DONCASTER and BASSETLAW AREA PRESCRIBING COMMITTEE MINUTES from Thursday 27 th August NHS Doncaster CCG RDaSH FT Doncaster LPC

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1 Present: DONCASTER and BASSETLAW AREA PRESCRIBING COMMITTEE MINUTES from Thursday 27 th August 2015 NHS Doncaster CCG RDaSH FT Doncaster LPC Dr Rumit Shah ( APC Chair) Mr Mark Randerson- Head of Medicines Management () Mrs Gill Bradley Deputy Head of Medicines Management () Dr David Crichton NHS Doncaster GP NHS Bassetlaw CCG Mr Rob Wise Medicines Management Lead Pharmacist (BCCG) Mr Peter Richards - Medicines Management Pharmacist (BCCG) Mr Stephen Davies Chief Pharmacist RDaSH FT Mr Andrew Houston - Senior Mental Health Pharmacist Dr Eric Dale - Consultant Psychiatrist RDaSH FT Ms Anne Burton Non Medical Prescriber Representative (RDaSH DCIS) Ms Julie Hall - Non Medical Prescriber Representative Mr Richard Harris LPC Member Mr Paul Chatterton - Deputy DBHFT Mr Andrew Barker Chief Pharmacist DBHFT Mr Lee Wilson Consultant Pharmacist DBHFT (RDaSH DCIS) Doncaster LMC Dr Mahmoud Al Khoffash Medical Director representative DBHFT Dr Dean Eggitt- LMC Secretary Dr P Wilson Chair LMC Minutes Only :- Dr Mark Pickering Doncaster Offender Health, Chair prisons D&T Committee Manjeet Kaur, Yorkshire & Humber Region Offender Health Pharmacist In Attendance: Angie Machin Minute Secretary (NHS Doncaster-) Agenda Discussion Points Item 08/15/1 Apologies Apologies were received from: Mr L Wilson, Mrs A Burton, Dr E Dale, Dr D Eggitt, Mr A Barker Action By 08/15/2 Declarations of Interest, Gifts or Hospitality No declarations were received 08/15/3 Minutes of last meeting The minutes of the last meeting held on the 30 th July were agreed as a true and accurate record and will be made available on the medicines management website. 1

2 08/15/4.1 Matters Arising not on the agenda Neurology mapping exercise A further partnership meeting involving Richard Grunewald Neurology Consultant STH and David Paling Neurology Consultant DBHFT to discuss the pathway for the management of adult epileptic patients in Doncaster has taken place. It was agreed at the meeting that: There are differing local interpretations of the definition for Amber-G There is a small number of Doncaster GP s who do not want to take over the prescribing of Amber-G anti-epileptic drugs. The reasons for this have not been captured/ identified. Discussion was held regarding the suitability of: Medication remaining Amber G with additional support ( if need identified) from Specialist Nursing Services or Development of Shared Care (similar model to Barnsley CCG) It was agreed at the partnership meeting that before moving further forward with the pathway mapping process it would be useful to explore the reasons behind the decision not to prescribe. Further actions will be discussed at the DCCG Medicines Management Committee, and the APC will be updated. Matters Arising 02/14/17.1 Draft Shared Care Protocol for Amiodarone prescribing DBHFT provided an update of the discussion with Cardiology regarding adopting the Sheffield SPC. In principle it does look reasonable to move forward with it although commissioning arrangements will need to be discussed further. The number of patients requiring repatriation would be useful to know. Therefore the Committee agreed that this should be discussed at DCCG Medicines Management Committee meeting to consider the way forward. 01/15/8.3 Draft Shared Care Protocol for the use of Melatonin in the management of sleep disorders in children and young people with neurodevelopmental disorders (off-label use) The Committee agreed to defer the approval of this paperwork until the September meeting. The leaflet produced by DBHFT to support the use of melatonin will be added to the protocol prior to approval. DBHFT DBHFT 08/15/5 Traffic Light Drugs for Review All drugs for review were requiring further consideration prior to categorisation. 08/15/6 APC Officers actions All officers actions were agreed as proposed, will be updated on the traffic light system. (AM) 2

3 08/15/7 Traffic Light Additions for Consideration All additions for consideration were agreed as proposed, will be updated on the traffic light system and the details included in the next APC bulletin. Adalimumab (Humira, Neotigason) used to treat Hidradenitis suppurativa (acne inversa) has been categorised as Red 1, 2, 3 Ciclosporin eye drops (Ikervis) used to treat severe keratitis has been categorised as Grey 4 for consideration at FLG Evolocumab (Repatha) used for Hypercholesterolaemia and mixed dyslipidaemia. Homozygous familial hypercholesterolaemia has been categorised as Red 1, 2, 3 Imiquimod (Aldara) off-label use for Melanoma has been categorised as Red 1, 2, 3 Methylphenidate used to counteract sedation with opioids in palliative care has been categorised as Amber -G Naloxegol (Moventig) used for opioid induced constipation has been categorised as Grey 4 for consideration at FLG Nitisinone (Orfadin) used for Hereditary tyrosinemia type 1 (HT-1) has been classified as Red 1, 2, 3 Pembrolizumab (Keytruda) used in advanced melanoma has been categorised as Red 1, 2, 3 Tafluprost & Timolol (Taptiqom) used for Open angle glaucoma or ocular hypertension has been categorised as Grey 4 for consideration at FLG (AM) 08/15/8 New Business 08/15/8.1 Development of draft SCP Riluzole (Sheffield STH) has spoken with Sheffield APG to ascertain the position with the SCP development. Although the principle of GP s being involved in shared care of these patients was agreed at the Sheffield APG, commissioning arrangements have not been arranged. Members agreed that it was important that local CCG s were able to contribute to the dialogue regarding the commissioning arrangements, and this was reflected in the SY&B Shared Care Principles. will contact Sheffield CCG again to enquire regarding the commissioning discussions. When SCCG are in a position to move forward with the work this Committee will be notified in order to contribute from a Doncaster perspective. 08/15/8.2 Somatropin use in Adults BCCG- has been contacted by a GP for advice on a letter received from Dr Kang Consultant Physician and Endocrinologist at DBHFT. The letter raises two concerns. a) Somatropin use in adults The Committee discussed re-categorising somatropin for use in adults, which is currently Red to Amber in line with the prescribing in children. The existing paediatric SCP could be expanded to include children and adults. Alternatively the Committee could explore the option of adopting the SCP in use in Sheffield. The Committee agreed to add this piece of (AM) 3

4 work to the current work plan. The request would then be made to DBHFT to lead on the development of the paperwork. b) Traffic Light entries The letter also indicates that Dr Kang and his colleagues often consider the TLS confusing. The Committee would like clarity as to the confusion, is it: Drug specific The TLS in general Dr Al Khoffash suggested he asked for a reminder as to the rationale of the categorisations to be highlighted in the Prescribing Matters Newsletter produced by DBHFT. BCCG agreed to speak initially with the GP and then to Dr Kang regarding the TLS and then feedback to the Committee. Dr Al Khoffash BCCG- 08/15/8.3 Version Control with Shared Care & Guidance documents The Committee discussed if DCCG- was the most suitable place to maintain version control on all new and updated SCP paperwork and guidance documents. The outcome was that it did seem the preferred option. All updated paperwork is uploaded on to the Medicines Management Website and organisations should access the paperwork from the website to ensure the most current protocols and proformas are being completed and sent to Primary Care. This process should be disseminated to all departments to reduce the risk of incorrect monitoring schedules are received by GP s. 08/15/9 DBHFT D&TC Update 08/15/10 Formulary Liaison Group Update 08/15/11 Doncaster Prisons Drug & Therapeutic Committee 08/15/12 RDaSH FT & Medicines Management Committee update The minutes of the meeting held on 3 rd July 2015 were received by the Committee 08/15/13 Barnsley Area Prescribing Committee Update The minutes of the meeting held on 8th July 2015 were received by the Committee 08/15/14 Rotherham Area Prescribing Committee update 08/15/15 Sheffield Area Prescribing Committee Update 08/15/16 Nottinghamshire Area Prescribing Committee Update The minutes of the meeting held on 21 st May 2015 were received by the Committee 08/15/17 Any Other Business DAWN (for information) All Dr Crichton informed the Committee that the problems that had been experienced with warfarin results sent via pathology links now appear to be resolved as results now appearing as expected. 4

5 Channels of communication between Secondary & Primary Care RDaSH FT described the background to a Serious Incident which is currently within the S.I. and Coronial process. As part of the proposed action plan the Chief Pharmacist from RDASH FT has been tasked with exploring communication pathways between Primary and Secondary Care. The rationale to this was that the incident involved the coordinated care for an individual with complex needs and care was provided within both Secondary and Primary Care. As part of undertaking this action the Chief Pharmacist asked the Committee for their views on methods of communication. Within the discussion members agreed that current methods of communication, if used robustly, were appropriate and allowed for all necessary information to be shared. Provider representation at the APC Unplanned Care Provision is to be provided by FCMS as from October 1 st As the company will be involved with a considerable quantity of prescribing the Committee was asked to consider inviting them to become a member of the APC. The Committee agreed that this was appropriate and led to the question if any other provider should be invited. BCCG suggested inviting a representative from Bassetlaw Health Partnerships. The option of inviting a representative from Public Health England was also suggested as services are commissioned by them e.g. drug and alcohol services, smoking cessation. BCCG will advise DCCG- of a contact name from Bassetlaw Health Partnerships. will contact Dr Rupert Suckling (Public Health Consultant) for his view. The option to attend the meeting or receive the agenda and minutes can be offered. The Committee also suggested if particular items on the agenda would benefit from other organisations these would receive ad-hoc invitations to attend. BCCG- Monitored Dosage System (MDS) - Patients admitted on to hospital wards (for information) 5 The Committee discussed the waste medication issue when patients are admitted on to hospital wards and the patient s medication is already dispensed into trays. It was explained that medication cannot be administered to patients in the hospital ward setting from MDS for several safety reasons including: No confirmation of drugs in the tray If a tablet was to be replaced or discontinued there would be no fail safe way to complete the task NICE Guidance 15 - Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use.

6 The Committee was asked to consider if APC was the correct forum to work on implementing any identified actions within the document. The Committee was advised that the Doncaster and Bassetlaw District Infection Prevention and Control Committee is a high level strategic group where this document will be discussed. The document will be added to the September APC agenda and feedback from the DIPC will be given. will enquire if there is a suitable mechanism for the LPC to receive feedback from the DIPC meeting. (MR) LPC The LPC were also asked to consider the role of Community Pharmacy in implementing NG 15 prior to the next discussion at September APC. It was the final APC meeting Mr R Harris would be attending. The Chair on behalf of the Committee thanked Richard for his contribution over the last years Richard was wished well for his future and was asked to stay in-touch. 08/15/18 Date, time & venue of next meeting 12 noon prompt Thursday 24 th September noon prompt Thursday 29 th October noon prompt Thursday 26 th November 2015 No December Meeting 12 noon prompt Thursday 28th January noon prompt Thursday 25th February noon prompt Thursday 31st March noon prompt Thursday 28th April noon prompt Thursday 26th May noon prompt Thursday 30th June noon prompt Thursday 28th July noon prompt Thursday 25th August noon prompt Thursday 29th September

7 12 noon prompt Thursday 27th October noon prompt Thursday 24th November