/ Gateshead Medicines Management Committee
28th November2012 0930-1130
Room 4, Education Centre
QEH
Attendees: / Consultant Anaesthetist, Gateshead Health NHS Foundation Trust (Chair)
Consultant Microbiologist, Gateshead Health NHS Foundation Trust
Prescribing Lead, Gateshead Clinical Commissioning Group (Vice-Chair)
GP (Primary care prescriber)
Chief Pharmacist, Gateshead Health NHS Foundation Trust
Head of Commissioning Medicines Management, NHS SoTW
Senior Pharmacist NECS
Medicines Governance Pharmacist, Gateshead Health NHS Foundation Trust (Secretary)
Community Pharmacist
Prescribing Representative, Gateshead Community Services
Regional Drug & Therapeutics Centre (Newcastle) Advisor
Primary Care Medicines Management Provider
Apologies: (item 1) / Prescribing Interface Lead Pharmacist, NTW Mental Health Trust
Item 2 / Declaration of Conflict of Interest With Any Agenda Items
Discussion:
No-one present had any interest to declare with today’s agenda items.
Item3 / Notes of meeting on 26th September 2012 / Enc 1
Discussion:
Minutes agreed as a true record.
Item4 / Ongoing Action Points / Enc 2
Discussion:
Circulated for information.
Item 5 / Matters Arising / Enc 3 & 4
Discussion:
a)Dekristol to ProD3 switch – no further progress.
b)Goserelin for Gynaecology Indications – no furtherprogress. Referred to shared care group to progress. Item to be removed from GMMC agenda.
c)Collagenase (Xiapex®) –has now received commissioning approval so has now been added to the formulary as a Tariff inclusion.
d)Pramipexole MR New Drug Request – no further progress to report.
e)Shared Care Prescribing Policy in SoTW – attached paper discussed. Agreed that proposal around opt-in of drugs covered by LES scheme unworkable as difficult to know practices have signed up to LES. Therefore concluded that far safer for all drugs on shared care to by opt-in by GPs via letter for individual patients signposting to full guideline on the GIN – this the same as what other areas currently do. Chair to share revised policy with GHFNT consultants and Vice-Chair to gain CCG approval of policy.
f)Ropivacaine New Drug Request – has now been confirmed that this request does not need to go to GHFNT New Interventional Procedures Committee so use has now be extended on the formulary to include shoulder & upper limb procedures under regional anaesthesia.
g)GMMC Revised New Drug Approval Process – discussed under Item 9.
h)Denosumab – response from LMC discussed. GMMC/CCG in agreement that for osteoporosis Denosumab is classed as a Green+ drug and no LES as requested by LMC is required. Therefore Denosumab has been classed as Green+ on the formulary with the expectation that GPs will now pick up repeat prescribing.
Denosumab remains a Red drug when used for bone mets in cancer treatment.
Item 6 / New Drug Requestsfor NovemberMeeting
Discussion:
None received.
Item 7 / New Drug Requests for February 2013 Meeting
Discussion:
- Inadine dressing – requested for use in orthopaedics by Mr Patterson
- Jelonet dressing – requested for use in orthopaedics by Mr Patterson
Item 8 / Gateshead CCG Antimicrobial Update
Discussion:
The SOTW Antimicrobial Committee which continue to meet twice a year or as needed. The local prescribing committees will keep oversight with minutes and agendas being a standing agenda item.
The management of C.Difficle remains a high priority locally.
Item 9 / NICE Guidance and Formulary Status of NICE Technology Appraised Drugs / Enc presented on day
Discussion:
Subgroup has met and enclosed paper has been put together for discussion at GMMC, CCG and GHFNT.
Future formulary needs to state which drugs CCG will fund. This different to the current formulary which for primary care is list of drugs GPs can prescribe and for secondary care a list of products stock by hospital.
Local New Drugs Approvals Policy will need updating once way forward is clear.
Number of options proposed for future structure of Local Decision Making around Medicines, including possibility of merging with North of Tyne APC. All are clear that this is no reflection on GMMC currently; it is about the most efficient way of doing things. Concerns expressed re complete takeover of GMMC by NoT APC, and the need to maintain good working relationships within Gateshead between primary and secondary care.
Conclusion:
- Comments on 1st draft of paper to AMB.
- Await steer from Gateshead CCG
- FM/JH to speak with GHFNT Medical Director – Does GHFNT wish to get involved with a North of Tyne Committee driven formulary.
Item 10 / SoTW Dermatology Specials Guidance / Enc 5 & 6
Discussion:
Paul Hardy in attendance.
Attached enclosures were discussed.
Conclusion:
GMMC supports comments from Sunderland Prescribing Committee.
GMMC feels only products on BAD list should be prescribed. Where a product is not listed on BAD list it should be replaced by the closet available product that is listed on the BAD list.
Item 11 / Gluten Free Product Supply / Enc 7
Discussion:
Paul Hardy in attendance.
Has been agreed to go ahead with “Off FP10” model for supply of Gluten Free products. Working Group currently producing a pathway and list of products/quantities to be supplied which will come back to GMMC for approval once finalised.
Item 12 / Guidelines for Lipid Management (FATS6) / Enc 8 & 9
Discussion:
Revised local guidelines for lipid management presented for approval. These have been produced with North of Tyne APC.
Conclusion:
Guideline approved.
Item 13 / Primary Care Rebate Schemes / Enc 10
Discussion:
Attached paper discussed. Primary care are getting more requests from industry to participate in rebate schemes. Currently three such schemes are in operation: Degarelix, Dabigatran and Rivaroxaban.
Paper highlights that schemes should be looked at on a regional basis with involvement of the regional pharmacy procurement specialist, who is developing a framework for the management of such schemes within the region.
Conclusion:
Paper endorsed by GMMC.
Item 14 / Role of Specialist Advice from Secondary Care / Enc 11a-11b
Discussion:
Letter received from Dr Razvi discussed.
Felt main specialities affected by such issues are pain, endocrine and Parkinson’s.
Often misunderstanding by specialists about product licensing and what unlicensed means, and thus the potential implications for prescribers is a factor.
Conclusion:
Issue referred to Joint Clinical Forum for resolution.
Item 15 / Update on Use of Rifaximin / Enc 12
Discussion:
Attached journal publication by Dr Reddy on use of Rifaximin circulated for info.
Item 16 / Medicines Management Information on CCG Websites / Enc
Discussion:
Attached enclosure circulated for information.
Item 17 / Gateshead CCG Prescribing Report Q1 2012-13 / Enc
Discussion:
Report circulated for information.
Highlights prescribing trends in primary care and how this relates to decisions taken by GMMC.
Noted that increase in pregabalin spend relates mainly to use in Mental Health.
Work underway to understand reasons for increase in spend on solifenacin.
Item 18 / Shared Care Guidelines for Approval
Discussion:
None received this month.
Item 19 / NHS SoTW PGDs For Approval / Enc 21,22
Conclusion:
- MMR Vaccine - approved
Item 20 / Exceptional Case Requests
Discussion:
None received this month.
Item 21 / NICE Guidance September & October 2012 / Enc 13
Discussion:
- CG150 – Headaches – relevant drugs on formulary
- CG151 – Neutropenic Sepsis – Martin Young to review GHFNT guidance. Relevant drugs on formulary.
- CG152 – Psoriasis – n/a to GHFNT as patients treated elsewhere
- TA264 – Stroke (acute ischaemic) – alteplase – on formulary
- TA265 – Bone mets with solid tumours – denosumab – NECDAG approved as red drug
Item 22 / Drug Safety Updates September and October 2012 / Enc 14-16
Following MHRA Drug Safety Updates issued since last meeting:
- Sept 2012 Drug Safety Update
- Oct 2012 Drug Safety Update
- Denosumab
Item 23 / Items from NETAG
Discussion:
- Perampanel (Fycompa®) for focal epilepsy – approved by NETAG for specialist use only. GHNFT does not have a specialist neurology service.
- Bevacizumab (Avastin®) for hereditary haemorrhagic telangiectasia – not approved by NETAG.
Item 24 / Items from NECDAG / Enc 17
Discussion:
See NECDAG minutes
Item 25 / Items for Information Only / Enc 18-20
Discussion:
Items circulated were:-
- NETAG Minutes 10.7.12 – not yet available
- NECDAG Minutes 26.9.12
- GMMC Meeting Schedule 2013
- Changes to Prescribing & Availability of Epanutin®
Item 26 / AOB
Discussion:
Boceprevir & Telaprevir for Hep C
Agreed that as GHFNT is now commissioned by CCG to provide treatment for Hep C that these two drugs can now be added to the formulary in line with their NICE Technology Appraisals. And also prescribers need to provide robust audit of use to demonstrate compliance with NICE TA.
Humulin I Kwikpen and Innolet Insulatard Insulin
Agreed to add these two disposable insulin pen devices to the formulary as other forms for Humulin I and Insulatard are already on the formulary.
Needles of Insulin Pens
Has come to light that Diabetes Specialist Nurses have begun switching patients from 12 & 8mm needles to 6 & 4mm needles. This results a 30% cost increase for primary care. This has not been discussed with primary care for GMMC. All agreed that where any decision has an implication for the primary care prescribing budget it needs to come to GMMC for approval. The chair will take this issue up with Diabetes Specialists Nurses.
Date of Next Meeting: Wednesday 13th February 2013 9am-12noonRoom 6, QEH Education Centre