Ms Lyndsey Hands, Graduate Trainee (observer) Mrs Sandra MacDonald (minutes) ACTION

Transcription

1 CONFIRMED MINUTES OF THE MEETING OF THE FIFE DRUGS AND THERAPEUTICS COMMITTEE HELD AT 12.30PM ON WEDNESDAY 16 AUGUST 2017 IN MEETING ROOM 2, WARD 6, VICTORIA HOSPITAL, KIRKCALDY. Present: Mrs Evelyn McPhail (Acting Chair) Dr Rob Cargill Dr Frances Elliot Mr Scott Garden Dr Iain Gourley Dr Alan McGovern Mr Ishtiaq Mohammed Ms Andrea Smith In attendance: 1 APOLOGIES FOR ABSENCE Ms Lyndsey Hands, Graduate Trainee (observer) Mrs Sandra MacDonald (minutes) ACTION Apologies for absence were noted from Ms Claire Dobson, Dr J Kennedy, Professor S McLean, Ms J Owens, Dr S Rogers. Mrs McPhail welcomed Lyndsey Hands, Graduate Trainee/Project Support Officer with IMPACT to the meeting as an observer and introductions took place. Mr Garden highlighted the importance of finance representation on the FDTC. Mrs McPhail to discuss with Carol Potter. EMcP 2 MINUTES OF PREVIOUS MEETING ON 28 JUNE 2017 The minutes of the meeting held on 28 June 2017 were confirmed as a true record. 3 SUMMARY OF ACTION POINTS FROM 28 JUNE 2017 MEETING The summary of action points was updated. Vitamin D Guidance Dr McGovern advised that the draft interim guidance has been discussed at the LMC. The LMC was supportive of the guidance, however there was some feedback in relation to the purchase of OTC vitamin D when there is no evidence of benefit. The final draft has been submitted to the August MSDTC for approval.

2 Risk Register - Risk 356 Clinical Pharmacy Input Mr Garden advised that risk 356 has been updated and will be included in the pharmacy report to be submitted to the next Acute Division Clinical Governance Committee meeting. Shared Care Protocols Dr McGovern advised that the existing Shared Care Protocols were discussed in general terms at the GP Clinical Steering Group. A meeting has been arranged between Dr McGovern, Dr Gourley, Mr Garden and Mr Notman to go through the Shared Care Protocols on an individual basis to identify those that are appropriate and can be approved temporarily and those that require amendment. An update to be brought back to the next FDTC meeting. SG AMcG Fife Formulary Committee Update It was noted that Dr Rogers has accepted the invitation to join the FDTC as chair of the Fife Formulary Committee. Mr Garden provided an update on further discussions with the Clinical Directors and finance business partners to clarify their roles in the Formulary submission process. Formulary submissions should be presented to the Formulary Committee with clear advice from the Clinical Director in collaboration with the finance business partner and clinical pharmacist. Where potential budgetary issues have been identified the submission should still be presented to the Formulary Committee for independent review and if supported clinically, escalated to the FDTC and EDG as required. In relation to submissions for medicines where it is clear that prescribing would take place in Primary Care it is recognised that part of the role of the finance business partner is to have discussions with their counterparts in Primary Care and this should be annotated on the submission form. Mr Garden to make minor amendment to the flowchart for the introduction of new medicines to make the process clearer and confirm in writing with the Clinical Directors. Guidelines for Supply to Hospital Outpatients It was noted that the final version has been added to the ADTC website. Mr Garden and Mr Notman to discuss communication of the guidelines/form. Ms Smith highlighted feedback from Nicky Connor in relation to a potential gap for non prescribers who make treatment recommendations i.e. school nurses. It was suggested that development of a template letter be considered. Ms Smith to feed back to Nicky Connor. SG SG/FN AS New Updated EAMS Operational Guidance - Glecaprevir/Pibrentasvir for Adults with Hepatitis C Mr Garden advised that he has discussed the EAMS Operational Guidance with the BBV Pharmacist who confirmed that there were no plans to use Glecaprevir/Pibrentasvir within NHS Fife. It was noted that the EAMS Operational Guidance has now been withdrawn. 2

3 SCAN Formulary Submissions approved through Lothian Formulary Committee Dr Elliot advised that an has been sent to Tracey Gillies, Medical Director, NHS Lothian and an acknowledgement received. An update will be brought to the FDTC in due course. National Therapeutics Indicators and Additional Prescribing Measures Baseline Document 2016/17 Ms Smith advised that this is being taken forward by Sally Tyson in collaboration with the GP Prescribing Leads and it is anticipated that a report will be brought to the FDTC in October. 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 Mr Mohammed introduced the update report with a summary of the discussions from the Fife Formulary Committee meeting on 26 July Mr Mohammed highlighted that a submission to include Fobumix Easyhaler in the Formulary for patients aged 18 years and over with asthma had been considered by the Formulary Committee, however this is on hold pending licence approval. Dr Elliot stated that the Scottish Government is in the process of updating the Respiratory Strategy and it is likely that this will incorporate prescribing guidance. 6.2 Antimicrobial Management Team Mr Mohammed introduced the six month update report produced by the Antimicrobial Management Team (AMT) and highlighted key points. It was noted that an unforeseen interruption to the supply of piperacillintazobactam since April 2017 has had an impact on the work of the AMT as alternative antibiotic protocols required to be developed. The diabetic foot infection and neutropenic sepsis guidance have been reviewed and updated and are on the agenda for consideration at the next MSDTC. There is consistent reporting of the new antimicrobial prescribing indicators on two downstream wards with good compliance in both wards. Dr Griffith has been invited to give a presentation on Fife s antibiotic 3

4 policy to the national SAPG meeting. The FDTC noted the issue in relation to primary care antimicrobial pharmacist support, particularly with regard to the impending review of the Primary Care Antibiotic Guidelines. Ms Smith to take forward. It was noted that pending recruitment and appointment to cover the role of primary care antimicrobial pharmacist, any issues continue to be supported by the Pharmacy Services Team. Mr Mohammed/Mr Notman offered to provide support with the updating of the guidelines. AS 6.3 Non Medical Prescribing Group Mr Mohammed introduced the update report from the Non Medical Prescribing Group and highlighted key items. It was noted that the Terms of Reference has been reviewed and membership of the group expanded. A survey has been carried out capturing information about competency, prescribing practice and training needs and an action plan developed which is being implemented. A business case for a non medical prescribing lead is being developed. The FDTC noted issues in relation to changes to the funding stream. Ms Owens to advise if the group wishes any support from the FDTC to progress this. Dr McGovern highlighted the bullet point relating to datix and proposals for a process to be put in place to capture medication incidents in GP practices. Ms Owens to clarify via whether the proposed process relates to the provision of educational/learning support. It was noted that the majority of General Practices do not use datix in the same manner as NHS Fife and non medical prescribers who are employees of General Practices have no contractual requirements to report to NHS Fife. JO JO 6.4 MSDTC Dr Cargill introduced the minutes from the MSDTC meeting on 27 June 2017 and gave a verbal update. It was noted that the amended HIV Pre- Exposure Prophylaxis Guidance has been approved. 7 SBAR - ADTC SUB-GROUPS REVISED REPORTING ARRANGEMENTS Mrs McPhail introduced the SBAR on the revised reporting arrangements for ADTC sub-groups together with the accompanying flowchart and highlighted the proposed changes. The Effective and Efficiency Prescribing Group has been removed from the flowchart as the work of that group is being taken forward through a number of different groups, particularly the Medicines Efficiency Huddle and the Acute Prescribing Forum. The Code of Practice - Medicines 4

5 Group has been replaced with the Safe Use of Medicines Group (SUOMG); the Terms of Reference for SUOMG to be brought to the next FDTC. The Homecare Group and Polypharmacy Steering Group have been included as sub-groups of the FDTC and the Medical Gases Committee a sub-group of the MSDTC. The FDTC approved the changes to the reporting arrangements of the sub-groups. The flowchart to be added to the FDTC website. Communication on the role of the MSDTC and Formulary Committee to be taken forward. Mrs McPhail to amend the SBAR for submission to the EDG. EMcP RC/SG/ IM EMcP 8 NATIONAL EFFECTIVE PRESCRIBING PROGRAMME WORK Dr Elliot gave a verbal update on the medicines efficiency work streams being taken forward by the national effective prescribing programme including the use of biosimilar medicines, respiratory and diabetes medicines. The National Effective Prescribing Programme has asked ADTCs if there are any areas of medicines efficiency that require some national impetus to take forward. Committee members to give consideration to this and forward any comments to Dr Elliot. All 9 SBAR - VALPROATE PATIENT SAFETY ALERT Mr Mohammed introduced the SBAR on the Patient Safety Alert issued in May 2017 relating to the use of valproate products in girls and women of child-bearing potential and briefed the FDTC on the background to this. This alert follows on from previous advice issued by the MHRA and the publication of the valproate toolkit which provides a set of resources for patients, GPs, pharmacists and specialists. Evidence suggests that a further concerted effort is needed to ensure that all girls and women of child-bearing age are informed of the risks associated with the use of valproate. The SBAR details the proposed actions within NHS Fife. Dr McGovern highlighted that a number of the proposed actions have previously been taken forward in Fife based on the recommendations in the original MHRA guidance. A patient safety initiative was undertaken in General Practice in 2016 in collaboration with colleagues in paediatrics, neurology and learning disability. It was noted that further work may be required to include patients transferring from other areas and community dispensing. Mr Mohammed to liaise with Fay Richmond, Clinical Services Support Manager, West Division to collate the work already carried out and identify what further actions are required. The final report from the General Practice patient safety initiative to be brought to the FDTC. IM 5

6 10 WEST OF SCOTLAND REGIONAL PROTOCOL FOR ORAL MESALAZINE Mr Mohammed highlighted the communication circulated by the ADTCcollaborative on behalf of the West of Scotland Gastroenterology Prescribing Subgroup relating to the development of a regional protocol for the use of oral mesalazine in the treatment of ulcerative colitis including recommendations for a preferred first line agent - Salofak. Mr Mohammed advised that feedback from local gastroenterology specialists is that they would wish to continue to use the current Fife Formulary recommended oral mesalazine product, Pentasa and would not be supportive of a switch to Salofak. Pentasa is a once daily preparation which aids patient adherence and remains a cost effective option. The FDTC noted the comprehensive work undertaken by the West of Scotland Gastroenterology Prescribing Subgroup and the feedback from local gastroenterology specialists and agreed that a switch from Pentasa to Salofak should not be progressed. 11 NHS SCOTLAND BIOSIMILARS UPTAKE DATA 31 JULY 2017 The NHS Scotland Biosimilar Update July 2017 was noted. It was noted that the infliximab data for some Boards including NHS Fife is incorrect and is being amended. 12 NHS SCOTLAND EFFECTIVE PRESCRIBING UPDATE: ADOPTION OF RITUXIMAB BIOSIMILAR Mr Garden highlighted the communication from the Scottish Association of NHS Medical Directors and the NHS Scotland Directors of Pharmacy on the adoption of rituximab biosimilar. It was noted that rheumatology are proceeding with the adoption of rituximab biosimilar. Discussions are ongoing at SCAN with regard to its use in cancer patients and the development of national protocols is awaited. 13 NHS SCOTLAND HOSPITAL ANTIMICROBIAL PRESCRIBING QUALITY INDICATORS 2017/18 The documentation on the NHS Scotland Hospital Antimicrobial Prescribing Quality Indicators 2017/18 was noted. This work is being taken forward through the Antimicrobial Management team. 6

7 14 REVIEWING PROPOSED FREE OF CHARGE MEDICINE SCHEMES OFFERED WHEN SMC/FORMULARY GUIDANCE IS PENDING Mr Garden introduced the briefing from National Services Scotland on free of charge medicine schemes and briefed the FDTC on the background to this. A meeting hosted by National Services Scotland which includes representation from SCAN, NHS Fife and the National Acute Pharmacists Group for Scotland has been organised for the autumn to build on the briefing and develop more definitive guidance. The FDTC noted that there is a robust governance process within NHS Fife for free of charge medicines through the unlicensed medicines route. Once the outcome of the national work is available consideration will be given to whether any actions require to be taken locally. 15 EAMS OPERATIONAL GUIDANCE 15.1 Idebonone (Raxone ) for Duchenne Muscular Dystrophy The FDTC noted the new EAMS operational guidance for idebonone (Raxone ) for Duchenne Muscular Dystrophy. Mr Mohammed highlighted that idebonone has recently been approved through the SMC for lebers hereditary optic neuropathy. A recent Fife Formulary submission was not supported by the Clinical Director and it was agreed that any requests to use idebonone for this indication would go through the non-formulary process Withdrawal of Atezolizumab EAMS The FDTC noted the withdrawal of the EAMS for atezolizumab for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma. 16 INDIVIDUAL PATIENT TREATMENT REQUESTS/PACS The updated table of Individual Patient Treatment Requests was noted. 17 SCOTTISH MEDICINES CONSORTIUM - REQUEST FOR EXPRESSIONS OF INTEREST FOR MEMBERSHIP FDTC members were asked to forward any expressions of interest for membership to Sandra MacDonald. The SMC has advised that expressions of interest from interested health professions from any background will be considered but there is currently a particular need for physicians to serve on SMC and the New Drugs Committee. The deadline for submission to the SMC is 22 August. All 18 ESTABLISHMENT OF NATIONAL APPEALS PANEL (PACS TIER 2) It was noted that Ms Smith had been put forward as the nominee from NHS Fife to participate in the steering group. Further information will be 7

8 circulated from Healthcare Improvement Scotland in due course. 19 POINTS FOR RAISING AT CLINICAL GOVERNANCE COMMITTEE It was agreed that the following items should be highlighted to the Clinical Governance Committee: FE Revised governance structure; Shared Care Agreements. 20 ANY OTHER COMPETENT BUSINESS There was no other business. Other Information a b c d Minutes of Diabetes MCN Prescribing Sub-Group 6 June For information. Minutes of Heart Disease MCN Prescribing Sub-Group. Next meeting 20 September Medicines Procurement Newsletter. The FDTC noted the Medicines Procurement Update June 17. Date of Next Meeting The next meeting is to be held on Wednesday 4 October 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 18 September 2017.) 8