CARDIFF AND VALE UNIVERSITY HEALTH BOARD. NOTES OF THE MEDICINES MANAGEMENT GROUP MEETING HELD ON WEDNESDAY 13 th JANUARY 2010

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1 CARDIFF AND VALE UNIVERSITY HEALTH BOARD NOTES OF THE MEDICINES MANAGEMENT GROUP MEETING HELD ON WEDNESDAY 13 th JANUARY 2010 Present: Apologies: Dr Chris Jones (Chair), Dr Charles Allanby, Darrell Baker, Sam Ghofar, Dr Sharon Hopkins, Dr Tim Kinnaird, Dr Helen Lawton, Kate Morris, Mandy Rayani, Dave Roberts, Fiona Walker. Dr Kesh Baboolal, Paul Davies, Katie Norton. 1. Welcome and introductions Dr Chris Jones welcomed the members to the first meeting of the Medicines Management Group (MMG). He explained that the MMG will be officially classified as a group, not a committee, which will report to the Health Board s Quality & Safety Committee. The primary function of the MMG is to focus on safety and quality in the use of medicines; a further priority is to focus on cost effectiveness. 2. Presentation medicines management across the community Fiona Walker and Kate Morris gave a presentation to the group (encs). It was agreed that a Task & Finish group would be established to populate the spider diagram in time for the next meeting. The importance of LEAN pathway work across the health community was also noted. 3. Terms of Reference The membership of the Group was reviewed and the following were noted: The membership in the Terms of Reference was broadly agreed For the purposes of the MMG, Pharmacy representation in the absence of a Head of Department will be two pharmacists from Primary Care, two pharmacists from Secondary Care and a Community pharmacist There will be further discussions between the Medical Director and Director for Primary Care, Community & Mental Health regarding GP representation on the group It was agreed that a clinical pharmacologist will be included on the group. Professor Routledge has been approached for a nominee Dr Kesh Baboolal and Katie Norton will be approached to establish whether they will attend the group themselves or identify nominees Dr Sharon Hopkins or her nominee will represent Public Health Action KM With regard to other matters: The MMG will meet monthly for the first six months Other topics that potentially need to be included in the Terms of Reference are (a) audit (b) to co-ordinate responses to NICE/NCEPOD and (c) outcomes Roles and responsibilities will be reviewed in the light of the information that emerges from the spider diagram (see 2) It was agreed that item 12 from the draft Terms of Reference (amendment of the Terms of Reference) was deleted 1

2 Structures The Drug and Therapeutics Committee (DTC) appraises medicines and manages the Formulary for both Cardiff & Vale and Cwm Taf Health Boards. It was noted that the Welsh Assembly Government is investing in new systems for the appraisal of all medicines by AWMSG. The impact of this development on the DTC is uncertain and the position will be kept under review. It was suggested that the Medical Director might find it helpful to meet with Dr Martin Edwards (Chair of DTC) before the meeting of DTC on 11 th February. It was agreed that the Chairs of the four sub-groups did not need to be members of the MMG but they will be provided with copies of the agenda and minutes to ensure they are aware of what is being discussed and will have access as required It was noted that Dr Graham Shortland (Associate Medical Director for Quality & Safety) will Chair the new Thromboprophylaxis & Anticoagulation Group, which will report directly to the Quality & Safety Committee. It was proposed that the Chairmanship of the Safe Medication Practice Group should be discussed with Dr Shortland. 4. Legacy issues Prescribing Advisory Groups To ensure continuity of the prescribing incentive scheme To ensure continuity of the use of Scriptswitch messages To develop better alignment/ co-ordination of prescribing practices across Primary and Secondary Care (e.g. use of diclofenac) and between Divisions Trust Medicines Committee (TMC) The annual report of the TMC was noted together with the legacy issues. It was agreed that responsibility for NPSA Alert 18 (Oral anticoagulant therapy) will fall to the Thromboprophylaxis & Anticoagulation Group. An action plan will be developed for the other TMC legacy issues Medicines Information Card The recent seminal event involving the death of a patient on Clopidogrel was noted. The use of medicines information (green) cards has been reviewed in the light of this incident. Recommendations will be presented at the Nursing & Midwifery Board in late January. There will be further discussion under matters arising at the next meeting of the MMG.. / / MR 5. Cost Reduction Programme (CRP) Verbal report on CRPs There was no finance representative present to provide an update. Thalidomide (Dr Chris Fegan in attendance) Dr Fegan briefed the group on a proposal to switch from using licensed Thalidomide to unlicensed Thalidomide: this would save the Health Board ~ 250k per annum. A letter from the MHRA was tabled which specifically stated that there should be no unlicensed products supplied within the UK and cost is not a legally acceptable reason for the use of unlicensed Thalidomide. 2

3 In the light of the MHRAs letter it was concluded that unlicensed Thalidomide must not be used within the Health Board. 6. Drug & Therapeutics Committee The DTC met in September and November 2009 and made a number of recommendations regarding the formulary. A summary of these recommendations will be brought to the next meeting for consideration by MMG. 7. NICE/ HCD Group Dr Sharon Hopkins briefed members of the activities of this group. Dr Chris Jones will take over Chairmanship of this group. 8. Individual patient funding requests (Dr Fegan in attendance) There was a lively discussion about the different options for dealing with these requests both within the Health Board and across Health Boards. Dr Chris Jones informed members of his intention to devolve local decisions to the Divisions and that he would be Chairing Cardiff & Vale s Individual Patient Request Group for external patients and that Rob Mahoney is drafting a paper. Dr Fegan advised that clinicians supported a separate approval process for expensive drugs but questioned the expertise applied. Dr Jones advised that clinicians are responsible for financial aspects of care provided and will have to participate in the approval process in the future. 9. GMC report on prescribing errors Dave Roberts briefed members on the report and agreed to provide more comprehensive information on the GMC recommendations. This issue will be referred to Dr Tony Turley and Dr Steve Riley for discussion by the Medical & Dental Education Board. 10. NICE CG76 Medicines adherence Lack of time prevented a full discussion of this topic which will be carried forward to the next meeting. A local action plan is required. 11. Date of next meeting pm on 26 th February Venue to be confirmed. NotesMedsMgt13Jan10/dr/lg/s:dr 18 th January

4 CARDIFF AND VALE UNIVERSITY HEALTH BOARD NOTES OF THE MEDICINES MANAGEMENT GROUP MEETING HELD ON FRIDAY 26 th FEBRUARY 2010 Present: Apologies: Dr Chris Jones (Chair), Steve Gage, Alison Gerrard, Sam Ghofar, Dr Helen Lawton, Karen May, Dave Roberts, Fiona Walker. Dr Charles Allanby, Darrell Baker, Kate Morris, Mandy Rayani QUORATE? 1. Minutes of last meeting These were approved as an accurate record. 2. Matters arising Dr Chris Jones will meet with the Chair of the Drug & Therapeutics Committee shortly Dr Graham Shortland has agreed to chair the Safe Medication Practice Group and will consider attending MMG Dr Chris Jones will meet with Andrew Evans to discuss the NICE/ HCD Group Further work will be done on the spider chart, including seeking medical input. Dr Lawton offered to complete the scoring chart from a primary care perspective, secondary care input is also required to ensure a balanced view. The action plan for legacy issues will be brought to the next meeting An update on the medicines information card will be brought to the next meeting Drs Steve Riley and Tony Turley have been asked to consider the GMC Report on Prescribing Errors. Dr Chris Jones will seek to use the outcomes to inform a proposed new junior doctor induction programme. An update on Medicines adherence will be brought to the next meeting A report on shared care is being drafted. It will be shared with Primary Care colleagues prior to presentation at the next meeting Further consideration needs to be given to a process for managing Individual Patient Funding Requests for medicines 3. Terms of Reference Following the last meeting it had been agreed that there would be two GP representatives on the group an LMC representative and a clinical champion The Finance Director has nominated Alison Gerrard as his representative The importance of linking the MMG with Divisional Directors was noted. It was proposed that this might be achieved by Dr Mark Smithies representing Katie Norton and Dr Richard Evans representing Dr Kesh Baboolal The need to amend Roles and Responsibilities was noted but it was agreed that this should be done when the work on the spider chart was complete Action FW/KM ALL 1

5 4. Management of medicines across the healthcare community The Director General of NHS Wales has established 14 National Programme Boards to implement key elements of the AOF for NHS Wales. The National Programme Board for Medicines Management had its first meeting on 10 th February Dr Chris Jones was unable to attend and was represented by Dave Roberts, who briefed the group on the membership of the Board. Notes of the meeting had been circulated prior to MMG. Following the National Programme Board meeting an AOF for Medicines Management was submitted to the Health Board on 11 th February Section 9 reflected the discussion at the NPB: further discussions are required on other sections of the AOF. It was noted that the Pharmacy Locality Teams had also submitted documents on AOF targets 7 & 8. Dr Chris Jones indicated that he is accountable for medicines management strategy within the UHB and wished to have weekly meetings during March to agree an Operational Plan for medicines management Dr Jones indicated that he wished to have three patient safety essential targets or must do s. Two of these had already been identified bare below the elbows and thromboprophylaxis. It was agreed that the other priority should be to improve the exchange of information between secondary care and GP surgeries. Dr Jones informed the group that the Assembly s AOF states that there should be a 10% increase in the proportion of staff providing services in a community setting, to be achieved between 2010 to 2013.Chief Executive expected 10% of the hospital based workforce to be transferred to primary care. Dave Roberts agreed to lead a Task & Finish Group to explore this requirement and to establish how better links could be established between pharmacists and GP surgeries. / 5. Cost Reduction Programme (CRP) Alison Gerrard informed the group that the Pharmacy Locality Teams were on target to make savings of ~ 1.25m on the primary care drug budget of 75m and the Pharmacy Directorate was on target to make savings of ~ 1m on the secondary care drug budget of 45m. Dr Jones expressed his thanks to all involved. 6. AWMSG The recent notification about the AWMSG appraisals carried out in December was discussed. Dr Jones noted that Ranolazine and Degarelix had been rejected by AWMSG and expressed his wish to ensure these drugs were not used within the UHB. 7. Drug & Therapeutics Committee (Mrs Rowena McArtney in attendance) The group received a report on the medicines appraised by the Drug & Therapeutics Committee in September and November The majority of the recommendations were neither costly nor controversial and the recommendation to add them to the Formulary was accepted. The one exception was Alitretinoin, an expensive new retinoid that has been approved by NICE: this will be added to the formulary but its use will be monitored through the NICE/ HCD Group. Alison Gerrard noted that there continues to be a need for evaluation of the financial impact of formulary /RMcA 2

6 changes. The NICE/ HCD group may perform this function for NICE and AWMSG appraisals. The group noted NICE Clinical Guidelines number 91, which drew attention to the cardio toxicity of Dosulepin. It was agreed that Dr Jones would write to medical staff drawing their attention to these guidelines and requesting them to switch patients to a less toxic alternative. 8. NPSA Rapid Response Reports Safer Lithium therapy. The two pharmacists who will lead on this are Wendy Davies (Secondary Care) and Anthony Hall (Primary Care) Vaccine Cold Storage. The leads on this are Wendy Davies (Secondary Care) and Sian Rowlands (Primary Care) The UHBs current arrangements are that the Nurse Director is responsible for nominating leads for NPSA Alerts and RRRs. The consensus was that it would be more appropriate for Dr Jones to undertake that responsibility for medicines. FW/ 9. Prescribing in paediatrics (Dr Dave Tuthill) Dr Tuthill presented the work which he had undertaken over the course of the last 5 years. The deficiencies in junior doctors prescribing had been identified and quantified. A range of measures had been introduced to improve junior doctors prescribing. This included consultants and pharmacists providing training for junior doctors and under graduates: training in prescribing was provided and the trainees were subsequently tested on their prescribing abilities. Subsequent monitoring had demonstrated that these measures had substantially reduced prescribing errors. In the ensuing discussion it was agreed that Dr Tony Turley and Dr Steve Riley would be asked to include Dr Tuthill in their discussions on how to support the proposed new junior doctor induction programme, including implementation of the recommendations of the GMC Report on Prescribing Errors. 10. Update on controlled drugs This item was deferred until the next meeting 11. Prescribing for staff The current policy and procedure on prescribing for staff needs updating. Members were asked to give their comments to Dave Roberts. ALL 12. Date of next meeting on Thursday 25 th March in the meeting room in the Clinical Research Facility at UHW. NotesMedsMgt26Feb10/dr/lg/s:dr 2 nd March

7 CARDIFF AND VALE UNIVERSITY HEALTH BOARD NOTES OF THE MEDICINES MANAGEMENT GROUP MEETING HELD ON THURSDAY 25 th MARCH 2010 Present: Apologies: Dr Chris Jones (Chair), Dr Charles Allanby, Darrell Baker, Adele Gittoes, Dr Sharon Hopkins, Dr Helen Lawton, Karen May, Kate Morris, Mandy Rayani, Dave Roberts Alison Gerrard, Sam Ghofar, Dr Tim Kinnaird, Dr John Thompson 1. Minutes of last meeting These were approved as an accurate record. 2. Matters arising Dr Jones had met with the Chair of the Drug & Therapeutics Committee (DTC) and was impressed with the work being undertaken. He indicated that the DTC would continue to meet for the foreseeable future. Dr Jones indicated that the NICE/ HCD Group will be disbanded as he will be drafting proposals for a new Clinical Effectiveness Steering Group and process for Individual Funding Requests for medicines. In future all NICE/ AWMSG issues will be dealt with at MMG: a Haematology representative will be required on the group. An update on the spider chart will be brought to the next meeting. The action plan for legacy issues will be brought to the next meeting An update on the medicines information card will be brought to the next meeting The uhb had agreed that its top three patient safety issues for 2010/11 would be (a) Thromboprophylaxis, (b) radical improvement in hand washing and reduction in the incidence of C diff and (c) prevention of pressure damage. Action KMo Operational Plan The Health Board needs to make savings of 75m on its budget of approximately 1bn. The medicines management contributions to this target have been identified as 4.5m on general medicines expenditure and a further 2m on NICE medicines. Local GPs had recently indicated that there was limited awareness of the Joint Formulary and suggested that savings of 10% could be made on medicines expenditure in primary care ( 75m). It was agreed that action is required to prevent medical staff work arounds to the Formulary. Dr Sharon Hopkins expressed concern about the deliverability of the NICE target, which she regarded as very high risk. The Operational Plan for Medicines Management had been circulated prior to the meeting. Kate Morris highlighted the following elements of the plan to the group: The growth in prescription numbers in primary care in Cardiff and Vale exceeds the national average, which puts additional pressure on the budget The AOF sets out a number of prescribing indicators for primary care 1

8 and performance during 2009/10 was generally good. The CRP savings achieved on medicines during 2009/10 was 2.2m The financial strategy for 2010/11 is forecasting total expenditure on medicines and the uhb s pharmacy staff will be 137m. The CRP target for 2010/11 is 6.5m The Operational Plan contains a mix of traditional and transformational schemes. These schemes will be subject to formal project management and an electronic dashboard is being developed to monitor progress. The importance of establishing good links between clinicians and clear accountability for each of the schemes. Primary care schemes will be signed off by Dr Mark Smithies and secondary care schemes will need to be signed off by the appropriate Divisional Director. There was a lengthy discussion about the Operational Plan and the following points were noted: Concern was expressed that some consultants request GPs to prescribe non-formulary medicines as a work around the control mechanisms that are in place in secondary care. Dr Jones indicated his willingness to deal with this issue. The existing contract rewards community pharmacists for the number of items that they dispense. This can be a perverse incentive as it fails to reward good pharmaceutical care. There was general agreement that a more modern contract could improve medicines management. The National Programme Board for Medicines Management has advised WAG that this needs to be addressed The group was informed that the Vale locality is piloting a scheme which rewards community pharmacists for stopping unnecessary treatment. There are three sizeable elements of the Operational Plan where savings have yet to be quantified: these are (a) NICE (b) the total procurement system for dressings and (c) clinical review of the use of analgesic patches 3. Terms of Reference Following Alison Gerrard s appointment to a new post the Finance Director has nominated Adele Gittoes as his representative Dr Jones had written to Katie Norton and Dr Kesh Baboolal to propose that they be represented by Dr Mark Smithies and Dr Richard Evans respectively. The need to amend roles and responsibilities was noted but it was agreed that this should be done when the work on the spider chart was complete. The terms of reference for the Safe Medication Practice Group were approved subject to a number of minor amendments. 4. Antimicrobial Group (Dr R Howe in attendance) Dr Howe shared his views on anti-microbial stewardship with the group. These were: Antibiotic resistance is becoming a problem particularly in primary care, where there is growing resistance to E coli, the single most common cause of urinary tract infections and bloodstream infections. The growing resistance to trimethoprim means that more expensive antibiotics need to be used. The wide spread use of antibiotics is one of 2.

9 the factors that has stimulated resistance Antibiotics can cause adverse effects, which means that they should not be used unnecessarily Research has shown that approximately 20% of antibiotic use is inappropriate. This may be because treatment was not indicated in the first place, has been continued when no longer necessary, a sub-optimal agent was used, or an inappropriate dose was used. This is a problem in both primary and secondary care. The old Cardiff & Vale NHS Trust established an Antimicrobial Group to address these issues in Membership of the group comprised microbiologists, other medical staff and pharmacists. A range of measures were introduced to improve antimicrobial prescribing. These included: A Trust policy on antimicrobials, which required all directorates to develop their own procedures for the use of antimicrobials An antibiotic credit card which summarised appropriate use of antibiotics in the medicine directorate and which is issued to junior medical staff Engagement of medical staff proved challenging in some directorates and the credit card now needs to be updated to reflect changes in the recommendations on the use of antibiotics. It was agreed that: Dr Howe would draft terms of reference for a new Antimicrobial Group and update the credit card for the medicine directorate, which would be paid for by the Medical Director. Dr Howe would liaise with primary care to arrange presentations at their education and training sessions. Dr Jones would liaise with Divisional Directors to inform them that antibiotic procedures are required for each of their areas and those procedures need to be implemented by July RH RH 5. C diff outbreak Dr Jones informed the group that the hospitals in Cardiff and Vale had a high incidence of C diff compared with other hospitals in Wales. In February there were 106 new cases with 80 new cases projected for March: the Medicine Directorate has the highest number of cases. The treatment of C diff normally requires approximately 19 days as an inpatient. The medical and nurse directors are jointly chairing the C diff action group which meets monthly. In the ensuing discussion a number of suggestions were made including the restriction of certain antibiotics (e.g. cefuroxime). It was agreed that Dr Jones, Dr Howe and Dave Roberts would meet with Divisional Directors to discuss the way forward and the need for better engagement of medical staff. 6. Management of medicines across the healthcare community The notes of the National Programme Board for Medicines Management had been circulated prior to the meeting and certain elements had been discussed under the Operational Plan. Members were invited to seek further information from Dave Roberts. The first meeting of the Task & Finish Group on pharmacy staffing will be 3

10 held during April. Nominations had been received from Katie Norton and Kesh Baboolal. Nominations will also be sought from Nursing and HR. The paper on medicines adherence (NICE CG76) was discussed. It was agreed that Darrell Baker would look at the NLIAH material to support implementation of this guidance. Dr Jones would arrange for it to be put on the agenda of the new Clinical Effectiveness Steering Group and for Peter Durning to be consulted for his views. The report on shared care was discussed. It was agreed that: An action plan would be brought to the next meeting of MMG and that compliance with the action plan would be monitored by MMG Complaints from GPs should be sent to Dr Graham Shortland 7. Drug & Therapeutics Committee (DTC) There was insufficient time to discuss the recommendations from the DTC meeting in February: this item was deferred to the next meeting. 8. NPSA Rapid Response Reports Omitted or delayed doses in hospital The action plan was noted and it was agreed that Jenny Jones would be asked to consider adding this to the annual audit programme. 9. Update on controlled drugs This item was not discussed. 10. Date of next meeting 9am 11am on Weds 21 st April 2010 in the meeting room in the Clinical Research Facility at UHW. NotesMedsMgt25Mar10/dr/lg/s:dr 31 st March

11 CARDIFF AND VALE UNIVERSITY HEALTH BOARD NOTES OF THE MEDICINES MANAGEMENT GROUP MEETING HELD ON THURSDAY 21 st APRIL 2010 Present: Apologies: Dr Chris Jones (Chair), Darrell Baker, Sam Ghofar, Adele Gittoes, Dr Sharon Hopkins, Dr Tim Kinnaird, Dr Helen Lawton, Kate Morris, Mandy Rayani, Dave Roberts, Dr Mark Smithies, Dr John Thompson, Fiona Walker Dr Charles Allanby, Lynne Aston, Dr Robin Howe Karen May, 1. Minutes of last meeting These were approved as an accurate record, with the exception that Fiona Walker had sent her apologies. 2. Matters arising The need for an official minute taker was reiterated. Terms of Reference for the Antimicrobial Group will be brought to the next meeting. Membership will include Primary Care representation. Copies of the antimicrobial credit card will be made available to fourth and fifth year medical students 3. TMC legacy issues The draft TMC action plan was discussed and the following were noted: All actions need to be taken forward as part of a whole system approach and not as separate actions for primary and secondary care The cytotoxic chemotherapy group will be asked to broaden its remit and to consider wider issues. Robert Williams will be invited to join the Medicines Management Group and to produce a merged system for recording, responding to and monitoring of NPSA Alerts and RRRs. The use of the existing newsletters for primary care and secondary care needs to be reviewed to improve cross fertilisation. Medicines management meetings need to conclude with what needs to be communicated. The addresses of all medical staff are required to ensure that the prescribing newsletters can be sent to them. Sources of this information might include Andrew Cooper (GPs), Carolyn Jones (hospital doctors) and the deanery. Action / RH /JT /MS /KM 4. Operational Plan Dr Jones expressed his thanks to colleagues for all the hard work that had gone in to producing the PID and action plan and noted that the work to date was as good as anything that had been produced within the uhb. He also stated that the target had now been increased to 8m, because GPs believe that 10% can be saved on their expenditure, through better compliance with the formulary Adele Gittoes briefed the group on the PID and action plan and highlighted that the action plan will be used to monitor progress at monthly meetings of the CRP Operational Group, which will report to MMG. The need for engagement of Divisional Directors in secondary care was also noted. Adele Gittoes informed the group that the CRP schemes identified in secondary care would have to be allocated to directorates before meetings with divisional directors/ managers had taken place: these meetings will be taking place during April/ May. Dr Jones acknowledged that the / 1

12 allocation of the savings would have to precede these meetings to comply with Finance s budgetary processes. The original requirements for medicines management were savings on 2m on NICE medicines and 4.5m on other medicines: to date the savings identified amount to 3.4m for other medicines. Attention was drawn to three resource intensive areas of the plan the NICE review, the total purchasing scheme for dressings and the review of the use of analgesic patches. The savings for the latter two schemes have yet to be quantified. Dr Jones explained that total CRPs identified to date amounted to 45m of the 80m target for the uhb. Additional measures (plan B) are required in all areas to deliver the additional savings. Adele Gittoes expressed concern that there unlikely to be enough pharmacy resources to deliver an expanded medicines programme which will deliver the full 8m savings. This was acknowledged by Dr Jones. There was a lengthy discussion about the use of non-formulary drugs and the following were agreed: The primary care representatives will draft a letter for Dr Jones to send to all hospital doctors. The letter will explain the need to comply with the formulary. Steps will be taken to ensure that junior medical staff receive key messages about the formulary and first line medicines, possibly through the induction process. A system will be developed to identify the inappropriate recommendation of nonformulary drugs by consultants and to bill their directorates for those drugs. An action plan will be brought to the next MMG meeting. Corporate Governance need to discuss the proposal that private prescriptions should not be sent to GPs asking them to prescribe medicines on the NHS The following additional measures were also noted: Membership of the CRP Operational Group needs to be expanded to include representation from Divisional Directors in primary care and secondary care Cardiology s approach to the cost effective management of hypertension should be (a) promoted across the uhb and (b) shared with other areas as an example of good practice that they could adopt GPs and consultants need to be contacted to ask for their ideas to contain expenditure Concern was expressed that the existing Prescribing Incentive Scheme rewards those practices that are bad prescribers rather than rewarding good prescribers The Good Prescribing Guide needs to be made available to fourth and fifth year medical students. The sixth edition of the Guide will be published in the summer of There may be the opportunity for better clinical care, which produces financial savings, by reviewing individual patients prescriptions in primary care 5. Medicines management across the healthcare community (i) Update on NPC toolkit The results of the audit against the NPC toolkit were noted. On a rating scale of 1 6 (where 1 = poor and 6 = excellent) the majority of the uhbs medicines management processes scored between 2 and 3. The consensus was that this was a very useful baseline for the new organisation. There was a lengthy discussion on how best to move forward. The Shared Care Sub-group is currently developing an action plan: it was agreed that the Sub-group would check the action plan against the tool-kit prior to implementation. The membership of the sub-group may need to be expanded to achieve this. HL/FW /JT HL/FW/ SH /SH /MS TK KM/MS /JT T&F Group. /FW 2

13 (ii) Strategic Task & Finish Group (TFG) The terms of reference for the TFG were briefly discussed and it was agreed that (a) the remit needed to include secondary care, primary care and the community and (b) finance and GP representatives would be identified. The first meeting of the group will be on 29 th April. 6. Recommendations from Drug & Therapeutics Committee All of the recommendations were accepted as none carried significant financial risk. The recommendation for Loperamide should have been that the tablets should be added to the Formulary as a second line product. This recommendation was approved. Information about these decisions will be shared with GPs and hospital doctors via the appropriate newsletters Adele Gittoes agreed to cost future recommendations prior to MMG meetings /KM /AG 7. Papers noted C difficile Improvement Plan AWMSG recommendations 8. Individual funding requests Dr Sharon Hopkins presented the draft Policy for making decisions on individual requests for treatment (IRT). Meetings of the IRT panel will take place twice monthly with two parts to each meeting (a) requests for treatments/ procedures not normally undertaken by the uhb and requests for treatment outside the uhb and (b) requests for medicines not normally provided by the uhb. Input from expert doctors and pharmacists will be required for (b). Requests to the IRT panel will need to be signed off at divisional level before going to the panel, which will not have a separate budget. Thus, the costs of approvals by the IRT panel will be borne by the divisions. Dr Hopkins invited comments on the draft policy, which is due to be considered by the Health Board on 11 th May. ALL 9. Date of next meeting 2pm 4pm on Weds 19 th May 2010 in the meeting room in the Clinical Research Facility at UHW. NotesMedsMgt21Apr10/dr/lg/s:dr 21 st April