Minutes of the Lambeth and Southwark Joint Prescribing Committee (JPC) meeting 2. 00 pm, Wednesday 15 May 2013 Room GO2-A, 160 Tooley Street Present: Dr Catherine Otty (CO) Dr Alan Campion Dr Sian Howell (SH) Dr Liz Williams (LW) Iris Javaid (IJ) Sarah Bell (SB) Gaurang Purohit (GP) Anna Jenkins (AJ) Vanessa Burgess(VB) Devika Sennik (DS) Ada Onyeagwara (AO) Helen Magnusen Baker(HB) Finlay Royle (FR) Rachel Heathcock (in attendance for antimalarial prescribing item) Kath McPherson (KM) GP, Chair (Southwark CCG) GP (Southwark CCG) GP, CCG Board Medicines Management Lead, Southwark CCG GP, (Lambeth CCG) Practice Nurse (Lambeth CCG) Practice Nurse (Lambeth CCG) Formulary Pharmacist, GSTT Chief Pharmacist, Southwark CCG Chief Pharmacist/AD Medicines Management, Lambeth CCG Senior Pharmaceutical Advisor, Southwark CCG Senior Prescribing Advisor, Lambeth CCG Senior Pharmaceutical Advisor, Southwark CCG Prescribing Advisor, Southwark CCG Local Director of Health Protection, South East London Health Protection Team Medicines Management Intelligence, Lambeth CCG (Minutes) Apologies: Dr Gillian Ellsbury Dilip Joshi Anna Hodgkinson (AH) Helen Williams Josie Mansell Sadru Kheraj Chris Barrass GP, /LCCCB Member and Medicines Lead, Lambeth CCG Community Pharmacist Senior Prescribing Advisor, Lambeth CCG Consultant Pharmacist Cardiovascular Disease GSTT Community Services Pharmacist GP, Lambeth CCG Director of Pharmacy 1. Introduction and welcome CO welcomed members to the meeting. 2. Minutes January 2013 and Declaration of Interests/Conflicts The minutes were accepted as an accurate record. Page 1 of 5
3. Matters Arising i. Erectile Dysfunction outcome of meeting with SLAM AO/HB met with SLAM consultants and it has been agreed that guidance for GPs on management of ED patients in primary care will be drafted by SLAM consultants. This will include a checklist to assess whether the patient should be treated in primary or secondary care. The draft guidance will be presented at the next JPC. The committee recommended a pilot scheme with a six-month review of the guidance, to assess the impact on costs/secondary care referrals. ii. Unapproved growth hormone shared care KCH Deferred iii. Anticoagulant Prescribing Update on audit deferred iv. NOACS Rebate Scheme NHS Lambeth CCG has agreed sign-up to the dabigatran and rivaroxaban schemes, subject to negotiation over data provision timing. NHS Southwark CCG is considering the schemes. Item closed. v. Sativex Shared Care Guidance The guidance has been approved by SEL Area Prescribing Committee and will be circulated and posted to intranet/internet. Item closed. 4. Guidelines for managing cow s milk protein allergy/intolerance in primary care FR reported that comments from NHS Lambeth CCG and LPP dietician have been circulated and noted. Clarification on whether the separate guideline on allergy testing, referred to in the main guidance, has been approved is needed and no comments have yet been received from GSTT. The committee noted that whilst there is pressure to approve these guidelines, they are not ready for approval and requested that a face-to-face meeting be set up to include representatives from KCH/GSTT, specialist interest GPs and pharmacists. The Committee requested that Adam Fox be invited to the meeting too KO/DA can email Dr. Fox if required to support this process. The reviewed guidelines will be presented at the next JPC ACTION: FR to organise meeting, KO/DA to support invite to Adam Fox if required 5. Osteoporosis Guidelines AO reported the guidelines have been drafted by Imtiaz Ahmed and were initiated by the MSK steering group. JPC made the following comments on the prescribing content: Recent MHRA strontium safety update re: cardiovascular safety of strontium to be added Vitamin D dosage/units and preparations add reference to Vitamin D guidelines The committee also commented that the document is too complicated and may not assist clinical decision-making because of this. There is also evidence to support use of hip protectors and to support walking as exercise; the Committee therefore requested that lifestyle advice should be added. Guidance on dental treatment for patients on bisphosphonates would also be useful. Action: AO to feedback to author on comments 6. Vitamin D Prescribing Guidelines AO informed JPC that the vitamin D guidance currently approved for NHS Lambeth CCG has been updated and the committee were asked to approve for use in Lambeth and Southwark. Obstetrics and gynae guidance is included but it has not been possible to get involvement with Paediatrics. The guidance comprises a treatment flow chart, guidance on treating renal patients, background information on preparations and evidence and a list of preferred Vitamin D products. AO reported that if Vitamin D is prescribed generically as colecalciferol costs can vary and are often very high. Costs are easier to control if prescribed as Dekristol. JPC recommended that the message about not Page 2 of 5
prescribing generically be emphasised. The guidance to only check Vitamin D levels in summer should be amended to suggest that levels be checked in summer. The guidance was approved. ACTION: AO to forward to acutes for approval via their committees 7. Insulin Passport A template of the insulin passport, recommended by the NPSA alert in 2011 was presented by DS to the committee. The template has been reviewed extensively by local diabetes experts and is in the process of being reviewed by a patient group. A local decision has been made to produce a plastic credit card sized version of the passport rather than use the national paper version. There will not be a space for entering the patient s other medication, as there is on the NPSA version. The alert states that the prescriber is responsible for issuing and completing the passport when insulin is started. A new card should be issued if the dose changes. The Diabetes Modernisation Initiative is funding the printing of the cards and once approved, it will be launched, along with the flyer and patient information leaflet, (which are already approved by JPC). The Committee approved the deviation from the National Passport based on the reasoning detailed in tabled enclosure E. Once the patient group has commented on the passport and any necessary amendments made, it will be sent to KO and DA for final approval via Chair s action. ACTION: AH/DS to forward the final passport to KO and DA for Chair s action once the patient group has reviewed 8. Shared Care Guidance List DS and AO presented a summary of current agreed shared care guidance, including expiry dates. The summary has been sent to KCH/GSTT and the trusts have confirmed which agreements they wish to continue and will be reviewed. GPs should inform their respective medicines management teams if they receive any requests for shared care for drugs not on this list, which will be posted to the intranet. The apomorphine shared care guideline has caused issues for Croydon CCG and they are not happy to accept it. KCH has agreed to update the shared care guidelines for this.an update on expired shared care agreements was requested for the next JPC. 9. Specials Discussions with GSTT/KCH on repatriating prescribing for patients on specials have taken place. Many specials are initiated by secondary care, are short term and have little evidence to support use. Lewisham CCG has run a pilot scheme, providing a liaison point between practices and initiating consultants. FR has carried out costings work with GSTT, involving 15-20 specials which calculated the cost saving of 200,000 on a total spend of 250,000 over a period of one year. As a result of the discussions a do not prescribe list of specials with actions for GPs has been produced. JPC suggested a template letter to send to consultants would be useful. Medicines Information at GSTT has offered to host an information line that GPs could contact for advice on alternatives to specials. It was noted that following advice from MI, a referral back to hospital might be generated. CO suggested that the Advice and Guidance function on the Choose and Book system could be used as this is free and takes around a week for a response. SH suggested targeted work with practices at individual patient level would also be a way forward. It was confirmed that EMIS searches could be exported to all practices. ACTION: Do not prescribe list to be completed then circulated for Chair s action action JS and FR 10. Repatriation of renal patients Project is ongoing at GSTT and KCH have begun the process. Repatriation for liver transplant patients is under negotiation. VB reported there has been one incident in Lambeth of a GP Page 3 of 5
discontinuing immunosuppressants for a patient with a dosette box. As a result the patient was without the medication for 2 weeks. Dosette boxes are excluded from the repatriation scheme. 11. Antimalarial Prescribing Rachel Heathcock presented a background report on antimalarial prescribing and an update on a data extraction project in Lambeth practices to examine who is being prescribed antimalarials. LSL and Greenwich have the highest rates of malaria in the country but numbers are decreasing. The restriction on NHS prescribing of Malarone has seen a dramatic fall in use of the drug with associated cost savings. The Lambeth data extraction project identifyied who is being prescribed antimalarials and this has showed the majority are Black Africans and from deprived areas. In the main they are Lambeth residents. There is a lack of awareness of the local prescribing policy which has not been widely promoted. RH confirmed that Lewisham CCG has decided to continue with the current policy and asked JPC to approve this for Lambeth and Southwark. SB queried the HPU stance on use of local preparations when patients are travelling and RH stated that there were risks associated with this and HPU would not recommend. SH raised concern about vulnerable children and commented that there should not be a cost pressure on families. JPC approved the continued use of the existing policy, subject to a one year review with better data on impact on children and demographics. Southwark is to reissue the antimalarial guidance letter as prescribing of Malarone is still high. Action: Letter to be re-issued to practices Southwark. 12. Community Pharmacy Update Deferred to next meeting Items for information 13. Minutes Area Prescribing Committee (APC) VB reported that the TOR, new drugs process and NOACs transfer of care were approved 14. Minutes of GKLT Joint Formulary Committee (JFC) GP reported that outcomes had been clarified in the latest version. 15. Minutes of GSTfT Drugs and Therapeutics Committee (DTC) 16. Draft minutes of KCH Medicines Management Group (MMG) 17. Secondary Care Monitoring Frameworks (KCH/GSTfT) 18. NICE Update 19. Extension letters for EHC and Chlamydia PGDS Items 15-19 were noted by JPC. 20. AOB South East London Area Prescribing Committee: SH will be the GP attending from Southwark and if SH is not able to attend then KO will go as deputy. DA will attend as Lambeth GP rep deputy Dr Liz Williams AC suggested that advice re Yasmin prescribing should be reissued. Page 4 of 5
Action: HB to develop some key prescribing messages for this across Southwark and Lambeth This was AO s last meeting the Committee thanked AO for all her hard work and wished her all the best for the future. The next meeting will be held on Wednesday 10 July 2013 in Room 407, Lower Marsh between 2.00pm-4.00pm. Page 5 of 5