14th May 2014 0900-1200
Room 4, Education Centre
QEH
Attendees: / Consultant Anaesthetist, Gateshead Health NHS Foundation Trust (Chair)
Prescribing Lead, Gateshead Clinical Commissioning Group (Vice-Chair) (from 10.30am)
GP (Primary care prescriber)
Consultant, Gateshead Health NHS Foundation Trust
Medicines Governance Pharmacist, Gateshead Health NHS Foundation Trust (Secretary)
Regional Drug & Therapeutics Centre (Newcastle) Advisor
Primary Care Medicines Management Provider
Community Pharmacist
Senior Pharmacist NECS
Pharmacist NECS
Pharmacist NTW Mental Health Trust
Apologies: (item 1) / Chief Pharmacist, Gateshead Health NHS Foundation Trust
Community Services Representative, South Tyneside NHS Foundation 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 12thMarch 2014 & 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 / Enc 4
Discussion:
a)Mini-Qufora New Drug Request– Heather Wilson attended the meeting to answer the questions raised by the GMMC at their last meeting on the application to add Mini-Qufora to the formulary. After discussion it was agreed to add Mini-Qufora to the formulary as a Green+ drug, and that a guideline for GPs on prescribing of bowel irrigation listing the products that can be prescribed plus dose/duration of therapy be put together.
b)Paediatric Dermatology Issues–Dr Reid attended the meeting to discuss the prescribing of Dermol 600 and other antiseptic skin products. After discussion it was agreed that the current prescribing of Dermol is appropriate provided it is used short-term only for flare ups of eczema when the skin is broken. Dermol should be discontinued when the skin is no longer broken. Use of Dermol prevents the need to use repeated courses of oral antibiotics. Dr Reid will ensure GP letters contain information of why Dermol has been chosen and give clear instructions on duration of therapy.
Item 6 / New Drug Requestsfor May 2014Meeting / Enc 4+5
Discussion:
Torasemide
Application not yet received. The chair will take this up directly with the cardiologists
Colsevelam
Application not yet received.
Generic Combined Oral Contraceptives
Requested by Dr Jewitt (present)
Requested for use as alternative to branded products as use could result in significant cost savings to primary care.
Noted that CASH clinics and Sexual health clinics are already using the Consilient Health products.
Evidence as per application form.
Reviews:
- NICE – not considered
- SMC – not considered
- AWMSG – not considered
- RDTC – not considered
- NoT APC – approved.
- LNDG – not considered
Requested as replacement for pepti-junior on the formulary in children with cow’s milk allergy.
Evidence as per application form.
Noted that are no cost implications to switch.
Conclusion:
- Generic Combined Oral Contraceptives – Morningside Healthcare and Consilient Health products approved as Green drugs.
- Nutramigen 1 and 2 – approved as Green drug to replace Pepti-junior on the formulary in patients with cow’s milk allergy.
Item 7 / New Drug Requests for July 2014
Discussion:
None received yet.
Item 8 / Antimicrobial Update
Discussion:
Nothing to report
Item 9 / Formulary Chapter Updates / Enc
Discussion:
The following chapters of the GHFNT formulary have been updated on the internet/intranet sites since the last meeting:
- 2 – Cardiovascular
- 4 – CNS
- 5 – Infection
- 6 – Endocrine
- 7 – Obstetrics, Gynaecology and Urinary Tract Disorders
- 8 – Malignant disease & immunosuppression
- 11 - Eye
Conclusion:
Chapter updates approved.
Item 10 / NTW Trust Antipsychotic Leaflet
Discussion:
Anthony Young gave the background to the development of this leaflet by NTW Mental Health Trust.
Currently antipsychotics are classed as Amber on the formulary in Gateshead and NTW would like to change this to Green+ to match practice in other localities covered by NTW. This leaflet will help support this change.
Conclusion:
Leaflet was approved.
Item 11 / Dossette Boxes
Discussion:
LMC/LPC recently met with local Trust Chief Pharmacists to discuss this issue. It was agreed that a simple generic letter would be produced which would be given out to all patients on discharge who have a compliance aid to remind them to contact their GP/Community Pharmacy as soon as possible after discharge to arrange future supplies in the community. This is to try to ensure patients do not run out of medication 7 days after discharge once hospital supply exhausted, and prompt GP/Community Pharmacy to check for any changes that may have been made during admission.
Item 12 / UKMi Medicinal Products Risk Assessment Tool / Enc
Discussion:
This is a new tool developed by UKMi. This tool facilitates a systematic assessment of in-use patient safety characteristics of any product for medicinal use prior to introduction to practice. It enables full consideration of the patient safety characteristics of all products for medicinal use, whether they are licensed or otherwise. And it is designed to be as holistic as possible: it considers the pharmaceutical characteristics of the product, any links between a product’s regulatory status and its in-use safety, as well as practical considerations such as issues associated with the product design or the impact of use in differing areas of practice.
Conclusion:
Agreed to adopt use of tool as part of New Drug Request procedure if secretary feels it is appropriate and will help in assessment of New Drug Request by GMMC.
Item 13 / NHS England Commissioning Circulars / Enc
Discussion:
Received for information.
- SSC1415 – Repatriation of Cystic Fibrosis
- SSC1417 – Hormone therapy for gender dysphoria
- SSC1419 – Sofosbuvir
- SSC1422 – Rituximab in ANCA
- SCC1423 – Multiple myeloma – Bortezomib (induction therapy)Subcutaneous Rituximab
Item 14 / Guidelines for Approval / Enc
Discussion:
Following guidelines have been revised & updated:
- Management of Rheumatic Disease Patients in Orthopaedic Perioperative Period – now includes information on new biologics
- Prescribing for Cow’s milk allergy in babies & young children – now includes information of using nutramigen
- DVT Pathway–these have been developed to support changes to ambulatory care in GHFNT and driver to keep patients out of hospital. The CCG have yet to review these guidelines and are keen to develop a single pathway for use across Newcastle and Gateshead. CCG would also like low risk patients to be managed in primary care and only high risk patients to be referred to secondary care for treatment initiation. There is also some work to be done by the commissioners around drug costs and activity costs.
- Lower Limb Cellulitis Pathway – reflects current practice and no changes made. Developed to support changes to ambulatory care in GHNFT.
- Symptomatic Anaemia Pathway– reflects current practice and no changes made. Developed to support changes to ambulatory care in GHNFT.
- Acute Alcohol Guideline - Anthony Young to attend meeting
Conclusion:
- Management of Rheumatic Disease Patients in Orthopaedic Perioperative Period – approved
- Prescribing for Cow’s milk allergy in babies & young children - approved
- DVT Pathway – drug aspects only reviewed. Suggest document modified to include information on dose of rivaroxaban (e.g. 15mg BD for 21 days, then 20mg OD thereafter).For commissioners to finally approve with appropriate input from CCG.
- Lower Limb Cellulitis Pathway - drug aspects only reviewed & approved. For commissioners to finally approve with appropriate input from CCG.
- Symptomatic Anaemia Pathway – drug aspects only reviewed & approved. For commissioners to finally approve with appropriate input from CCG.
- Acute Alcohol Guideline –still in draft. Comments to NTW Mental Health Trust by end of May 2015. Needs wording strengthening that multivitamins and vit B co strong should not be routinely prescribed for alcoholics as little evidence to support use.
Item 15 / Shared Care Guidelines for Approval
Discussion:
None received this month.
Item 16 / Primary Care PGDs For Approval
Conclusion:
None received this month.
Item 17 / Exceptional Case Requests
Discussion:
None received this month.
Item 18 / NICE Guidance MarchApril 2014 / Enc
Discussion:
- TA307 – Colorectal cancer (metastatic) – aflibercept – not recommended by NICE.
- TA308 – Vasculitis (anti-neutrophil cytoplasmic antibody associated) – rituximab (with corticosteroids) – approved as an option by NICE. Formulary will reflect this. Noted is funded by NHS England.
- TA309 – Lung Cancer – pemetrexed – not recommended by NICE.
- TA310 – Lung Cancer – afatinib – approved as an option by NICE. Formulary will reflect this
- TA311 – Multiple Myeloma – bortezomib (induction therapy) - approved as an option by NICE. Formulary will reflect this.
- CG179 – Pressure Ulcers – no specific drugs involved.
Item 20 / Drug Safety Updates MarchApril 2014 / Enc
Following MHRA Drug Safety Updates issued since last meeting:
- March 2014Drug Safety Update
- April 2014 Drug Safety Update
- Noted the new restrictions on use of domperidone, this has been communicated to prescribers.
Item 21 / Items for Information Only / Enc
Discussion:
Items circulated were:-
- GHFNT Drug Expenditure Report Q4 2013/14
Noted that this year there have been no drugs coming off patent with big savings to offset growth as in previous years.
The main areas of growth in secondary care are:
Infection – working with microbiology to understand why our use of tigecycline is how compared to other Trusts locally
Anaesthetics – due to increased activity within the Trust in the main
Nutrition & Blood – due to switch from cosmofer to ferrinject as IV iron preparation of choice. This was approved by GMMC on basis on saving nursing time but was noted at time that drug cost would be greater. Also compared to other Trusts in UK our use of IV iron is higher than oral iron.
Endocrine – due to barrier in transferring out patients on denosumab to primary care. This should resolve from 1st April 2014.
Cardiovascular – due to switch to regadenosan from adenoscan to save nursing time but was noted at time that drug cost would be greater. Also due to increased use of therapeutic tinzaparin due to increased referrals for DVT/PE, and increased use of prophylactic tinzaparin post-surgery.
Dressings – appears to be increased use of dressings in theatres and also on some medical wards.
- GMMC Annual Report 2013/14
- Gateshead CCG Q3 2013/14 Report
Item 22 / AOB
Discussion:
Outpatient Prescribing
The Chair has been tasked to review the mechanism by which outpatient prescribing occurs in GHFNT. The communications from the Osteoporosis Clinic to GPs was highlighted as an example of good practice.
Homecare
Noted new NHS Alert of supply of drugs via Homecare and work is underway to respond to this.
Prescribing of Multiple Antidementia Drugs
There are an increasing number of patients receiving multiple antidementia drugs. The issue has been referred to NTW Mental Trust who will undertake an audit.
Supply of IV antibiotics in the Community
GHFNT has received a few requests recently from GPs to dispense IV antibiotics that community pharmacies have been unable to acquire. Discussion took place on the current pathways for the supply of IV antibiotics to patients in the community via the Gateshead Intermediate Care (GIC) Team. It was noted that the only currently approved pathways are for cellulitis and orthopaedic patients, but there has been some creep into other therapeutic areas. Following key points were raised in discussion:
- Work underway to clarify exactly which antibiotics can be given in the community by the GIC team and for what indication.
- GPs should not be initiating IV antibiotics outside of the cellulitis pathway.
- Current practice is that patients should be referred to ambulatory care who will make decision on whether to initiated IV antibiotics and organise a supply from GHFNT Pharmacy.
- Microbiologists are not asking GPs to initiate IV antibiotics.
- Community Pharmacies are have regular issues getting supplies of IV antibiotics from wholesalers. It was initially agreed that Young’s Pharmacy, ASDA and Sainsbury’s would hold stock of flucloxacillin, amoxicillin, clindamycin and ceftriaxone but due to supply issues this will cease once new mechanism can be put in place for South Tyneside Foundation Trust to supply GIC team directly.
Date of Next Meeting: Wednesday9th July 2014 9am-12noonRoom 4, QEH Education Centre