The healthiest place to live and work, by 2025

Size: px

Start display at page:

Download "The healthiest place to live and work, by 2025"

Shanna Garrett
6 years ago
Views:

1 28/04/ /06/2017 [Date] Cannock Chase Clinical Commissioning Group The healthiest place to live and work, by 2025 Joint Clinical Commissioning Group (CCG) South Staffordshire Area Prescribing (APG) Meeting Friday 23 rd June pm Boardroom 1, Edric House, Rugeley WS15 1UW Members: Dr Mark Stone (MS) - Chair S&S CCG GP Representative Mohammed Azar (MA), Deputy Chief Pharmacist South Staffordshire & Shropshire Healthcare NHS Foundation Trust (SSSFT) Sue Baker (SBa) (SSSFT) Susan Bamford (SB), Head of Medicines Management East Staffordshire (ES) CCG Samantha Buckingham (), Interim Head of Medicines Optimisation Cannock Chase (CC), South East Staffordshire & Seisdon Peninsula (SES&SP), and Stafford & Surrounds (S&S) CCGs Tania Carruthers (TC), Clinical Director of Pharmacy Heart of England NHS Trust (HEFT) A Dr Judith Crosse (JC) ES CCG GP Representative Sarah Duckworth (SD), Senior Pharmacist Burton Hospitals NHS Foundation Trust (BHFT) Gill Hall (GH), Service Development Manager for Community Pharmacy SS LPC A Tracy Hall (TH), Non-Medical Prescribing Lead Staffordshire & Stoke on Trent Partnership Trust (SSOTP) Daniel Hurley (DH), Pharmacist Virgin Healthcare Mary Johnson (MJ), Senior Pharmacist SES&SP CCG Fiona McKean (FM), Assistant Director for Clinical Services and Medicines Management Royal Wolverhampton Hospitals NHS Trust (RWT) Bina Mistry (BM), Clinical director Pharmacy Services, SSOTP A Lisa Nock (LN), Principal Pharmacist in Surgery BHFT Dr Anna Onabolu (AO) CC CCG GP Representative Dr Clare Pilkington (CP) SES CCG GP Rep Sharuna Reddy (SR), Pharmaceutical Adviser CC CCG A Dr Mukesh Singh (MSh) CC CCG GP Representative Jonathan Snape (JS), Interim Principal Pharmacist Clinical Transformation County Hospital Elizabeth Street (ES), Chief Pharmacist Burton Hospitals NHS Foundation Trust (BHFT) Susan Thomson (ST), Chief Pharmacist Page 1 of 8

2 28/04/ /06/2017 [Date] Cannock Chase Clinical Commissioning Group Members: University Hospitals North Midlands (UHNM) In Attendance: Vanessa Ridout (VR), Executive Assistant Primary Care CC, SES&SP and S&S CCGs Kelly Carter (KC), Administrative Assistant Primary Care CC, SES&SP and S&S CCGs Visitors: 1. Welcome and Apologies Apologies from Dr Gill Hall; Dr Clare Pilkington; Judith Cross; Fiona McKean; Linda Forrester. 2. Minutes of the previous meeting held on Friday 28 th April Gluten free section a little misleading TH asked this to be reworded. Free prescribing must be stopped at national level to be removed from the minutes. In any other business it should state Wendy Holland not Hollings. The sentence around syringes being supplied needs to be clearer. Minutes reworded to: A syringe needs to be supplied and should be included within continuing care planning. 3. ACTION: Changes to be made to original minutes. Matters arising not on the agenda or carried forward from the last meeting Opioid prescribing needs to be included in the APG newsletter following recent publication of Faye s Story. KC/VR 4. Items for Information 4.1 NICE Technology Appraisals Mukesh Singh entered the meeting at 13:18 There are two on the list which are the responsibility of the CCGs to commission and fund. TA442: Ixekizumab for treating moderate to severe plaque psoriasis CCG responsibility but cost-neutral with other similar treatments and factored into CCG budget planning for high cost drugs. SB alerted the group to an error under section 443. Obeticholic acid for treating primary biliary cholangitis should read NHS-E responsibility to commission and fund. Page 2 of 8

3 TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs CCG responsibility but costneutral with other similar treatments and factored into CCG budget planning for high cost drugs. Need to update the South Staffs net.formulary with all NICE technology Appraisals. /MJ 4.2 MHRA Drug safety updates - April and May 2017 MS advised the group on the highlights from Aprils update. Valproate is continually ongoing as a risk and there is a new alert asking for patient review and further consideration. advised that she would get pharmacy advisors do a search and highlight the practices prescribing Valproate. SB is aware that in East Staffs this has been done to minimise any risk. Ponatinib This isn t something to highlight for primary care. Multiple sclerosis therapies healthcare staff are asked to report any suspected adverse effects after swapping or switching therapies. If the patient s white blood cell count is low, the prescriber wouldn t stop the dose or switch the dose. Include in newsletter for information. Mays update included-: Finasteride highlight depression and sucicidal thoughts ADR in APG newsletter. It has been highlighted that there are elearning modules available to improve the reporting of suspected adverse drug reactions. To include in newsletter. Retigabine use to be confirmed in primary care and included in newsletter if appropriate. ACTION: APG newsletter to be updated with all of the above items. The agenda went to item 5.4 ESCA s from SSSFT (due to not being fully quorate) 5. Items for approval 5.1 Asthma Guidelines There may be some changes by NICE guidance which is currently being reviewed (no release date at present). Page six gives an idea from BTS what is a low, medium and high dose. There was a comment ed to from JC about having a summary sheet. But group felt that pages 2/3are a good summary for GPs as a quick look guideline. Page 3 of 8

4 To remove children 5-12years. A separate guideline needs to be produced for children <12years. Need to change the review dates on the RICaD for tiotropium. With changes identified above the guideline is approved by the Group. ACTION: changes to be made to the guidelines as agreed above. 5.2 COPD Guidelines These guidelines now contain a lot more information. A few things from NICE guidance had changed. Page 5 is the treatment pathway for GPs to follow. MSh suggested a one page flow chart for the GPs would be useful. Need to check page eight where it states steroids daily for 7 days. This is because NICE says differently. Page 2 pneumococcal vaccine to check it is every 5 years. Opioid use in palliative care need to include information from GOLD and refer to palliative care teams. On group D to specify specialist only Carbocistine dose to add initial dose of 750mg TDS until satisfactory dose is achieved then maintenance dose of 750mg BD. ACTION: changes to be made to the guidelines as agreed above. MA and SBa left meeting at 2:05pm 5.3 Diabetes Guidelines The group looked at the comments on page three. U1 and RR2 comment upheld. Need to change 7.0 targets to 7.5 Hb1c control and the 6.5% target to 7.5% in monotherapy box.when states above 7.0% to change to above 7.5%. Remove reference to alogliptin first-line on page 3 table. There are concerns that patients on linagliptin are being changed to alogliptin when there were clinical reasons for the linagliptin prescribing. It was discussed if the potential risk of the bladder cancer with pioglitazone is relevant to mention in summary table. It was decided that this could be removed and keep incident risk within main text only. Pg 4 to keep CKD as 4-5. Page 4 of 8

5 To change notes on glycaemic control under 1.2 as above. Under 1.3 lifestyle measures: The group discussed if blood pressure targets needed to be in there. SB stated that in the NICE guidelines there is a lot about monitoring blood pressure. Update first statement and remove bulk of text. To include relevant links to NICE guidance but do not include all text. Remove alogliptin as bold text from table 2.1 and list all formulary choices. It was queried under point on page nine whether everyone would know what an SU is. To define abbreviation. It was decided that the costings shouldn t be seen as the most important factor treatment should be based on clinical need with a knowledge of the costeffectiveness. Group agreed to remove costings and have these tabled in an appendix. There were concerns around the information contained in the section on multiple daily regimes. There is a worry that the patient won t lose weight because they are having the insulin and lots of meals in between. The choice of insulins to be discussed with diabetes specialist nurses post-meeting. It was discussed that the appendix numbers would need checking and correcting (pg. 29). MSh suggested a one page flow chart for the GPs would be useful. ACTION: changes above to be discussed with Mary Johnson and a follow-up meeting to be arranged with the diabetes specialist teams. Guideline not agreed at present and will need to be brought back to the next APG. /MJ 5.4 ESCA s from SSSFT - Atypical antipsychotics in LD (Note this one has not been through FWG) MS asked the group for any comments, concerns or worries they have with the following ESCA s. The ESCA for atypical antipsychotics in patients with learning disabilities went to the Formulary Working Group with work still to be done. All changes that have been made are highlighted in red. There has been a change on the first page around the consent to treatment advising if the patient doesn t have capacity to consent, a best interest decision will be made by all parties, including family and carers. MS suggested that the issue with a patient having learning disabilities and getting consent could have their decisions made by an independent advocate. There was a discussion whether or not it s a governance issue if the patient gets discharged automatically if the reply from the GP requesting shared care isn t acknowledged within the 28 days. It was decided that the GPs had to respond and it couldn t be presumed by SSSFT that the patient is stable Page 5 of 8

6 enough. MS expressed that is was especially important if the patient has learning difficulties to see an active response from the GP and chase the process if they don t. Statement to be updated in all the ESCA s. TH queried that diversion therapy isn t mentioned in the ESCA. MS thought the meaning behind the word discharge can be misconstrued between what SSSFT think and the CCG. There needs to be wording that the patient still has open access to the service if they need it. If you are discharging them this doesn t give out the message that this is shared care. The wording on the document will need to reflect this by stating an active follow up is needed by both organisations. The word discharge may cause confusion. Wording to be reviewed but otherwise ESCA s are approved. Bullet point 3 needs to be changed from of to on. - ADHD in children and adolescents The wording has been changed which has been highlighted in red. All the updates have been done to the same standard. - Atypical antipsychotics MS advised the group that there needs to be some assurance the monitoring is done in Primary Care so it doesn t affect the LIS. MSh asked if the patients signed the shared care agreements. The group discussed that they did so all parties are aware and there was a three way agreement between the GP, consultant and the patient. This is a safety net. - Lithium The changes are highlighted in red throughout the agreement. It was discussed that if there is a concern about a patient, who has been discharged, they still need a process to monitor patients who may destabilise. - Melatonin The standard caveats are in place. SSSFTH only support use of Circadin MR or the Bio-melatonin products. Support is provided for the review of melatonin suspensions. - Fluxetine in children and adolescents In the Formulary Working Group it was discussed whether a child reaching 18 years old would be transferred back to their GP or another service in SSSFT. It was discussed that it depends on the child s needs. MA can find out and let know. This will need to be a factor considered as age range goals are changing constantly. There will need to be a review of patients needs at 18 and maybe before they turn 18 so there is a smooth transition into adult services. Page 6 of 8

7 - Drugs in dementia MSh raised concerns that there are commissioning issues in Cannock. Patients aren t being monitored until they are stable. MSh is aware that this has been reported. It was discussed that teams may need to be re-educated and it was highlighted there is lack of provision in SSSFT. A discussion took place over the transfers of patients. Need to consider and think about if a patient moves area. - ADHD in adults It was queried whether children would automatically migrate over to the adult care. On page six there are blank sections that need updating. MA will update. ACTION: All changes to be made and ESCAs approved post-meeting by the chair. /MA A general leaflet on shared care prescribing would be advantage for patients. 5.5 PGD template for salbutamol reversibility testing Need a SOP in each individual practice to administer adrenaline. This is a CCG PGD in place in practices already. Happy to keep it as a PGD. To review if pharmacist inclusion is appropriate or not. ACTION: SB to review amendments. SB 6. Items for Discussion 6.1 Rebate schemes-governance procedure Agreed any rebates signed up to would need to be reviewed and agreed at this group. Any current rebate agreements need to be submitted to the APG retrospectively. ACTION: to review current rebated in SAS/CC/SES&SP and submit to next APG. 6.2 Medicines Committee Minutes - FWG May SSSFT Minutes The minutes that are missing need to come back to the group. Maureen Hamilton will need to be contacted for copies of the HEFT minutes. to contact her. 7. Items for Information No items Page 7 of 8

8 8. Any Other Business Tracey Hall NMC standard consultation process out for comments. Needs to be circulated to practices for consultation. Needs to go through the nursing lead at the CCG. ACTION: TH to provide relevant information to go to the CCG nurse leads. Opioid management guidelines raised by SB. Document to be reviewed through FWG. Prescribing of HalerAids on FP10 prescriptions was discussed to be confirmed if this is allowable. TH Date and Time of Next Meeting Date: Friday 18 th August 2017 Papers to be received by Friday 4 th August Time: pm Venue: Boardroom 1, Edric House, Rugeley WS15 1UW ALL Page 8 of 8

The healthiest place to live and work, by 2025

28/04/2017 23/06/2017 18/08/2017 13/10/2017 15/12/2017 Cannock Chase Clinical Commissioning Group The healthiest place to live and work, by 2025 Joint Clinical Commissioning Group (CCG) South Staffordshire