BHR CCGs AREA PRESCRIBING SUB-COMMITTEES TUESDAY 22 ND APRIL 2014 BOARDROOM A, BECKETTS HOUSE, ILFORD, IG1 2QX

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1 PRESENT Dr M Hamilton-Farrell (MHF) Chairperson for this meeting Dr G Kalkat (GK) Dr C Okorie (CO) Dr R Adur (RA) Oge Chesa (OC) Belinda Krishek (BK) Sanjay Patel (SP) Heather Walker (HW) Dinesh Gupta (DG) Olufunlola Apakama (OA) Mohamed Kanji (MK) Julia Quant (JQ) Imran Khan (IK) Dr D Weaver (DW) Youssaf Razzak (YR) Denise Baker (DB) APOLOGIES Dr Ian Grant (IG) Dr Richard Duffett (RD) Diane Meid (DM) Portia Omo-Bare (POB) IN ATTENDANCE Stuart Jones (SJ) Dr R Fowler (RF) Dr R Kotian (RK) Mo Das (MD) Hannah Patten (HP) Wilma Williams Kelly (WWK) BHR CCGs AREA PRESCRIBING SUB-COMMITTEES TUESDAY 22 ND APRIL 2014 BOARDROOM A, BECKETTS HOUSE, ILFORD, IG1 2QX Co-Chair Barts Health NHS Trust Joint Prescribing Group GP, Clinical Director Prescribing Lead, Barking & Dagenham Clinical Commissioning Group (CCG) GP, Clinical Director Prescribing Lead, Redbridge CCG GP, Clinical Director Prescribing Lead, Havering CCG Deputy Chief Pharmacist, Barking & Dagenham, Havering and Redbridge CCGs (BHR CCGs) Chief Pharmacist, BHR CCGs QIPP Pharmacist, BHR CCGs Chief Pharmacist, North East London Foundation Trust (NELFT) Chief Pharmacist, Barking Havering and Redbridge University Hospitals NHS Trust (BHRUT) Prescribing Advisor for BHR CCGs, representing Barking & Dagenham CCG Prescribing Advisor for BHR CCGs, representing Havering CCG Prescribing Advisor for BHR CCGs, representing Redbridge CCG Prescribing Advisor for BHR CCGs, representing Redbridge CCG GP, Vice chair Barking and Havering Local Medical Committee (LMC) Representative Assistant Chief Pharmacist, BHRUT Project Support Officer, BHR CCGs (minute taker) Consultant Haematologist and Divisional Director, Clinical Services BHRUT, Chair BHRUT Drugs and Therapeutics Group (DTG) Consultant Psychiatrist, Chair North East London Foundation Trust (NELFT) DTG Lay member Chief Pharmacist, GM Pathology & Infection Control, BHRUT Principal Clinical Biochemist, Clinical Biochemistry / Pre-natal Screening, King George Hospital, BHRUT Consultant Respiratory Physician, Queen s Hospital Consultant Paediatrician, Queen's Hospital & King George's Hospital Chief Pharmacist, Partnership of East London Co-operatives (PELC) Clinical Nurse Specialist - Tissue Viability - West, NELFT Tissue Viability Clinical Lead -East, NELFT

2 17.1 Welcome / Introduction / Apologies A list of apologies was received as shown on page 1. Novartis Pharmaceuticals UK Limited were thanked for providing lunch for this meeting Declarations of potential conflicts of interest None was received. Novartis Pharmaceuticals UK Limited whilst having sponsored lunch did not remain in attendance once the meeting had commenced Minutes of the previous meeting and redacted minutes These were accepted without amendment a BHRUT formulary Sildenafil/tadalafil first line status (item 16.4c in February minutes) It was agreed that the only reference to patient age would remain in the criteria for the prescribing of vardenafil for patients over b Business case for North East London Medicines Management Common Drugs Formulary including responses to comments from CCG Prescribing Leads progress update (item 16.4d in February minutes) It was confirmed that clarification had not been received regarding the additional costs relating to the funding of this project. BHRUT advised that confirmation was awaited from the business planning round regarding their involvement in the project c BHR CCGs Working with Industry policy ( item 16.4e in February minutes) This item was to be added to a future agenda. The document in its present format had been approved by the BHR CCG Boards d LES proposal update (item 16.4g in February minutes) A proposal document to remunerate GP practices for their uptake of shared care had been submitted to the borough teams for action. It was no longer called a local enhanced service (LES) but a shared care clinical management and prescribing proposal e Commissioning and funding of complementary and alternative medicines (item 16.9 in February minutes) The document was discussed and additional wording was requested. A further request to change the title to Position statement on Homeopathic preparations was agreed. 17.4f Other matters arising Rivaroxaban for treatment of deep vein thromboembolism (DVT) (BHRuT) (item 16.4a in February minutes) It was reported that other NEL CCGs were seeking a similar SCG and may comment on the BHR CCGs document in the future. Shared care guidelines for comment and decision The use of human growth hormone (Somatropin) in adults with growth hormone deficiency (BHRUT) ((item 16.7 in February minutes) A response from secondary care was still awaited. CSU attendance (item in February minutes) This had been discussed with the Commissioning Support Unit APC submission templates for comment and decision 2 P a g e

3 a b c BHR CCG Drug Application and Commissioning Impact Document It was agreed that the document should remain in its present format and N/A inserted in any non-relevant sections. BHR Area Prescribing sub-committees agenda item template An amendment to the options section was requested. Template cover letter Amendments were requested. All three were approved subject to amendments Nurse practitioner prescribing audit Partnership of East London Co-operatives (PELC) (action from March 2013 meeting) Details were presented of the Antibiotics Patient Group Direction (PGD) Audit, the new service being provided by urgent care practitioners for PELC at the GP Unit, Whipps Cross University Hospital. Assurances had been provided that the nurse practitioners had followed the specific details outlined in the PGD and documented patient information to fulfil the PGD requirement. The audit data had proved useful in establishing the number of patients that had been seen by the nurse practitioner and therefore not requiring a visit to a GP. The audit was noted Interim Gender Dysphoria Protocol and Service Guideline 2013/14 GPs had been requested by the Gender Identity Clinic (GIC) to prescribe hormone therapy, and associated blood monitoring and tests, without supporting information, potentially outside the GPs competence, compromising patient safety. It had been acknowledged that prescribing of testosterone esters had been occurring; however, the indication for which they were prescribed was not apparent from EPACT. Concerns had been raised at a national level. The specialised services circular released after the papers had been sent out added nothing new but rather encouraged GPs to work with GICs Tissue Viability Wound Care Formulary, NELFT The final draft document of the Tissue Viability Wound Care Formulary was discussed. A brief explanation of the work undertaken to evaluate the contents was provided and assurance was given that any future products for inclusion would be substantiated with the relevant evidence to support use. Future requests for inclusion to the formulary would be submitted to the NELFT Community Health Services (CHS) DTG. It was acknowledged that this formulary was for primary care use only and had not been cross referenced with any secondary care wound care formulary. Additional amendments were requested HP stated that the formulary was also to be considered at a Waltham Forest Medicines Management meeting Shared Care Guidelines i) for the use of nebulised Colomycin injection (Colistimethate Sodium) in the treatment of Pseudomonas aeruginosa infections in adults with noncystic fibrosis bronchiectasis 3 P a g e

4 ii) shared care financial forecasting tool Shared care guidelines were presented for the use of Colomycin injection for the above indication. The meeting was advised that within the Chronic Obstructive Pulmonary Disease (COPD) cohort of patients, a substantial number suffering from pseudomonas aeruginosa would benefit from this treatment as an option. It became apparent that bronchiectasis had been identified on the list of NHSE commissioned services and therefore clarity would need to be sought before this item could be considered further. Not approved Proposal to extend the provision of Emergency Hormonal Contraception (EHC) through community pharmacies Extension approved subject to amendment Primary Care Assessment Tool (Appendix 1 of BHRUT Supporting Management Guidelines for Children aged over 2 years with Asthma and Wheeze The whole document was felt to be very informative and it was agreed that Appendix 1 should be added to the BHR CCGs website. Endorsed BHR CCGs PBR excluded drug challenge outcomes Data had been circulated relating to the challenges that had been made on behalf of the BHR CCGs during a nine month period. It was explained that challenges were made for various reasons including the lack of indication details, cost information, NHSE commissioned drug, or any unusual drug request. Secondary care advised that although the challenges were received by them they were not made aware of the responses that were returned to commissioning teams. Noted Medicines Management Workplan (including list of branded generics) This document had been submitted to each CCG board and had been agreed as a two year work plan. Cost effective branded generic prescribing was also to be implemented within the plan. Work plan noted BHR CCGs and BHRUT Guideline for the Diagnosis and Management of Vitamin D Deficiency in Adult Patients Details of revisions were provided to the initial joint vitamin D guidance that had been published in January Amendments to the document had been made in accordance with specialist information gathered and the recent National Osteoporosis Guideline published in April A key change was narrowing of the values for deficient to <30 mmol/l, insufficient to mmol/l and >50 being replete. Concern was raised regarding the advice that pregnant women who were identified as vitamin D deficient should be treated in the same way as other adult patients. Evidence to support this statement was requested Any other business No other items for discussion For information a. Barts Health NHS Trust & Local GPs Joint Prescribing Group minutes for February 2014 b. BHRUT DTG minutes for January 2014 c. NELMMN minutes for January P a g e

5 d. Procedures and guidelines for the use of the McKinely T34 Syringe pump/driver for adults (18 years for age and over) NELFT Documents approved subject to amendments since last BHR CCG APC meeting Rivaroxaban for treatment of deep vein thromboembolism (DVT) BHRUT Prescribing Guidelines of Infant Formula for infants with Cow s Milk Protein Allergy (CMPA) NELFT & BHR CCGs Shared Care Guidelines: Mercaptopurine & Azathioprine in Inflammatory Bowel Disease Patient Group Direction (PGD) for the Supply of Antibiotics by Emergency and Urgent Care Practitioners working for PELC Algorithm for treatment of infections PELC BHR CCGs Interface Prescribing Policy Date of next meeting: Thursday 19 th June 2014 The meeting closed at 2.58pm 5 P a g e