Venue: Boardroom, New Century House, Tameside and Glossop. Present: Name Designation Organisation CCG members

Transcription

1 GREATER MANCHESTER MEDICINES MANAGEMENT GROUP Date: Thursday 17 th November 2016 Time: 1pm 3pm Venue: Boardroom, New Century House, Tameside and Glossop. Present: Name Designation Organisation CCG members Dr Helen Burgess (HB) GP Prescribing Lead and GMMMG (Chair) South Manchester CCG Liz Bailey (LB) Medicines Optimisation Lead Stockport CCG Dr Connie Chen (CC) GP Central Manchester CCG Kenny Li (KL) Head of Medicines Management Manchester CCGs Leigh Lord (LL) Locality Lead Pharmacist NHS Trafford CCG Dr Alison Lyon (AL) GP Prescribing Lead Bolton CCG Keith Pearson (KP) Head of Medicines Optimisation NHS HMR CCG Jeanette Tilstone (JT) Head of Medicines Optimisation NHS Bury CCG Claire Vaughan (CV) Head of Medicines Optimisation Salford CCG Dr Sanjay Wahie (SW) Clinical Director NHS Wigan CCG Annette Walker (AWa) Director of Finance NHS Bolton CCG Ben Woodhouse (BW) Head of Medicines Optimisation Bolton CCG Regional and Secondary Care members Charlotte Skitterall (CS) Director of Pharmacy (Co-Chair) University Hospital South Manchester Trust Petra Brown (PB) Chief Pharmacist Manchester Mental Health and Social Care Trust Jane Wilson(JW) Director of Pharmacy Greater Manchester West MHT Additional Adam Irvine (AI) Chief Executive Officer Greater Manchester LPC Jane McDonald (JMc) Director of Improvement GM AHSN Support Sue Dickinson (SD) Director of Pharmacy RDTC Andrew Martin (AM) Strategic Medicines Optimisation GM Shared Service Pharmacist Bhavana Reddy (BR) Head of Prescribing Support RDTC Andrew White (AW) Head of Medicines Optimisation GM Shared Service In attendance: Mike Burrows, Managing Director, GM AHSN for agenda item 2.1 Minutes by: Bhavana Reddy, RDTC Chair: Dr Helen Burgess, South Manchester CCG Item Topic 1 General Business 1.1 Apologies for Absence K Kinsey, J Brown, R McDonald, P Burns, L Smith, R Hey. N Dunkerley. Action A round of introductions took place. 1

2 Conflicts of Interest Declarations It was noted that there had been no conflicts of interest declared by members currently present. HB asked the group if any new conflicts relating to the agenda had arisen since the agenda had been circulated. No conflicts were declared. Sharing of papers prior to the meeting: A discussion took place around sharing of papers prior to the meeting on the password protected site. It was noted that members with a financial conflict of interest would not be sent the papers for that particular agenda item for which they are conflicted so a query had arisen around whether the papers for the GMMMG meeting should be shared prior to the meeting on the password protected site which would then be visible to non GMMMG members and the group would not be aware of their conflicts. After some discussion, it was agreed that the papers should only be shared following the meeting and for items that are completed where any undue influence on decision making is not possible. The group also stated that healthcare professionals would be required to declare interests to their employer and these would be publically available, so if the group wished to check the COI of those accessing the password protected site this was possible. Minutes of the Previous Meeting. SW indicated he had sent his apologies these would be updated and the minutes published on the GMMMG site. Matters Arising from Key Actions: AHSN to map out IT interfaces JMc had shared paper copies of the AHSN s access to pathology results across GM. This paper summarised the current position and identified a potential solution in Datawell an innovative platform that enables health data to be shared between healthcare providers. This item had now been completed so would be removed from the matters arising document. GM Antivirals. It was noted that all localities had local plans in place and there wasn t currently any plans to move to a single GM plan. Public Health appeared to be happy with the current situation as long as they had a list of OOH contact details and stock. It was agreed that the shared service should update the previous scoping document with the above information and share this with CCGs. Another issue was raised around the choice of vaccine. CCGs had contacted public health but they hadn t had any official recommendations around which vaccinations (trivalent or quadrivalent) should be ordered. It was agreed that GMMMG should encourage a response by writing to PHE and copying in Keith Ridge, Chief Pharmaceutical Officer although it was unclear who at PHE the group should write to. It was noted that PHE currently offer the quadrivalent vaccine to children as they are more prone to catching influenza B viruses, the decision of what type of vaccine to order for ACTION: BR to put papers on password protected site after meeting. Minutes and Agenda to be published on main public site once approved. RDTC to publish on website GM SS to share scoping. ACTION: BR to contact PHE for advice in the first instance on behalf of GMMMG. 2

3 adults is left to practices and CCGs to agree. The flu letter is normally sent out in May. GMMMG Gluten Free Foods Policy (next steps) The group discussed the next steps regarding updating of the GMMMG Gluten Free Foods policy. It was noted that there had been a parliamentary debate regarding this however there was some misinformation surrounding that debate that needed to be corrected. It was also noted that any region looking to change their policy on gluten free foods would need to go to public consultation. The group therefore agreed the following steps: A task and finish group would be set up to look at the service as whole rather than just the supply of prescriptions. Different supply routes can be considered however patients should be encouraged to maintain a healthy diet and utilisation of foods and recipes that are naturally gluten free rather than emphasising the prescribing of gluten free products. Any changes to the policy would need to be done in line with a change to the way these patients are managed and dietetic support given to them. It was agreed that whilst Gluten Free may not be the highest priority area for GM; it could be used as a test case and the review methodology and process developed by the task and finish group be utilised for other higher priority projects. The group agreed to renew the date on the current policy; this would be circulated to members and would be updated on the website via Chairs sign off. It was also agreed that the gluten free work should form part of the wider GM agenda on self-care. Strategic Direction 2.1 Presentation from Mike Burrows, AHSN Managing Director 1.30pm MB attended the meeting at 1.30pm to give the group an update on key projects the GM AHSN was working on and to start the discussion around how GMMMG and the AHSN could work better together moving forward. It was noted that AHSN was now part of Health Innovation Manchester. MB touched upon the following topics: background to Devo Manc, the financial challenge, the unique features of GM as a health economy and accelerating innovation into practice. It was agreed that early discussions with GMMMG would ensure that any AHSN work on new innovative projects would ensure alignment with GMMMG recommendations. MB offered to attend future meetings to ensure that the lines of communication were kept open. 2.2 GM Medicines Strategy, Co-ordination and Oversight. AW introduced this agenda item and the paper that had been drafted regarding the above. It was noted that there were two separate issues outlined in the cover sheet: The first was regarding AGG feedback on GMMMG delegated decision making authority and the development of GMMMG into a clinical standards board. Whilst AGG was supportive of the re-structuring of GMMMG into a clinical standards board and the need to revise membership they didn t feel the case for delegated decision making authority had been proven. Therefore it was felt that the group should go ahead and become a clinical standards board and a further paper outlining the need for delegated ACTION: Shared Service to share current Gluten Free Policy with members and update on GMMMG Task and finish group to be formed in the new year. 3

4 decision making could be put forward at a later date. The second issue was regarding the inclusion of medicines as a separate work stream under GM devolution. AW fed back that Jon Rouse had proposed the development of a Medicines Strategy Board, as he felt there is a clear need to elevate medicines to a higher status within the GM transformation programme - by establishing an overarching medicines enabling work stream, as significant as estates, IMT and workforce. AW stated that the new medicines strategy board would cover the industry working, hospital pharmacy transformation and community pharmacy and medicines optimisation. The aim was to change the approach i.e. medicines as an investment in improving care outcomes, not just a cost. GM offers a unique opportunity to link all aspects of medicines (and devices, diagnostics, med tech and telemedicine) together in a unique way to improve population health and wealth. Questions were raised around where GMMMG would fit with regards the new medicines strategy board. The aims of the strategy board would be to provide the requisite leadership and oversight to drive the major GM level cross cutting programme of work required and it is intended that the board would oversee and support the work of the GMMMG to develop medicines policy and optimisation. It is envisioned that the strategy board will support GMMMG in developing into a clinical standards board and would support the vision of GMMMG to reduce variation and highlight best practice across GM. There were some concerns from CCGs and Trusts that this had been rushed through with limited time for comments or feedback from organisations however AW stated that whilst he had asked for more time there was an urgency to get this in place as other work streams have been running for 6 months already. AW agreed to share the updated paper with members and there would be further opportunity for feedback in the coming months. 2.3 GMMMG New Subgroups proposed membership. It was noted that there were sufficient names put forward for each of the three groups however there are still some gaps with regards specific roles required for some of the groups. e.g. procurement for the high cost drugs group. It was also noted that all three groups are populated predominantly by pharmacists although there are some clinicians, there are very few finance, commissioning or contracting colleagues represented. It was agreed that the groups would be set up to meet in January however the gaps would need to be plugged in the meantime with requests for specific roles going out to organisations. It was agreed that the chairs should be contacted to put forward availability. A query around ongoing work from existing groups was raised. It was noted that the work is ongoing in the background despite the groups not physically meeting. NTS has completed all urgent items on the work plan and is following up outstanding items such as specialist feedback via . Similarly interface had recently been sent an to agree RAG status for various outstanding items. It was noted that most of the work for the subgroup meetings has to take place outside of meetings so that items can be progressed. 2.4 PbR Excluded drugs list AM introduced the above agenda item and he indicated that the national tariff is intended to cover TWO financial years. The group raised concerns about this as there is limited information available currently. The group to conduct gap analysis and share with Chairs. However meetings to be arranged for January as previously agreed. ACTION: AM to publish final document on 4

5 thanked AM for his work on this document and agreed that in future years that the high cost drugs subgroup is the appropriate forum to review this document. AM indicated that the list would be updated as and when the PbR excluded list is finalised. GMMMG approved this document for adoption across GM. 3 Medicines Optimisation There were no items for discussion raised at this meeting. 4. GMMMG Subgroups 4.1 Formulary Subgroup 1. November update from the FSG to publish on website The formulary had been updated with the latest NICE TAs and MHRA updates. The above updates were approved. 4.2 New Therapies Subgroup. 1. Recommendations for Approval: a. Ferric Maltol for IDA in IBD The group was informed that this had been approved for use following failure of at least three previous ferrous products and prior to use of IV iron. Ferric Maltol has the potential to be cost saving if it is tolerated by patients as was suggested from the clinical trials. A potential cost saving of around 348,166 per annum for the Greater Manchester region was indicated by the cost model. GMMMG approved this recommendation. to publish on 4.3 Interface Prescribing Sub-group 1. IPS August minutes The group noted and ratified the minutes from the interface group. 2. October update report The group noted the update report and approved the proposed RAG status decisions. 3. GMMMG approved the following Shared Care Guidelines: Guanfacine for childhood and adolescent ADHD Mycophenolate mofetil for interstitial lung disease. 5 Reports from Associated Committees 5.1 GM CCG leads Pharmacists Meeting. to publish on The CCG leads meeting discussed many of the items covered at GMMMG today as well as some further discussions on antibiotics, non-medical prescribing and funding for medicines risks projects 5

6 GM Chief Pharmacists. CS fed back that the HPTP plans had to be submitted by the end of October and had been shared with NHS improvement and organisations were awaiting any feedback. Plans were consistent across GM and CCGs could contact their local chief pharmacist if more detail on this is required. JW fed back that the proposal to support BB s post for longer than a year had not been approved. SB was currently drafting a paper to gain support to move forward. GMMMG raised concerns that the good work achieved so far would stall without this role. Local Professional Network. No feedback was been received regarding the above. 6 AOB 6.1 RMOCs An asking for nominations onto the RMOC steering board had been received via clinical commissioners for CCGs and a similar should have been sent to Chief Pharmacists. It was agreed that GMMMG should nominate individuals. HB encouraged those interested to put their names forward. It was noted however that these nominations were for the steering group who would sit above the RMOCs themselves. The group agreed it would be useful to put someone forward for the actual RMOC meetings also. SD suggested that the group nominate members and put them forward to Mike Prentice who is the Medical Director for the northern region and who will chair the RMOCs. It is intended that the RMOCs will start meeting from April Gender Dysphoria treatments Post meeting note: There was insufficient time to discuss the above issue in any detail however it had been suggested that the interface group or the new pathways group look at producing an information sheet on the above drugs to aid GPs in prescribing in this specialist area. Whilst it is recognised that this is a service commissioned by NHS England and is not the responsibility of CCGs; GPs are still expected to prescribe these drugs without a shared care protocol so would value some information to aid in the safe prescribing of these treatments. 7 Items for Information No items were discussed. 7.1 Date, time and venue of next meeting ACTION: to add to work plan for new shared care group. Thursday 15 th December pm Salford Pendleton Gateway (across the road from SJH) 6