12thJune2013 0900-1200
Room 4, Education Centre
QEH
Attendees: / Consultant Anaesthetist, Gateshead Health NHS Foundation Trust (Chair)
Consultant Microbiologist, Gateshead Health NHS Foundation Trust
GP (Primary care prescriber)
Chief Pharmacist, Gateshead Health NHS Foundation Trust
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
Prescribing Lead, Gateshead Clinical Commissioning Group (Vice-Chair)
Apologies: (item 1) / None received
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 10th April 2013 & Decision Summary / Enc 1+2
Discussion:
Minutes & Decision Summary agreed as a true record.
Item4 / Ongoing Action Points / Enc 3
Discussion:
Circulated for information.
Item 5 / Matters Arising
Discussion:
a)Needles for Insulin Pens – been agreed within GHFNT that new safety needles are for staff use only not for patient use. Community services currently producing guidance for community nurses. Noted that implementation of HSE guidance on reducing needle stick injuries has been deferred until Nov 2013.
b)Buccolam Switch – no further progress by Newcastle to report. GMMC agreed to continue to progress switch to licensed product in Gateshead. Also agreed to that to avoid confusion between different products prescribing would need to be by brand name in future.
c)Linaclotide New Drug Request–noted now approved by SMC. Mr Mercer-Jones has responded to questions raised by GMMC at last meeting. Agreed to approve Linaclotide as Red drug on the formulary for use by Mr Mercer-Jones/Dr Johns only. The initial script will be for 1 month supply, and then subsequent scripts will be until next review appointment. This decision will be reviewed in March 2014 with a view to status changing to Green +.
Item 6 / New Drug Requestsfor June 2013Meeting / Enc 4-6
Discussion:
Abatacept for Rheumatoid Arthritis
Requested by Dr Kellyfor use in rheumatoid arthritis
Expects 10 patients a year and will be used in patients who would otherwise have had an anti-TNF but is contra-indicated.
Reviews:
- NICE – approved May 2013
- SMC – approved
- NoT APC – approved.
- NICE Bites May 2013
Pirfenidione for Pulmonary Fibrosis
Requested by Dr Allcock for use in IPF as now NICE approved.
Flutiform
Requested by Dr Allcock for treatment of asthma in those 12years and older.
Evidence presented as per application form.
Reviews:
- NICE – not considered
- SMC – approved Oct 2012
- AWMSG – not considered
- RDTC – not considered
- LNDG – not considered
- MTRAC – not considered
- NETAG – not considered
- NoT APC – approved
Glycopyrronium bromide
Requested by Dr Allcock for treatment of COPD.
Evidence presented as per application form.
Reviews:
- NICE – not considered
- SMC – approved Jan 2013
- AWMSG – not consider
- RDTC – Nov 2012 – may be more cost-effective that alternatives but long-term date and direct comparator trials lacking.
- LNDG – not considered
- MTRAC – approved Nov 2012
- NETAG – not considered
- NoT APC – approved
- DTB – June 2012 – insufficient evidence to recommend over existing product.
Requested for addition to formulary as on North of Tyne Formulary, and often used by specialists in preference to other antihistamines.
Mycophenolate for Pulmonary Fibrosis
GMMC asked to confirm formulary status of mycophenolate when used for this indication. Noted that mycophenolate is not licensed for this indication and evidence base is week. Also NICE are developing a CG on Idiopathic Pulmonary Fibrosis and the current draft does not recommend use of mycophenolate.
Conclusion:
- Abatacept for RA – approved as red drug as per NICE TA280.
- Pirfenidione -Approved for addition to formulary in line with NICE TAG as red drug. Noted will only be available by clinics approved by Specialised Commissioning.
- Flutiform – approved as Green drug for use in asthma only. Not expecting existing patients to be switched to flutiform.
- Glycopyrronium (Seebr®) – refused. The group noted that there are now three LAMAS available. The GMMC felt that to accept a second LAMA onto the formulary it should offer differences to tiotropium (e.g. design of inhaler), and Seebri® device is similar in design to Tiotropium.
- Fexofenadine – approved as Green drug
- Mycophenolate – should not be prescribed for idiopathic pulmonary fibrosis. It approved on the formulary for shared care use in gastro, RA, transplant and dermatology only.
Item 7 / New Drug Requests for August 2013
Discussion:
- None received to date
Item 8 / Antimicrobial Update
Discussion:
Nothing to report.
Item 9 / Formulary Chapter Updates / Enc 9-14
Discussion:
The following chapters of the GHFNT formulary have been updated on the internet/intranet sites since the last meeting:
- 1 – Gastrointestinal
- 2 – Cardiovascular
- 3 – Respiratory
- 4 – Central Nervous System
- 5 – Infections
- 6 – Endocrine
Conclusion:
Chapter updated approved.
Agreed in future to list changes since last version on page 1.
Noted that infections chapter needs further revisions and to ensure that when doing updates Red drugs are appropriately annotated.
Item 10 / Request for change of routine GCSF used in Gateshead - routine use of Zarzio instead of lenograstim / Enc 15
Discussion:
Enclosed briefing paper was discussed.
Conclusion:
Change to the formulary approved as follows:
Zarzio® – for majority of neutropenic patients
Lenograstim – for stem collection patients
Pegfligrastim – for oncology patients as Cancer Network says more cost-effective for this group of patients as single dose rather than 3-5day dose so saves District Nurse time.
Item 11 / Alfentanil Guideline / Enc 16
Discussion:
Request received from GHFNT Palliative Care team to adopt South Tyneside Alfentanil Information sheet for GPs and Community Pharmacies in Gateshead. This would be send to relevant GP/Community Pharmacy by palliative care team each time a patient is commenced on an alfentanil syringe driver, as has happens in South Tyneside.
Conclusion:
Guideline approved.
Item 12 / Guidelines for approval / Enc 20
Discussion:
Following existing guidelines have been revised & updated:
- Osteoporosis Guideline – to follow
- Sip Feed Guideline – to follow
- Gluten Free Guideline – to follow
- Constipation Guideline
- ENT Guideline
Conclusion:
- Osteoporosis Guideline – further meetings to be arranged to update
- Sip Feed Guideline – agreed to review & update via email
- Gluten Free Guideline – agreed to review & update via email
- Constipation Guideline - approved
- ENT Guideline – approved medicines aspects of this guideline only. Not for GMMC to approve/comment on referral/treatment pathway of these patients
Item 13 / Rivaroxaban
Discussion:
GMMC is asked to approve Rivaroxaban as a Green + drug for patients with DVT/PE whom the anticoagulant service have identified as difficult to manage on warfarin and/or tinzaparin, and refer to haematologists for advice on their management.
Would remain non-formulary for all newly diagnosed DVT/PE patients until DVT/PE referral/treatment pathway redesigned.
Conclusion:
Approved.
Item 14 / Denosumab
Discussion:
Denosumab was approved as a Green+ drug in Nov 2012. GHFNT are encountering problems in transferring patients for primary care.
Conclusion:
This needs some pathway redesign with commissioners. Until such time as this in place prescribing of Denosumab will largely remain in secondary care. CCG will inform GHFNT when patients can be transferred to primary care.
Item 15 / Apomorphine injection for Parkinson’s disease
Discussion:
PD team would like to develop shared care guideline for apomorphine injection as it is classed as Amber on the formulary. This should be ready for approval in Aug 2013
We will be only handful of patients.
There is one patient due to start in July 2013 and this will be on non-formulary basis with agreement of GP/CCG/PD team.
Item 16 / Formulary Choice of Emollients / Enc
Discussion:
Dermatology services in Gateshead are largely provided by Newcastle and therefore, it would make sense to have a formulary for emollients that matches that of Newcastle. Noted that North of Tyne APC have recently rationalised the list of emollients on their formulary.
Conclusion:
Agreed to change Gateshead formulary for emollients to match that of Newcastle.
Item 17 / District Nurse Dressing Request Form / Enc
Discussion:
Form is to be used by DNs to request dressings from GP practices.
Aim is to reduce inappropriate prescribing and provide information to practices on the wound management plan for the patient.
Conclusion:
Approved
Item 18 / LMWH Information Sheets for Primary Care / Enc
Discussion:
LMWH information sheets have been developed as part of the NPSA alert on LMWH treatment doses to provide information on monitoring requirements and doses per kg for patients.
Sheets will be distributed to all GP practices, OOH providers and community pharmacists
Conclusion:
Approved
Item 19 / Shared Care Guidelines for Approval
Discussion:
None received this month.
Item 20 / NHS SoTW PGDs For Approval
Conclusion:
None received this month.
Item 21 / Exceptional Case Requests
Discussion:
None received this month.
Noted new online CCG IFR system has now gone live.
Item 22 / NICE Guidance April 2013May 2013 / Enc
Discussion:
- CG159 – Social anxiety disorder - all relevant drugs on formulary. n/a to GHNFT as pts treated in MTW Mental Health Trust
- CG160 – Feverish illness in children– no specific drugs included
- TA278 – Asthma – Omalizumab (review of TA133 + TA201) – approved by NICE. Noted use extended & GHFNT signed up to PAS scheme.
- TA280 – RA – abatacept (2nd line) – rapid review of TA234 - approved as an option by NICE. Approved for addition to formulary in line with NICE TAG.
- TA281 – Gout – canakinumab - appraisal terminated by NICE. Drug not on formulary in Gateshead.
- TA282 – Idiopathic pulmonary fibrosis – pirfenidone – approved by NICE. Approved for addition to formulary in line with NICE TAG. Noted will only be available by clinics approved by Specialised Commissioning.
- TA283 – Macular oedema – ranibizumab - ilateshead.ry. drug ed use extended & GHFNT signed up to PAS scheme.remain in secondary care. ed drugs are appropriately anno approved by NICE. n/a to GHNFT as pts treated in Newcastle or Sunderland.
- TA284 – Bevacizumab with paclitaxel and carboplatin for advanced ovarian cancer – not approved by NICE. Drug not on formulary in Gateshead.
- TA285 – Bevacizumab - not approved by NICE. Drug not on formulary in Gateshead.
- TA286 – inhaled loxapine - TA274 – appraisal terminated by NICE. Drug not on formulary in Gateshead.
Item 23 / Drug Safety Updates April & May 2013 / Enc
Following MHRA Drug Safety Updates issued since last meeting:
- April 2013Drug Safety Update
- May 2013 Drug Safety Update
- None
Item 24 / Items for Information Only / Enc
Discussion:
Items circulated were:-
- GHFNT Trust Drug Expenditure Report Q4 201213
- RDTC TNF inhibitor guidance
- NHS Gateshead CCG Prescribing Engagement Scheme
Item 25 / AOB
Discussion:
Rotigotine Patches
Noted there has been a change to storage conditions for rotigotine patches and they can now be stored at room temperature rather than in the fridge.
Unfortunately batches of the product which require fridge storage still remain in UK supply chain so to avoid confusions manufacturer have confirmed all batches can be stored in the fridge until supplies of the old batches are exhausted.
Ferrinject
There appears to have been an increased use in of IV iron in heart failure patients recently. Agreed that the Chair will contact the cardiologists to understand if there has been a change in practice and the reasons behind this.
CCG Decision Approval Process
Discussions are ongoing with CCG Executive about ratification by CCG of decisions undertaken by GMMC.
GMMC Workplan 2013/14
This has been prepared and will be circulated to members via email.
Date of Next Meeting: Wednesday14th August 2013 9am-12noonRoom 4, QEH Education Centre