Minutes of the meeting held on Thursday 19 September 2016
In the Board Room, PCH
There were no declarations of interest with regard to items discussed.
In Attendance:
Dr C Gardner / Deputy Medical Director – ChairMrs A Ritchie / Pharmacist Team Manager Procurement and Formulary - Joint Secretary
Mrs S Mavani / Pharmacist Team Manager Medicines Governance – Joint Secretary
Dr D Woolf / Consultant Paediatrician
Ms S Drake / Team Lead (S1 Access)
C Johnson
Dr K Jephcott / Interface Lead Pharmacist, Greater East Midlands Commissioning Support Unit
Oncology Consultant
Dr R Mittra / Consultant Geriatrician
16/49 Apologies for Absence:
Mrs C McIntyre Chief Pharmacist (Deputy Chair)
Mr K Claire Lead Pharmacist, Peterborough and Borderline PCG
Dr M Sahni Consultant Anaesthetist
Ms K Board / Specialist Pharmacist – C&PJPG/HCD, C&PCCGDr D Mlangeni / Consultant Microbiologist
16/50 / Minutes of the Formulary and Medicines Management Meeting held on 21 July 2016.
Item 16/41.2.1 – Lecicarbon A suppositories, the outcome of this item is that it was not approved. Otherwise the minutes were agreed as correct.
16/51 / Matters arising from the Minutes/Action Log:
The action log was reviewed and updated accordingly.
16/52 / Review of Terms of Reference:
CG distributed draft copies of the updated ToR and a proposed new agenda format. One of the main reasons behind the amending of the two documents is down to the requirements of the Carter report. The meeting has also been streamlined to remove any items that do not seem to add any value and the quoracy has been changed. Comments to be forwarded to CG by week closing 23 September; if no further comments received, both items will be endorsed and the ToR will then go through to QGOC for final endorsement.
16/53 / Formulary Items given Chair’s Approval, New Drug Requests and Updates:
16/53.1 Chair’s Approval
16/53.2.1 - Sodium aurothiomalate injection in rheumatoid arthritis – It was assumed that this item was already on the formulary, but this is actually not the case. Dr Sharma on A/L so unable to attend to present, the committee however had no comments or concerns.
Outcome: added to formulary
16/53/2/2 – Timolol 0.5% eye gel for use in lobular capillary haemangioma – AR presented on behalf of Mr Bond. Papers showed that patients treated with timolol 0.5% gel responded to treatment. It was known that there is a child with the haemangioma on their eye lid and therefore the product that has been formulated for use in the eye would be of benefit. It was noted that Great Ormond Street Hospital use timolol 0.5% eye gel on infantile haemangiomas.
Outcome: added to formulary
16/54 / 16/54.1 NICE Technology Appraisals published July and August 2016
TA398 Lumacaftor-ivacaftor for treating cystic fibrosis homozygous for the F508del mutation – Not recommended.
TA399 Azacitidine for treating acute myeloid leukaemia with more than 30% bone marrow blasts – The Trust use and fully comply.
TA400 Nivolumab in combination with ipilimumab for treating advanced melanoma – Not used in the Trust.
TA401 Bosutinib for previously treated chronic myeloid leukaemia – The Trust use and fully comply.
TA402 Pemetrexed maintenance treatment for non-squamous non-small-cell lung cancer after pemetrexed and cisplatin – The Trust use and fully comply.
TA403 Ramucirumab for previously treated locally advanced or metastatic non-small-cell lung cancer – Not recommended.
TA404 Degarelix for treating advanced hormone-dependent prostate cancer - The Trust use and fully comply, however concerns regarding Lincolnshire and the primary care rebate scheme, AR to check with Cambridgeshire and Peterborough what they do in relation to this.
TA405 Trifluridine-tipiracil for previously treated metastatic colorectal cancer – The Trust use and fully comply.
16/54.2 NICE Clinical Guidelines published July 2016
The below were circulated for information;
NG49 – Non-alcoholic fatty liver disease (NAFLD): assessment and management
NG50 – Cirrhosis in over 16s; assessment and management
NG51 – Sepsis: recognition, diagnosis and early management
NG52 – Non-Hodgkin’s lymphoma; diagnosis and management
16/55 / Horizon Scanning
16/55.1 – New Medicines newsletter July 2016 – Disseminated for information purposes
16/55.2 – NICE Technology Appraisals in Development expected publication September 2016 to February 2017 – AR advised that the Trust is about to budget set for tariffs of excluded drugs. The Trust will be expected to predict its spend on excluded drugs for the next financial year, therefore we need to predict which TAs will be used in specialist areas. There may be a financial risk to the Trust if the estimate is not accurate.
16/56 / Unlicensed Medicines Update
No update
16/57 / Medicines Optimisation:
16/57.1 Formulary Reviews including previous submissions – For future agendas.
16/57.2 Items from C&PJPG. Nothing to report as the meeting has not yet been held.
16/57.3 High Cost Drugs: Nothing to add.
16/57.4 Shared Care Guidelines:
16/57.4.1 Sodium Aurothiomalate injection
16/57.4.2 Hydroxycarbamide
CG noted that his comments regarding pregnancy and the contraindications which he has previously raised with other SCG, have not been included on either of the two guidelines. SM advised that she will ascertain if the clinicians are happy for their contact details to be added. To be reviewed by Cambs and Peterborough before being brought back to this committee.
16/58 / Trust policies and guidelines for approval:
16/58.1 Policies/Documents given Chair’s Approval: None.
16/58.2 New Policies/ Guidelines/Documents:
16/58.2.1 Management of infants of mothers testing positive for syphilis – This has been QA’d by the Specialist Pharmacist and no concerns raised.
Outcome: approved
16/58.2.2 Guidelines for the use of LAT gel for paediatric wounds at Peterborough City Hospital Emergency Department – This gel is unlicensed so a risk assessment is required.
Outcome: approved pending unlicensed risk assessment
16/58.2.3 Policy for the Early Discharge of Low Risk Adult Oncology patients admitted with Neutropenic Sepsis.
Outcome: approved
16/58.3 Policies/ Guidelines/ Documents for Review:
16/58.3.1 Medicines Management Policy
This has been amended in light of the Carter Report. An overarching policy is being looked into due to the potential merger.
Outcome: approved
16/58.3.2 Neonatal Abstinence Syndrome
This policy now mentions SSRIs. Therefore, more detail regarding what updates have been made is required on the version control
Outcome: Approved pending required amendments
16/58.3.3 Unlicensed Medicines Policy
Queries raised regarding responsibilities of Pharmacy Technicians, changes required surrounding what the Pharmacy Technicians can and cannot do. Discussion regarding how to ensure the risks associated with unlicensed medicines have been acknowledged and understood (question on page 23.) A link to the intranet was suggested as a way of reminding clinicians of the unlicensed drugs and it could also link to the form and the policy.
Outcome: SM and AR will discuss further and update at the next meeting.
16/59 / Reports from Groups and Subcommittees/ Associated Medicines Update:
16/59.1 Antibiotic Prescribing Group: No update.
16/59.2 Medication Safety Committee (Safer Prescribing Group)
Reduction in FY1 time to one hour for drug chart training/assessments as mandated by Deanery.
16/59.3 IVIG demand management panel
CG advised that these meetings do need to be held; possibly they could be added onto the end of this committee, once per year.
16/59.4 Thrombosis Committee: Nil to report.
16/59.5 Oxygen & Medical Gases
The Oxygen Committee has been incorporated into this committee. Oxygen prescribing problems will be resolved when the introduction of a new drug chart takes place.
16/59.6 NMAG: No update
16/60 / Meeting dates for 2017
Discussion surrounding whether or not the timing of this committee should be moved to help fit in around clinics. Consensus that there will never be an ideal time to hold a meeting which would suit all attendees; therefore it will remain the same.
Discussion took place suggesting papers should be distributed two weeks in advance, so that a week can be given for comments before the agenda is finalised a week in advance. No late submissions allowed, unless given special approval by the chair. However, the committee agreed that this suggestion in practice will not be feasible and therefore we will continue with the current practice.
Administration support required to assist with agenda preparation.
16/61 / Any Other Business: No items.
Date of Next Meeting: Thursday 24th November 2016 at 12.45pm, in the Board Room, 4th Floor, PCH
Minutes of Formulary and Medicines Management Committee Page 1 of 4
15 September 2016