Primary Care Prescribing Committee (PCPC)

Primary Care Prescribing Committee (PCPC) Minutes of the Primary Care Prescribing Committee held on: 20 th February 2018 - Time: 12.30-14.00 at CCG, Carisbrooke Room / Bembridge Room, Building A, The Apex, St Cross Business Park, Newport, Isle of Wight, PO30 5XW. PRESENT: Oommen John (OJ) (Chair) Caroline Allen Tracy Savage (TS) Beth Shaw (BS) Nick Puckett (NP) Paul Howard (PH) Annie Adams (AA) Daphne Williams (DW) Michelle Legg (ML) Pauline Mairs (PM) Fran Alverez (FA) Debbie Cumming (DC) Matthew Leek (MaL) MINUTED BY: Chantal Cave (Medicines Optimisation Team Administrator) (CC) Item number as per agenda Item Title / Heading 1. Apologies / Introductions Liz Harrison (LH), Marie Locke (ML) Kieron Cooney (KC), Adam Poole (AP), Himanka Rana (HR) 2. Declarations of Interest Tracy Savage, Oommen John, Michelle Legg, Beth Shaw and Paul Howard. 3. Minutes of last meeting 16.01.17 were agreed as a true record. Action 4. Outstanding Actions Introductory meeting to be arranged to discuss a Joint Formulary. To include Adrian Green (Chairman of Drugs Advisory Committee), Gill Honeywell (Chief Pharmacist at IOW NHS Trust) OJ and TS. Update: Agenda item 7- Formulary Update. MOT 5. Matters Arising Compilation of Shared Care Agreements (S) from mainland hospitals BS BS explained that the Shared Care Agreement database for regional Ss has been collated. The MOT will look at discrepancies between agreements and develop guidance. BS encouraged PCPC members to report requests for external shared care agreements to the CCG Shared Care inbox (sca@iow.nhs.uk) and BS is working on a policy statement for GPs. The PCPC members concluded that there has been a lack of communication and that more integrated working is essential. OJ would like to highlight that Dermatology have sent red drugs on Ss. BS will follow this issue up with LH. Page 1

Discharge Summaries FA FA explained an ongoing issue of community pharmacies no longer receiving faxes of discharge summaries. ML supports pharmacists receiving discharge summaries but would like assurance that the process is robust and streamlined. TS explained the proposed electronic notification of discharge that will be sent to pharmacies. The MOTIVE service becomes effective from 9 th April to enable pharmacists to provide targeted Medicine Use Reviews (MURs) or New Medicine Service (NMS). A launch event will take place in early March with information disseminated to GPs in the March edition of the MOT Newsletter. Liothyronine and Armour Thyroid TS TS introduced the SHIP8 CCG Priorities Committee draft policy recommendation on the use of liothyronine in the treatment of hypothyroidism and the CCG guidance on the prescribing of liothyronine (tri-iodothyronine, T3) and /or desiccated thyroid or thyroid extract products. TS clarified that Liothyronine should not be prescribed unless the patient has been seen by an NHS Endocrinologist. explained that EPACT data identifies spending of 200,000 p/a on Liothyronine by the CCG. TS confirmed that the SHIP8 policy did not support the initiation of prescribing of Amour Thyroid. TS explained that Liothyronine prescribing will need to be audited on a case by case basis with guidance for practices and prescribing by private consultants monitored. explained in the NHS England Drugs of Limited Clinical Value (DoLCV), The British Thyroid Association states the Liothyronine can only be prescribed after Levothyroxine has failed and patients have had a carefully audited trial of 3 months duration. The SHIP8 policy will be presented at the CCG Clinical Executive meeting in March 2018. ACTION Dermatology Ss. BS to follow this issue up with LH. MOTIVE Launch event information included in March MOT Newsletter SHIP8 CCG Priorities Committee draft policy recommendation on the use of liothyronine to be presented at the March CCG Clinical Executive meeting. BS to check CCG position with LMC in regard to medicines initiated by private specialist being prescribed on FP10. BS TS BS 6. COPD GSK research projects. Presented by Nick Puckett (Organisation Development Manager, One Wight Health) NP NP explained that One Wight Health (OWH) has been working closely with Dr Himanka Rana and Vectasearch to assess the effectiveness of TRELEGY ELLIPTA relative to non-ellipta Multiple Inhaler Triple Therapies (MITT) for chronic Obstructive Pulmonary Disease (COPD) control within the usual clinical practice setting. The Intrepid study summary was distributed to the PCPC members. Page 2

NP proposes that OneWight Health will act as the pick site co-ordinator for 16 GP practices across the Isle of Wight. OWH will act as the administrator and contact patients to gauge interest on signing up to the study. Details will then be passed onto Dr Rana and Vectasearch will develop the project. NP clarified that no data will leave the practice except those with patient consent and that patient letters are sent via OWH on behalf of practice. NP explained that funding for the project is standard research funding and a memorandum of understanding has been drawn up between Vectasearch and OWH. NP explained that it has been presented at the Practice Manager s Forum, and expressions of interest will be followed up and individually written to. 7. Formulary Section I. Update II. Thickener Review BS Update; BS explained that the Formulary is continuing to be refined and updated. BS has received notification that the NET Formulary is in place to be accessed. BS explained that the Formulary will match SystmOne to ensure that the formulary is accurate. BS explained to the PCPC the benefits of the NET formulary; a web based system that is pre-populated with BNF chapters / live data /audit trails / can be linked to shared care agreements and the MOT website / an integrated traffic light system and can pivot primary and secondary prescribing. BS will investigate the different interfaces available. TS communicated an aim to organise a Task and Finish group to link with MOT pharmacists and Trust Pharmacists and a wider intention for an Area Medicines Optimisation Committee. TS proses that governance and processes will be developed under the newly formed Area Medicines Optimisation Committee and will enable joint working and collaboration with consultants. SALT Thickener Formulary Review; explained that on 1 st February 2018 the Medicines Optimisation Team held a SALT Thickener Formulary Review and Nestle Resource Thicken Up Clear was chosen as the preferred option. The product won overall on quality, safety and was competitively priced. confirmed that the formula is suitable for all patients and will be used across secondary and primary care. TS confirmed that an action plan is being developed to support care homes with the use of this product. BS confirmed that the formulary will be updated to reflect this on SystmOne and ScriptSwitch has been updated. Page 3

ACTION Information on Nestle Resource ThickenUp Clear to be included in the March 2018 edition of the MOT Newsletter. 8. Pain and Medicines Management strategies: I. Isle of Wight Palliative Care Symptom Guidelines II. Opioid Review Report - Lidocaine Patches - Just in Case III. Prescribing of (long term) drugs with potential for habituation by psychiatry. IV. Discussion re Strategy going forward for QPSS PH AP TS Isle of Wight Palliative Care Symptom Guidelines; PH presented the updated draft of Isle of Wight Palliative Care Symptom Control Guidelines, accompanying Consultation Log and Recommended Traffic Light Allocations for palliative medicines on the Isle of Wight to the members of PCPC. PH requested feedback from the PCPC with an aim to secure approval from PCPC on the proposed document. The Guidance is pending approval from the Earl Mountbatten Hospice Quality and Governance Committee and St Mary s Hospital NHS Trust Clinical Standards Committee. PH highlighted a post submission change to Lidocaine conversion. The PCPC commended and approved the guidance. PH will inform the MOT that the guidelines have been approved by the EMH and St Mary s Hospital Trust, upload the guidelines onto the Primary Care launch screen and seek to implement the guidelines on a SystmOne template. will send out an update in the MOT Newsletter. ML explained that an update can be distributed at the CCG Locality meetings. Opioid Review Report; presented the Opioid Action Plan and Report for the South Wight Locality. explained that herself and David France (MOT Pharmacist) worked alongside an individual practice, remotely reviewed their patients on SystmOne, provided prescriber education and drafted a letter for those patients who would need to be reviewed for clinical safety. explained that the practice has reported that patients are receptive to the discussions. Lidocaine Patches; explained that an audit of lidocaine 5% medicated plaster prescribing for inpatients at the Isle of Wight NHS Trust was conducted at the Trust by an interim pharmacist and reported to DAC. The audit quoted is over an 8 month period. During those 8 months 12 patients were admitted already using the patches in primary care. Of the 18 patients started on patches whilst in hospital over the 8 month period, Page 4

only 4 were discharged with a patch, 3 of whom as out of license use with a full supply for short term use, not to be continued by the GP. The remaining 1 was in license. It is expected that all off licence prescribing of Lidocaine 5% medicated plasters (with the exception of chronic neuropathic pain in an outpatient setting) will be accompanied by an Unlicensed and Off-Licence Liability Form The MOT will present an update in the March 2018 MOT newsletter and continue discussions with Gill Honeywell. Just in Case; explained that there has been a number of Just In Case medications being used in a care home setting and errors have been made. has proposed an audit will take place as part of the MOT Technician Check process. Prescribing of (long term) drugs with potential for habituation by psychiatry; AP sent apologies and the item will return to PCPC at a later date. Discussion re Strategy going forward for QPSS; TS explained that learning outcomes from the opioid review demonstrates that reducing opioid prescribing would be valuable piece of work to undertake. ML would welcome practice support and PH would welcome a consistent message. OJ concurred that Opioids are a high priority and it should form part of the QPSS 18/19. TS explained that Polypharmacy will remain on the QPSS and a focus on polypharmacy reviews for care homes informed by SI reviews. Guidelines around Anti-Coagulants, NOACS and a consideration of deprivation indexes may also feature. ACTION PH to update MOT on the approval of the Palliative Care Symptom Guidelines by the Earl Mountbatten Hospice Quality and Governance Committee and St Mary s Hospital NHS Trust Clinical Standards Committee. PH to include Palliative Care Symptom Guideline update in the MOT Newsletter and ML to distribute an update at the CCG Locality meetings. /ML Updated guidance on Lidocaine patch prescribing to be included in March MOT Newsletter TS to present a draft version of QPSS 18/19 at the March PCPC 9. Prescription Ordering Direct (POD) TS TS explained that Prescription Ordering Direct (POD) has been discussed as an alternative to managed repeats by community pharmacies. This will enable a centralised base for patients to order repeat prescriptions. TS explained that when the scheme was introduced to Coventry and Rugby CCG there was a greater Page 5

than 6% reduction in Primary Care costs overall. TS recognised that this would initially impact work load but it would benefit practices in the long-term by reducing work load and offer an enhanced clinical oversight of prescription ordering. PM highlighted the issue of redeployment of practice staff. The PCPC concluded that the idea has many benefits but would like further clarification of the scheme. 10. SIP Feeds I. Invest to save proposal II. Guideline development TS/ TS/ TS asked the members to review the Oral Nutritional Supplement (ONS) proposal and feedback to TS regarding any observations and concerns. ML commended the proposal. 11. Finance MaL MaL explained that budgets for 2018/19 are being considered with an aim for an update at the March PCPC meeting. MaL is working closing with TS regarding the financial element of the QPSS 2018/19. ACTION CC will distribute the December prescribing data to the prescribing leads once EPACT report data is available. CC 12. AOB: AA raised the concern that there has been an increase in outpatient discharge of the white sheet. OJ concluded that is an ongoing concern and will discuss further with TS. FA distributed his B12 policy to the members of the PCPC for information AA FA 13. Date of Next Meeting: Tuesday 20 th March 2018 12.30-14.00 at the Beech Grove Surgery, The Mall, Brading, PO36 ODE. Page 6

Members Dr Oommen John (Chair [OJ]) Tracy Savage AD Medicines Optimisation(Deputy Chair [TS]) Dr Michelle Legg, GP, Tower House (ML) Dr Kieron Cooney, GP, St Helens Medical Centre (KC) Dr Benjamin Browne, GP, East Cowes (BB) Annie Adams, South Wight Medical Practice (AA) Caroline Allen, Deputy Head, Medicines Optimisation () Beth Shaw, Clinical Pharmacist Advanced (BS) Matthew Leek, CCG Finance Manager (MaL) Francisco Alvarez, LPC Rep and Community Caroline Morris, Head of Primary Care & Corporate Business (CMo) Melanie Rogers, Director of Quality and Clinical Services (MR) Pauline Mairs, Commissioning Manager (PM) Adam Poole (AP), GP Argyll House Pembe Hassan-Hicks St Helens (PH-H) Rachel Howard Esplanade (RH) Cath Miskin Shanklin (CM) Gill Honeywell St Marys (GH) Paul Howard Consultant in Palliative Medicine (PH) Pharmacist (FA) Daphne Williams, Patient Representative (DW) Georgina Newnham, Community Hearth Failure Nurse (GN) Vicky Cooney, St Helens Medical Centre (VC) Hayley Jeneson (HJ) Locality Specialist Medicines Optimisation Team Annika Conroy Project Support (AC) For information Clinical Executive Committee Primary Care Operational Group Page 7

Primary Care Prescribing Committee (PCPC) Date of Action Description Meeting 20/02/2018 SHIP8 CCG Priorities Committee draft policy recommendation on the use of liothyronine to be presented at the February CCG Clinical Executive meeting. 20/02/2018 Information on Nestle Resource ThickenUp Clear and Lidocaine patch prescribing to be included in the March edition of the MOT Newsletter. 20/02/2018 BS to check CCG position with LMC in regard to medicines initiated by private specialist being prescribed on FP10. Date Action Made Responsibility Updates Status 20/02/18 TS Paper prepared and presented at Clinical Executive meeting Thursday 15/03/18 Completed 20/02/2018 Included in the MOT newsletter - distributed to general practices and pharmacies 12/03/18. Completed 20/02/2018 BS Action 20/02/2018 MOTIVE Launch event information to be included in March edition of MOT Newsletter 20/02/2018 PH to update MOT on the approval of the Palliative Care Symptom Guidelines by the Earl Mountbatten Hospice Quality and Governance Committee and St Mary s Hospital NHS Trust Clinical Standards Committee. 20/02/2018 to include Palliative Care Symptom Guideline update in the MOT Newsletter and ML to distribute an update at the CCG Locality meetings 20/02/2018 Included in the MOT newsletter - distributed to general practices and pharmacies 12/03/18. Event took place on 07/07/18 20/02/2018 PH 20/02/2018 /ML Included in the MOT newsletter - distributed to general practices and pharmacies 12/03/18. Completed Action Completed 20/02/2018 TS to present an outline of QPSS 18/19 at the March PCPC 20/02/2018 TS Action Page 8