NEWT Guidelines - Frequently asked questions

Click on the + to expand each group of questions and answers.

What type of subscription do I need?

What type of subscription do I need?
- The subscription that you need is based on the type of work that you do, and how many people are going to be using the website. Click here and choose the button relating to your area of work, and the website will give you information on what subscription levels are available to you.
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What are the options for ICBs / Medicines Management Teams?

The subscription for ICBs, and Medicines Management Teams is based on the size of the population they serve. It is also possible for an individual within the team to have access for only the population they are specifically responsible for.

Population size
Up to 50,000	£160 (£120*) + VAT	50-100,000	£215 (£160*) + VAT
100-150,000	£250 (£190*) + VAT	150-200,000	£290 (£220*) + VAT
200-250,000	£320 (£240*) + VAT	250-300,000	£360 (£270*) + VAT
300-350,000	£400 (£300*) + VAT	350-400,000	£435 (£325*) + VAT
400-450,000	£465 (£350*) + VAT	450-500,000	£500 (£375*) + VAT
500-600,000	£550 (£410*) + VAT	600-700,000	£590 (£440*) + VAT
700-850,000	£625 (£470*) + VAT	850-1,000,000	£670 (£500*) + VAT
1-1.15 million	£720 (£540*) + VAT	1.15-1.3 million	£760 (£570*) + VAT
1.3-1.45 million	£800 (£600*) + VAT	1.45-1.6 million	£850 (£640*) + VAT
Prices for larger populations available on request

There is also the option to purchase discounted access for GP surgeries.

Click here for further information. For prices of supplementary access options, the full details are on the order form (click here for the order form).

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What are the options for PCNs?
- Pharmacy teams working solely in patient-facing roles can use the new "Patient-facing Pharmacy teams" access level, which can be used across multiple surgeries, nursing homes etc.
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What are the options for NHS hospitals?
- One named user access - access for one named user only, in a patient-facing or Medicines Information role.
  Single area access - access from one area only, and staff would have to go to that area (e.g. the MI room) in order to access the guidelines.
  Five area access - access by any staff working in five discreet areas. MI and the dispensary are two separate areas. If dispensary is included as one of the five areas, all pharmacists may access from their wards (but ward staff will not be able to, except on any named wards included in the access).
  Hospital-wide access - access for all staff working in any part of the hospital. This includes any peripheral buildings located on the same site (i.e. within the same postcode) but not any linked centres, clinics, rehabilitation units etc which are in different postcode areas.
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Our Mental Health Trust is spread out over a large area.
- The new "mental health Trusts and long-term residential care" is intended for organisations which may be geographically spread out, and where patient turnover is lower than in acute general hospitals.
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For a full list of subscription options available:-
- Click here for a full list.
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How different subscription types can be used.
- We've got access for a single area - our MI department. Can the emergency duty pharmacist use the login out of hours?
  - Yes, out of hours they can. This would also be the case if the single area was the dispensary.
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- We've got access for a single area, but now want to expand our access to a larger level.
  - We would charge the pro-rata difference for the remainder of the year, i.e. if £60 had been paid for single area access, and five area access was now wanted (£200), with six months remaining on the license, we would charge £70 (plus VAT) more. The licensee would not qualify as a "current subscriber" until the end of their first year.
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- What is the definition of "area"?
  - The background intention is that one "area" is one physical location in which one book could reasonably be used - only with the benefits of electronic access, printability, updates etc. For each "area", as many people as use that area can access the guidelines, whilst they are working in that area. Therefore if you bought for your dispensary, all your pharmacists, technicians, ATOs, could access the guidelines whilst working on site. If one area was your stroke ward, then the site could be accessed by all nurses, doctors, physios, dieticians, SALT, etc working there for the benefit of the patients on that ward. As the guidelines are online, rather than a disc or a "downloaded" document, they can be accessed by any computer with an internet link, by anyone with a license.
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- Does "up to 5 areas" mean 5 hospitals within one Trust?
  - No. Up to five areas means five wards or locations within one hospital - all within one (seven digit) postcode area. The background intention is to relate it to the presence of five physical books - i.e. one in MI, one in dispensary, two on admissions wards, one on a stroke ward. Other buildings on the same site can be included, but only if they are in the same postcode. Peripheral hospitals/rehabilitation centres associated to the Trust are to be treated separately. Access for multiple hospitals may require either multiple licenses, or (for lower patient turnover facilities such as community rehabilitation hospitals) the new “long term residential care” license.
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- We have 30 pharmacists in a single hospital, and would like them all to have access.
  - If a multi-area subscription is purchased, and one of the areas is the pharmacy dispensary (not MI, which is a separate area), then we will allow all clinical pharmacists working on-site to use the access whilst doing their ward work. They will not, however, be able to supply passwords to their wards. Only the "named wards" (the other "areas" in the license) will be able to have password access.
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- Isn't MI part of Pharmacy?
  - We count MI as a separate "area", because of the wider region it covers.
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- We have 20 pharmacists and technicians who visit nursing and residential homes across our area providing clinical patient services.
  - The new "patient-facing pharmacy team" access level is intended for itinerant pharmacy teams providing patient-facing services across a region.
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Ordering

How do we subscribe? How do we get access?
- Use the button in the top left corner of the website pages ("Click HERE to subscribe") and choose the level of subscription appropriate to your work. Print off the order form, complete it, and send it to us by email, fax, or post.
  We will process your request and send you an invoice against which you can make payment (or raise an order for payment to be made).
  When we receive confirmation that payment has been received, we will email you with a username and password which you will be able to use immediately.
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How much does it cost to access NEWT?
- The cost of subscription depends on the type of work that you do, and how many people are going to be using the website. Click here and choose the button relating to your area of work, and the website will give you information on what subscription levels are available to you and their costs.
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We're a Medicines Management Team working in an ICB - how much will our subscription be?

The subscription for Medicines Management Teams is based on the size of the population served.

Population size
Up to 50,000	£160 (£120*) + VAT	50-100,000	£215 (£160*) + VAT
100-150,000	£250 (£190*) + VAT	150-200,000	£290 (£220*) + VAT
200-250,000	£320 (£240*) + VAT	250-300,000	£360 (£270*) + VAT
300-350,000	£400 (£300*) + VAT	350-400,000	£435 (£325*) + VAT
400-450,000	£465 (£350*) + VAT	450-500,000	£500 (£375*) + VAT
500-600,000	£550 (£410*) + VAT	600-700,000	£590 (£440*) + VAT
700-850,000	£625 (£470*) + VAT	850-1,000,000	£670 (£500*) + VAT
1-1.15 million	£720 (£540*) + VAT	1.15-1.3 million	£760 (£570*) + VAT
1.3-1.45 million	£800 (£600*) + VAT	1.45-1.6 million	£850 (£640*) + VAT
Prices for larger populations available on request

Click here for further information.

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I'm a pharmacist working for an ICB, but I only want access for myself, not the whole team.
- We are happy to offer access based on the size of population which an individual is responsible for, i.e. the population served by their practice(s).
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We've got access for a single area, but now want to expand our access to a larger level.
- We would charge the pro-rata difference for the remainder of the year, i.e. if £60 had been paid for single area access, and five area access was now wanted (£200), with six months remaining on the license, we would charge £70 (plus VAT) more. The licensee would not qualify as a "current subscriber" until the end of their first year.
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What is the definition of "area"?
- The background intention is that one "area" is one physical location in which one book could reasonably be used - only with the benefits of electronic access, printability, updates etc. For each "area", as many people as use that area can access the guidelines, whilst they are working in that area. Therefore if you bought for your dispensary, all your pharmacists, technicians, ATOs, could access the guidelines whilst working on site. If one area was your stroke ward, then the site could be accessed by all nurses, doctors, physios, dieticians, SALT, etc working there for the benefit of the patients on that ward. As the guidelines are online, rather than a disc or a "downloaded" document, they can be accessed by any computer with an internet link, by anyone with a license.
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Does "up to 5 areas" mean 5 hospitals within one Trust?
- No. Up to five areas means five wards or locations within one hospital - all within one (seven digit) postcode area. The background intention is to relate it to the presence of five physical books - i.e. one in MI, one in dispensary, two on admissions wards, one on a stroke ward. Other buildings on the same site can be included, but only if they are in the same postcode. Peripheral hospitals/rehabilitation centres associated to the Trust are to be treated separately. Access for multiple hospitals may require either multiple licenses, or (for lower patient turnover facilities such as community rehabilitation hospitals) the new “long term residential care” license.
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We have 30 pharmacists in a single hospital, and would like them all to have access.
- If a multi-area subscription is purchased, and one of the areas is the pharmacy dispensary (not MI, which is a separate area), then we will allow all clinical pharmacists working on-site to use the access whilst doing their ward work. They will not, however, be able to supply passwords to their wards. Only the "named wards" (the other "areas" in the license) will be able to have password access.
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We have 20 pharmacists and technicians who visit nursing and residential homes across our area providing clinical patient services.
- The new "patient-facing pharmacy team" access level is intended for itinerant pharmacy teams providing patient-facing services across a region.
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When will we receive our access details?
- Your login details will be sent to the email address you provide on your subscription form once we have received confirmation of payment. Please be aware that we are an NHS hospital providing clinical services to patients; The NEWT Guidelines does not have a full-time staff, and therefore it may take a little time for us to process your orders.
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We sent our subscription form to you 10 days ago, but haven't heard from you yet.
- Please bear with us. We are a busy acute hospital, and The NEWT Guidelines does not have a full time staff. Your order will be processed in due course. If you have not heard from us more than 20 days after you sent the form, please get in touch.
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We've paid for our subscription, but we haven't heard from you.
- Please get in touch with us. Send us the details of how and when you made payment, along with any reference number that was used, and the address to which payment was sent (your Finance department should be able to provide these); this will help us to track the receipt. Payments are frequently received without sufficient information to properly identify them, and this can lead to delays in processing and acknowledgement.
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Discounts, payments, invoices, getting access details etc
- Is there a discount for UKMI members?
  - No, sorry.
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- Is there a discount if we purchase more than one subscription at the same time?
  - Yes, there is a 20% discount for anyone purchasing two or more secondary care or specific primary care licenses together.
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- We have/are purchasing a website subscription. Do we get a discount on the book?
  - Yes. Copies of the 4th edition of The NEWT Guidelines book can be purchased for £25 each (plus postage and packing) when purchased and paid for at the same time as any subscription to the website (new subscriptions and renewals). Current subscribers can purchase copies of the book for £35 each (plus p&p) when ordered through the named individual on the subscription.
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- Can you provide us with an invoice?
  - Yes. If you require an invoice to make payment against, simply send us the completed subscription form and we will send you an invoice.
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- What payment methods do you accept?
  - Payment methods we accept are BACS, credit card, and cheque. If you require an invoice against which to make payment, simply send us the completed subscription form and we will send you an invoice. The invoice will include all the information you need to make payment.
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- Can we pay by card?
  - Yes. For further information see our Payment methods page.
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- When will we receive our access details?
  - Your login details will be sent to the email address you provide on your subscription form once we have received confirmation of payment. Please be aware that we are an NHS hospital providing clinical services to patients; The NEWT Guidelines does not have a full-time staff, and therefore it may take a little time for us to process your orders.
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- We sent our subscription form to you 10 days ago, but haven't heard from you yet.
  - Please bear with us. We are a busy acute hospital, and The NEWT Guidelines does not have a full time staff. Your order will be processed in due course. If you have not heard from us more than 20 days after you sent the form, please get in touch.
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- We've paid for our subscription, but we haven't heard from you.
  - Please get in touch with us. Send us the details of how and when you made payment, along with any reference number that was used, and the address to which payment was sent (your Finance department should be able to provide these); this will help us to track the receipt. Payments are frequently received without sufficient information to properly identify them, and this can lead to delays in processing and acknowledgement.
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Renewing a subscription
- We'd like to renew our subscription. How do we do this?
  - We'd be very pleased to have you back.
    We usually send out renewal reminders with the appropriate paperwork 2-3 months before your subscription expires. However, if you want to start the process yourself, click here to go to the renewals page, choose the appropriate form, complete it, and send it to us. We will then begin your renewal for you.
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- I don't know what level of access we had last year .
  - Don't worry - we need to know how you want to use the website now, not how you were using it last year. You will get the renewal discount if you maintain a continuous subscription, even if your level of access is different to what it was previously. Just complete the renewal form (click here) indicating the appropriate level of usage, and we will take it from there
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- I think my subscription may have expired
  - Check with the person in your workplace who handles the subscription - this is probably the person who gave you the password. Ask when the subscription was due to expire, and whether there is a new password (they may already have received it).
    If you are the person who handles the subscription, and you believe that the subscription is in the process of being renewed, please contact your Finance department to find out whether payment has been made. It is unfortunately frequently the case that payments are received without sufficient information to allow us to process them.
    Your Finance department should be able to tell you:-
    the exact date of payment
    the method of payment
    any reference number/order number on the payment
    Please contact us, providing the above information along with your username. This will enable us to quickly locate your payment and process your renewal.
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- My password no longer works. Can my access be re-instated?
  - If your account has been suspended because we have not received your payment (and please note, payments frequently arrive without sufficient information to identify them), we will not be able to re-instate access until payment has been received.
    If payment has been made, please contact your Finance department for remittance advice on the payment, and send it to NEWT.Guidelines@wales.nhs.uk. Please note that electronic payments usually take three days to clear, and give us at least two weeks following the date of payment to provide your access details. If you have not heard from us two weeks after the date of payment, please get in touch.
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- Why is the expiry on our renewed subscription still March, when we didn't make payment until May?
  - Continuous subscribers are entitled to a renewal discount only if their subscription remains unbroken. The discount is given because it is easier for us to keep your old account than to set you up with a new one. It is also better for you, because you are less likely to have your access cut off.
    As these discounts are substantial, it is almost always better value for you to retain your current account details and expiry date, than to change them. However if you have concerns, please get in touch with us.
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- We received an invoice from you, but we haven't received our access details yet.
  - Access details are sent out to the email address on your application form as soon as possible after we receive confirmation that payment has been made.
    In large organisations, payments frequently go astray due to insufficient information to track them. If you believe that payment has been made, please send us the following information (your Finance department should be able to provide you with these):-
    the method of payment
    the date of payment
    the name and address to which payment was made
    any reference number associated with the payment
    This will help us to trace the receipt at this end. Once we have confirmation, we will be able to promptly provide your access details.
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- We sent our renewal form to you 10 days ago, but haven't heard from you yet.
  - Please bear with us. We are a busy acute hospital, and The NEWT Guidelines does not have a full time staff. Your order will be processed in due course. If you have not heard from us more than 20 days after you sent the form, please get in touch.
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Clinical / content
- How often do you update the website?
  - General updates are posted on the website weekly. Urgent updates are made more quickly. Approximately five pages a week are updated.
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- Why aren't newer medicines always included?
  - Unfortunately, as there is not much experience with newer medicines, there may be no reports of whether these products can be given outside their product license. Sometimes the manufacturers can provide information, but often they are only able to advise against giving the medicine "off-license".
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- Why do you advise de-ionised water?
  - There are a small number of medicines in the guidelines for which we recommend the use of de-ionised water. This is done where there is information suggesting that the active ingredient may be affected by the ions in tap water, reducing absorption. Although this risk may be small, the NEWT Guidelines Advisory Board has reviewed the specific monographs where it is recommended and determined that the effective administration of the drugs involved is important, and therefore the use of de-ionised water in order to avoid the risk of treatment failure is worthwhile.
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- Why do you often recommend intravenous as first line?
  - There is a section on the website which explains how we determine the order of recommendations: General Guidance > Choosing an appropriate method of administration.
    Put simply, all patients should receive a licensed formulation by a licensed route. Therefore the first-line choice will often be a non-enteral treatment. However, if this first-line option is not feasible for an individual patient, for instance if this would necessitate hospital admission or insertion of an intravenous line which would be an unacceptable risk, then the second-line (or third-line) option should be followed. This is why the guidelines offer more than one option in many cases.
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- Contact Pharmacy for advice? What am I supposed to say?
  - The "contact Pharmacy for advice" comment is used when the guidelines should not be followed "blindly", i.e. when the patient's status should be reviewed before a method of administration is altered. For instance, if an epileptic patient is being managed with an enteral feeding tube, it is important to consider how well the patient's condition is controlled, whether there are any recent drug levels, whether the current medical status may affect drug absorption or cause alterations in drug handling etc before giving advice on how to change the drugs.
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- Why don't you always give advice for jejunal tubes?
  - We only give information on jejunal tubes when it is available. Most anecdotal reports and references do not specify the type of tube involved, and many of these will refer to gastric-terminating tubes. Where there is information available, we will provide it, but otherwise the information is solely listed as relating to "enteral tubes", and there is a possibility of reduced absorption via tubes terminating lower in the gastro-intestinal tract.
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- Why are some of the reference so old?
  - Much of the information in the guidelines - particularly that relating to enteral feeding tubes - is based on anecdotal reports. Therefore sometimes the best information is that which has been around the longest. When a tablet has been crushed in many centres for years with no reports of any negative effects, the information is actually more reliable than a paper only published this year. However when new information is published which supersedes the old, the guidance is of course updated.
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Technical
- The login box just keeps re-appearing
  - This would usually indicate that you are putting in an incorrect password. Ensure that both your username and password are entered entirely in lowercase. The other common reason for this is that your subscription has expired - see "I think my subscription may have expired" below.
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- I think my subscription may have expired
  - Check with the person in your workplace who handles the subscription - this is probably the person who gave you the password. Ask when the subscription was due to expire, and whether there is a new password (they may already have received it).
    If you are the person who handles the subscription, and you believe that the subscription is in the process of being renewed, please contact your Finance department to find out whether payment has been made. It is unfortunately frequently the case that payments are received without sufficient information to allow us to process them.
    Your Finance department should be able to tell you:-
    the exact date of payment
    the method of payment
    any reference number/order number on the payment
    Please contact us, providing the above information along with your username. This will enable us to quickly locate your payment and process your renewal.
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- My password no longer works. Can my access be re-instated?
  - If your account has been suspended because we have not received your payment (and please note, payments frequently arrive without sufficient information to identify them), we will not be able to re-instate access until payment has been received.
    If payment has been made, please contact your Finance department for remittance advice on the payment, and send it to NEWT.Guidelines@wales.nhs.uk. Please note that electronic payments usually take three days to clear, and give us at least two weeks following the date of payment to provide your access details. If you have not heard from us two weeks after the date of payment, please get in touch.
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- Something else / strange is happening
  - Please screenshot the screen you see immediately after entering your user details, and send the image to newt.guidelines@wales.nhs.uk, along with any other information you think is relevant. It is often helpful for us to know what internet browser (including version number) you are using.
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The NEWT Guidelines book:-
- Will the paperback still be available? Will it be updated?
  - The 4th edition was published in August 2021. We anticipate that we will print a 5th edition in the future and that a paper copy of The NEWT Guidelines will continue to be available.
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- Do you offer any discounts?
  - There are discounts available for people purchasing five or more copies. We also reduce postage as much as possible for multiple-copy orders.
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- Do you offer discounts to booksellers?
  - Only the ones which we offer to all purchasers - on orders of five or more copies.
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- How do we order the book?
  - Complete the order form (click here) and send it to us. We will then send you an invoice against which you can make payment.
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- We have/are purchasing a website subscription. Do we get a discount on the book?
  - Yes. Copies of the 4th edition of The NEWT Guidelines book can be purchased for £25 each (plus postage and packing) when purchased and paid for at the same time as any subscription to the website (new subscriptions and renewals). Current subscribers can purchase copies of the book for £35 each (plus p&p) when ordered through the named individual on the subscription.
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