (OTC) Low fire risk 2nd line
Emollient preparations - Restricted Use
Emollin® spray
Usually only on advice from specialist where:
Sore and inflamed skin so unable to spread cream/lotion
Where access to the affected site is difficult High fire risk
Dermol® cream (OTC) Only if infection present or is a frequent complication
Zeroveen® cream (OTC)
Usually only on advice from specialist Restricted to paediatric use where
they are unable to tolerate other emollients; ACBS borderline substance•
for patients with endogenous and exogenous eczema, xeroderma,
ichthyosis and senile pruritus associated with dry skin only
3. Emollients with urea
Emollients - Restricted Use
imuDERM® (OTC) Equivalent to Balnuem® cream
Balneum® Plus cream (OTC) Usually only on advice from specialist
Eucerin Intensive lotion Usually only on advice from specialist
Calmurid® cream (OTC) Usually only on advice from specialist
Dermatonics Once Heel
Balm® cream Inpatient use only on advice from specialist
4. Emollient bath and shower preparations
Soap substitutes available OTC include:
Epimax® ZeroAQS®
Dermol 600® bath emollient may be used if
recommended by a specialist for infected atopic eczema
for 14 days
Aveeno® bath oil may be recommended by a specialist
where there is an issue with paraffin based
products
There is a lack of good evidence to support the prescribing
of these items. These should only be prescribed at the
request of secondary care in exceptional circumstances.
Patients should be encouraged to wash with soap
substitutes
Usually only on advice from specialist Restricted to
paediatric use where they are unable to tolerate other
emollients; ACBS borderline substance- for patients with
endogenous and exogenous eczema,
xeroderma, ichthyosis and senile pruritus associated
with dry skin
5. Barrier Preparations
Barrier preparations: Please see CCG Skin Care Algorithm for indications of use and correct treatment depending on
level of moisture damaged skin
Barrier Cream – 1st Line
Conotrane® Cream (OTC) 100g tube £0.88 Primary Care only- use 1st line
For use on intact skin.
Sudocrem (OTC) Primary Care only
Barrier Cream – 2nd Line
Medi-derma S Barrier Cream - 2nd Line 90g tube £5.95 For use where Conotrane trialled and
failed - can be used on damaged skin.
Barrier Ointment and Incontinence Cleanser – Restricted use
Medi Derma-Pro Skin Protectant
Ointment (equivalent to Proshield) 115 tube £8.50 For severe moisture excoriation
Trial for up to 2 weeks
*When skin integrity restored return to
1st line barrier cream*
Medi Derma-Pro Foam & Spray
Incontinence Cleanser
(equivalent to Proshield) 250ml bottle £5.95
Barrier Films
Medi Derma Barrier film applicators
(for use on peri-wound skin)
1ml
Applicators (5) £3.70 For use on moisture damaged skin
around wounds, skin fold and creases. Medi Derma Barrier Film Pump Spray 30ml spray £5.35
6. Pressure sore prevention and low friction products
Pressure reducing gel or foam pads are not an alternative to appropriate pressure relieving equipment. Patients
will still require a skin and pressure relief assessment, undertaken by a clinician within this field of expertise.
Pressure reducing gel pads are not for use over broken skin.
Aderma Dermal Gel Pads
10x10x0.3 cm £4.43
Gel pressure relieving strips 10x10x1.2 cm £13.30
20x20x0.3 cm £17.70
30x5x0.3 cm £6.65
Not to be used over broken skin
Gel pressure relieving pads for
vulnerable intact skin
Does not replace appropriate
pressure relieving equipment
50x2.5x0.3 cm £5.55
Heel Standard £15.49
Heel Extra Large £17.66
Sacrum/Ankle Wrap
£17.40
Kerrapro Gel Pads
50x2.5x0.3 cm £5.39
Gel pressure relieving strips 30x5x0.3 cm £6.47
10x10x1.2M cm £12.95
Not to be used over broken skin
Gel pressure relieving pads for
vulnerable intact skin
10x10x0.3 cm £4.30
Heel £15.18
Sacrum/Ankle £17.09
Dyna-Tek Foam
Positioning Products
Foot & Heel protector (pair)
£3.99
Not for use as seating pressure relief
Devon Utility Pad £3.87
Silk Garments
Product Size Price Comments
DermaSilk:
Facial Mask
Infant £16.69
Silk garments can be washed
repeatedly and reused
2 pairs of garments to be ordered at one time
(one to wear / one to wash)
Silk garments are restricted products - for the use of patients
with severe skin disorders, causing the skin to become very
fragile, for example Epidermolysis Bullosa
Child £16.69
Teen Size £21.29
Adult Size £21.29
Body Suit
0-3 months £38.81
3-6 months £38.90
6-9 months £40.01
9-12 months £41.04
12-18 months £41.12
18-24 months £42.16
24-36 months £42.24
3-4 years £43.35
Briefs 3-6 years £22.09
7-10 years £22.09
Shirt Roll Neck
3-4 years £47.93
5-6 years £51.13
7-8 years £53.26
10-12 years £55.40
Adult Small XXL £78.78
Shirt Round Neck Adult (Male) Small XXL £78.78
Adult (Female) Small XXL £78.78
Tubular Sleeves (pair) 33cm long £27.77
50cm long £34.27
Leggings (pair)
0-3 months £27.71
3-6 months £27.77
6-9 months £28.88
9-12 months £29.93
12-18 months £29.99
18-24 months £31.05
24-36 months £31.11
3-4 years £32.22
Adult (Male) Small XXL £79.71
Adult (Female) Small XXL £79.71
Gloves (pair)
Small Child £15.02
Medium Child £15.02
Small Adult £21.09
Medium Adult £21.09
Large Adult £21.09
Pyjamas (set)
3-4 years £72.28
5-6 years £76.74
7-8 years £80.07
10-12 years £83.41
Knee Length Undersocks (2 pairs) Standard Length £24.66
Longer Length £24.66
Undersocks (per 2 pairs)
Child 3-8 £18.75
Child 9-1 £18.75
Child 2-5 £18.75
Adult 5½ - 6½ £18.75
Adult 7 - 8½ £18.75
Adult 9 - 10½ £18.75
Adult 11-13 £18.75
Process for Reviewing Formulary Products
NO YES
YES NO YES NO
ATTACH TWO
IMPARTIAL,
COMPARATIVE
CONTROLLED
STUDIES/BEST
SUPPORTING
EVIDENCE
SEND TO DENISE HUTCHINSON
Medicines Management Team, Endeavour
House, Russell Road, Ipswich IP1 2BX
OR EMAILTO
FORMS WILL BE DISCUSSED AT
SUFFOLK CCG SPECIALIST REVIEW
PANELS FOR:
CONTINENCE / STOMA / TISSUE INTEGRITY
A DECISION WILL BE MADE AT THE
RELEVANT PANEL - FORMULARIES WILL
BE UPDATED ACCORDINGLY AND MADE
AVAILABLE ON IESCCG & WSCCG
WEBSITES
IS THE PRODUCT ON FORMULARY?
DOES THE PRODUCT NEED TO BE
ADDED?
DOES THE PRODUCT NEED TO BE
REMOVED?
COMPLETE
SECTIONS 1 & 2 OF
EXCEPTION
REPORTING
FORM
COMPLETE
SECTIONS 1 & 3 OF
EXCEPTION
REPORTING
FORM
COMPLETE THE
EXCEPTION
REPORTING
FORM: SECTIONS
1 & 3
NO ACTION
REQUIRED