Apologies for absence were noted from Ms Claire Dobson, Dr I Gourley, Dr J Kennedy, Professor S McLean, Mr I Mohammed.

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1 CONFIRMED MINUTES OF THE MEETING OF THE FIFE DRUGS AND THERAPEUTICS COMMITTEE HELD AT 12.30PM ON WEDNESDAY 4 OCTOBER 2017 IN MEETING ROOM 2, WARD 6, VICTORIA HOSPITAL, KIRKCALDY. Present: Dr Frances Elliot (Chair) Dr Rob Cargill Mr Scott Garden Dr Alan McGovern Mrs Evelyn McPhail Mr Fraser Notman Ms Jeanette Owens Dr Steve Rogers Ms Andrea Smith In attendance: Mrs Sandra MacDonald (minutes) 1 APOLOGIES FOR ABSENCE ACTION Apologies for absence were noted from Ms Claire Dobson, Dr I Gourley, Dr J Kennedy, Professor S McLean, Mr I Mohammed. 2 MINUTES OF PREVIOUS MEETING ON 16 AUGUST 2017 The minutes of the meeting held on 16 August 2017 were confirmed as a true record. 3 SUMMARY OF ACTION POINTS FROM 16 August 2017 MEETING The summary of action points was updated. Vitamin D Guidance Mr Notman advised that the interim Vitamin D Guidance was approved by the MSDTC in August and has been added to the ADTC website. Information on the salient points from the Guidance has been circulated to GP practices. Work on bone health which will incorporate vitamin D is ongoing. Shared Care Protocols Dr McGovern provided feedback from the meeting of the short life working group set up to discuss the issues and progress the interim review of existing out of date Shared Care Protocols. Mr Mohammed has agreed to provide professional support to drive this work forward in collaboration with key stakeholders.

2 Polypharmacy Steering Group Update - Reduction in Antipsychotics in Patients over 75 Years Dr Elliot advised that this is being taken forward through the Mental Health Prescribing Group. SCAN Formulary Submissions Approved Through Lothian Formulary Committee Dr Elliot has had initial discussions with colleagues in NHS Lothian and feedback has been positive. Dr Elliot to discuss at a Lothian ADTC meeting in due course. Guidelines for Supply to Hospital Outpatients Mr Garden confirmed that the form has been finalised and printed copies are awaited. The guidelines and form have been added to the ADTC website. A launch/implementation/communications plan is required to support the introduction of the form across Fife. The GP Prescribing Groups were identified as an appropriate forum for taking this forward. Mr Garden to liaise with S Tyson/F Forrest. FE SG Ms Smith advised that the development of a template letter for use by non prescribers is being progressed. National Therapeutics Indicators Mrs McPhail advised that the report will be submitted to the ADTC meeting in December. Membership The importance of finance involvement on the ADTC was highlighted, particularly in relation to forecasting work. Mrs McPhail to follow up with C Potter. EMcP EMcP AMT Update Report - Primary Care Antimicrobial Pharmaceutical Support Ms Smith informed the Committee that an individual has been identified to potentially take on this role. Non Medical Prescribing Group Ms Owens advised that potential funding to secure a Non Medical Prescribing Lead post is being explored. Job descriptions from other Boards are being gathered. One avenue being considered is a combined Advance Practice Lead/Non Medical Prescribing Lead post. National Effective Prescribing Programme Work Dr Elliot stated that discussions about the role of the Programme in relation to the Single National Formulary work are ongoing. Any proposals in relation to national medicines efficiency work are welcome and should be fed back to Dr Elliot. 2

3 Valproate Patient Safety Alert Mr Mohammed to feed back at the December ADTC meeting. IM 4 ANY OTHER MATTERS ARISING FROM THE MINUTES None. 5 DECLARATION OF INTERESTS There were no declarations of interests. 6 ADTC SUB-GROUP UPDATE REPORTS 6.1 Fife Formulary Committee Dr Rogers introduced the update report with a summary of the discussions from the Fife Formulary Committee meeting on 20 September The review and sign-off process for Formulary Submissions for the introduction of new medicines was supported by the Formulary Committee. A number of the submissions received by the Formulary Committee were withdrawn as they had not been signed off by the Clinical Director and the Committee proposed that a reminder regarding the timelines for consideration of submissions be issued. The Formulary Committee discussed the requirement to complete a Formulary Submission for SMC abbreviated submissions and it was proposed that where the abbreviated submission relates to a product already on the Fife Formulary for that indication a Formulary submission did not require to be completed. The majority of SMC abbreviated submissions are cost neutral or have minimal budget impact, relate to replacement of an unlicensed product with a licensed version or extension to the licence e.g. for paediatric use. The SMC abbreviated submissions would continue to be recorded in the SMC decisions table which is discussed at the Formulary Committee and a Formulary submission would be requested where this is deemed appropriate. The ADTC noted the governance process in place for the consideration of SMC abbreviated submissions and supported this going forward. 6.2 Medicines Reconciliation Group Dr Cargill introduced the update report from the Medicines Reconciliation Group. The ADTC noted the ongoing work in liaison with GP Clusters to improve the communication of medication changes made in hospital to Community Pharmacy. 3

4 6.3 MSDTC Dr McGovern highlighted concerns raised at the Cluster Quality Leads Group around the transfer of appropriate information to Community Pharmacy and the extra administrative step that would require to be taken in General Practice. There are proposals to establish a General Practice Safety Group to take forward patient safety issues. It was suggested that the General Practice Safety Group would be the appropriate forum to take this forward in collaboration with Nick Haldane, Clinical Lead for Patient Safety (Primary Care). Mr Garden highlighted a move from use of the language medicines reconciliation to safe prescribing. Dr Cargill introduced the minutes from the MSDTC meeting on 22 August 2017 and gave a verbal update. Shared Care Agreements remain an issue and the progress made by the short life working group is welcome. The process for the consideration of Clinical Guidance is working well, however a potential issue with ensuring appropriate stakeholders are round to table was noted. The ADTC noted the change in business support for the MSDTC. 6.4 Medicines Homecare Governance Group - Terms of Reference and Membership Mr Garden introduced the proposed Terms of Reference and Membership for the Medicines Homecare Governance Group and briefed the ADTC on the background to this. Comments from the ADTC included an amendment to the wording to clarify that the role of the group includes implementation and monitoring. Subject to the agreed amendment, the ADTC approved the Terms of Reference and Membership of the Medicines Homecare Governance Group. Following further discussion around the reporting structure for the Medicines Homecare Governance Group, it was agreed that the Group should report to the MSDTC. The Medicines Governance flowchart to be amended accordingly. EMcP 7 SBAR - POLYPHARMACY FRAMEWORK Dr McGovern introduced the proposed NHS Fife Polypharmacy Framework. The Framework was developed by the Polypharmacy Steering Group in consultation with specialist services to support clinicians to undertake polypharmacy reviews across all care settings in 4

5 Fife. Comments from the ADTC included the addition of a statement at the beginning of the Framework about giving consideration to realistic medicine and a personalised approach to care. Subject to agreed amendment the ADTC supported the content of the Framework and its inclusion on the ADTC website. 8 NHS SCOTLAND BIOSIMILAR UPTAKE DATA: 15 SEPTEMBER 2017 The NHS Scotland Biosimilar Update September 2017 was noted. 9 HEALTH BOARD COST COMPARISON Mr Notman highlighted the Health Board cost comparison data June 2016-June It was noted that Fife s position in respect to cost per patient continues to improve. This is backed up by Formulary compliance information (69% compliant by cost and 80% by volume). It was also noted that there has been a significant drop in the number of patients on non Formulary medicines. 10 RISKS DUE FOR REVIEW IN DATIX Risk out of date Shared Care Protocols. This was discussed under agenda item 3. Mr Notman to update the management actions and move the review date forward 6 months. FN 11 EAMS OPERATIONAL ARRANGEMENTS FOR ALECTINIB IN NHS SCOTLAND The ADTC noted the EAMS operational arrangements for Alectinib in NHS Scotland. Mr Garden advised that this has been circulated to the relevant oncology team. It was noted that there are no plans to use Alectinib within NHS Fife at this time. 12 INDIVIDUAL PATIENT TREATMENT REQUESTS/PACS 12.1 Latest Submissions The updated table of Individual Patient Treatment Requests was noted New PACS Process Mrs McPhail briefed the Committee on the background to the introduction of the Peer Approved Clinical System (PACS) process. PACS1 relating to the management of requests for ultra-orphan medicines has been adopted in NHS Fife and the associated paperwork is on the ADTC website. PACS2 which is due to replace Individual Patient Treatment 5

6 Requests was expected to be implemented from 1 October 2017 and Boards were initially instructed to have a policy in place by that date. There was however some lack of clarity around medicines covered by PACS2. The Scottish Government has advised that the roll out of PACS2 has been deferred, with the finalised date to be confirmed in due course. In the meantime current IPTR processes should continue. The ADTC noted that work to review the NHS Fife Newly Licensed Medicines Policy is underway. The Policy will be updated to reflect the PACS2 process once further communication from the Scottish Government is received. 13 HIS MEDICINES THEMATIC ANALYSIS FLASH REPORT The ADTC noted the Healthcare Improvement Scotland Analysis of Oxycodone Events Flash Report. Mrs McPhail highlighted that the actions agreed locally within NHS Fife are reflected across other Health Board areas. 14 YELLOW CARD CENTRE ANNUAL REPORT AND LOCAL REPORT The ADTC noted the Yellow Card Centre Scotland Annual Report April 2016 to March 2017 and NHS Fife Yellow Card Report April 2015 to March There was a discussion around raising the profile of the reporting of adverse drug reactions through the Yellow Card Scheme. Dr Cargill proposed that this be taken forward through the Safe Use of Medicines Group. RC 15 HIS PHARMACY & MEDICINES STAKEHOLDER BRIEF: SEPTEMBER 2017 The ADTC noted the Healthcare Improvement Scotland Stakeholder Brief September POINTS FOR RAISING AT CLINICAL GOVERNANCE COMMITTEE It was agreed that the following items should be highlighted to the Clinical Governance Committee: FE Homecare Medicines; Biosimilars Update; Polypharmacy and Holistic Medicines Agenda. 17 ANY OTHER COMPETENT BUSINESS There was no other business. 6

7 Other Information a Minutes of Diabetes MCN Prescribing Sub-Group September Not available. b Minutes of Heart Disease MCN Prescribing Sub-Group September Not available c Medicines Procurement Newsletter September The ADTC noted the Medicines Procurement Update September 17. d Date of Next Meeting The next meeting is to be held on Wednesday 20 December 2017 at 12.30pm in Meeting Room 2, Ward 6, Victoria Hospital, Kirkcaldy. (The deadline for submission of papers to be considered for the agenda is 4 December 2017.) 7