This Respond and Advise Clinical Reference Group (CRG) covers covers specialised endocrinology services. Endocrine glands secrete hormones directly into the blood stream. The main endocrine glands are the pituitary gland, thyroid gland, pancreas, ovaries, testes and adrenal glands. Many endocrine conditions may be treated in local hospitals, but patients with complex or co-morbid conditions may require referral to specialist centres for consultant opinion or further management.

Scope

This clinical reference group covers:

• the management of people with specialist thyroid conditions including thyroid malignancies and complex parathyroid conditions in pregnancy, hypoparathyroidism and complex problems of calcium/phosphate handling
• services for people with pituitary/hypothalamic conditions including adrenal insufficiency and complex pituitary conditions in pregnancy
• services for people with neuro-endocrine tumours
• services for people with defined Familial Endocrine Conditions which need genetic markers
• services for people with defined reproductive conditions including intersexual states.

Membership

• Chair: Professor Neil Gittoes, Consultant Endocrinologist and Honorary Professor at the Centre for Endocrinology, Diabetes and Metabolism (CEDAM), University Hospitals Birmingham
• Ian Wren, Lead Commissioner
• Professor John Newell-Price, Clinical Member/Cancer Liaison
• Dr Daniel Flanagan, Clinical member
• Phillip Newland Jones, Pharmacy lead
• Angeline Walker, Public Health lead

Affiliates

• John Wass, Endocrinology GIRFT

Products

A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.

Service specifications

Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.

The following service specifications fall within the scope of this CRG:

• Specialised endocrinology service (adult)
• Insulin-resistant diabetes service (all ages)
• Islet transplantation service (adults)
• Pancreas transplantation service (adult)

Policies

Commissioned

• Metreleptin for congenital leptin deficiency (all ages) – effective from 1 April 2019
• Teriparatide for osteoporosis in men (adults)
• Lomitapide for homozygous familial hypercholesterolemia
• Cinacalcet for complex primary hyperparathyroidism in adults
• Pasireotide: an injectable medical therapy for the treatment of Cushing’s disease
• Pegvisomant for acromegaly as a third-line treatment (adults)
• Tolvaptan for hyponatraemia secondary to the Syndrome of Inappropriate Antidiuretic Hormona (SIADH) in patients requiring cancer chemotherapy

Not routinely commissioned

• Telotristat for treating carcinoid syndrome diarrhoea (adults)
• Teriparatide for the treatment of osteogenesis imperfecta (adults)
• Pasireotide for acromegaly as third-line treatments (adults)

Get involved

If you are interested in the work of the internal medicine NPOC or its CRGs, you can register as a stakeholder.  For details on our latest consultations please visit NHS England » Consultations

Get in contact

For any questions or queries relating to the work of the internal medicine NPOC or any or its CRGs, please contact: england.npoc-internalmedicine@nhs.net