MINUTES OF THE MEDICINES MANAGEMENT GROUP MEETING

MINUTES OF THE MEDICINES MANAGEMENT GROUP MEETING Date & Time of Meeting: Venue: Wednesday 8 th February 2012 @ 1.30pm Boardroom, Glangwili Hospital, Carmarthen Present: In Attendance: Dr. Carol Llewellyn-Jones, Chair, HDHB Jenny Pugh-Jones, Head of Medicines Management (Acting), HDHB Sarah Isaac, Interface Pharmacist, HDHB Gareth Lewis, Carmarthenshire Lead for Pharmacy & MM Delyth Simons, Pembrokeshire Lead for Pharmacy & MM Dr. Liam Cassidy, Carmarthenshire GP Dr. Mark Turtle, Consultant Anaesthetist, Carmarthenshire (Part meeting) Chris Hayes, Associate Director of Nursing, HDHB (Part meeting) Geraint Morgan, Ceredigion Lead for Pharmacy & MM (via video conference) Keith Jones, Head of Financial Planning, HDHB Mr Sam Dentten, Deputy Chief Officer, Hywel Dda Community Health Council Carol Jones, Admin support for Corporate MM team. Agenda Item Item 1 The Chair opened the meeting and acknowledged that apologies for absence had been received from: Action Karen Howell, Director of Primary Care, Community & Mental Health Dr. Sue Fish, Medical Director, HDHB Natalie Vanderlinden, Ass. Director Therapies & Health Science, HDHB Dr. Mathew Sargeant, Consultant Psychiatrist, Carmarthenshire Dr. Mike Simmons, Consultant, Public Health Wales 2 Declaration and Register of Interests There were no declarations of interest given at the meeting. 3 Minutes The minutes from the last MMG were checked for accuracy and were declared a valid representation of the meeting held on the 14 th December 2011. Page 1 of 6

4 Matters Arising from the minutes It was noted by Sarah Isaac that work was currently ongoing in relation to dabigatran. Following the Final Appraisal Determination (FAD) on the use of dabigatran etexilate for the prevention of stroke or systemic embolism in people with atrial fibrillation, the Hywel Dda Health Board (HDHB) is still awaiting the NICE final decision. The MMG have tasked the HDHB Cardiologists, Haematologists and Care of the Elderly Physicians to produce an implementation plan for the managed entry of dabigatran on to the HDHB formulary. The position statement issued in October 2011 remains in place that until NICE issues its final Technology Appraisal, all prescribing (initiation and continuation) of dabigatran, and hence clinical responsibility, needs to be undertaken by and remain with hospital consultants. In addition, any requests by consultants to prescribe dabigatran will need to be considered by the Individual Patient Funding Request (IPFR) Panel. Dr Adrian Raybould chair of the Task & Finish group will provide an update at the next MMG meeting. Sarah Isaac advised that the Acute Coronary syndrome (ACS) guidance that was being developed by ABMU and HDHB was still ongoing and would be presented at the MMG once it had been completed. Delyth Simons queried consistency with policies and in particular the Controlled drug policy. Following a brief discussion, it was agreed to add this to the MMG agenda for agreement prior to going through the appropriate channels and being put on the Hywel Dda intranet site. SI to update MMG Re: Dabigatran at next meeting CD Policy to be presented at the MMG mtg once comparison is completed 5 Introduction of new drugs or dressings onto the formulary/update of formulary review. Any approved decisions are added to the formulary and scriptswitch. Chronic pain guidelines DEFERRED - MMG supported the findings of the Clinical Formulary Group, that changes were to be made to the original guidelines and that the amended guideline be ratified by the clinical formulary group prior to being reviewed by the MMG. Sildenafil / Viagra for the treatment of Raynaud s Phenomenon APPROVED Following discussion regarding patient numbers, financial implications and protocol, MMG agreed that this would be added to the formulary for restricted use by Rheumatology Consultants in line with the HDHB protocol for the treatment of Raynaud s phenomenon. This is an Off-label use and should only be prescribed in secondary care. To be ratified by Clinical Formulary Group following changes SI to inform Dr. Julie Barber, ABMU / all HDHB Rheumatologists of decision to approve for restricted use in secondary care Page 2 of 6

Electronic Formulary - MMG were informed by Sarah Isaac that the electronic formulary had been circulated to a wide range of clinicians throughout HDHB, and she was now awaiting comments back, which in turn would be fed back to the MMG at the next meeting. SI to collate comments and feedback at next MMG meeting. 6. (agenda item 6 actually followed item 8 at the meeting) Patient Group Directives/Guidelines PGD sub group update and minutes Chris Hayes updated the MMG on the PGD sub group minutes and PGD sub group workplan for January 2012. She noted that the initial Crisis Resolution team PGDs for development for use within the Mental Health Service were near completion. Jenny Pugh-Jones raised the issue of oxygen supply in outpatients and following a lengthy discussion which included issues such as risk, it was agreed that it would be beneficial to explore the approach of other Health Boards. It was therefore agreed that Chris Hayes would inform MMG of any further discussions or developments on the proposal for a National Oxygen PGD. MMG - Approved the request for the authorisation to develop PGDs for X-Ray IV Contrast Agent and X-Ray Oral Contrast Agent. CH to advise MMG of any further discussion or developments for a National Oxygen PGD CH to ask PGD group to check and agree the X-Ray PGDs 7. 8. 8a. NICE & AWMSG Guidance NICE Guidance Report A summary of actions and progress was provided by Sarah Isaac, who informed MMG that these would now be added to the Hywel Dda formulary and included on scriptswitch and the prescribing newsletter. AWMSG Report The NICE/AWMSG Co-ordination Group summary of actions and progress on the All Wales Medicines Strategy Group (AWMSG) Recommendations in January 2012 were perused by MMG within an excel document which contained Appraisal Recommendations and Medicines not endorsed for use within NHS Wales. Ministerial Ratification of AWMSG recommendations A summary of medicines that have had ministerial ratification of AWMSG recommendations in November & December 2011 were circulated and Sarah advised that they would be circulated and placed on the HDHB formulary within 3 months of publication. Page 3 of 6

8b. & 8c. 8d. Analysis of NSAID Prescribing in Hywel Dda / Analysis of PPI prescribing in Hywel Dda. Two reports by the Welsh Medicines partnership (WMP) which summarised comparative data for Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) and Proton Pump Inhibitor (PPI) prescribing in Wales and data specific to HDHB was perused and discussed by the MMG. It was agreed that it would be good practice to share these reports with GPs and all prescribers due to ongoing work in these areas within HDHB. Tapentadol prescribing guidelines A brief discussion was held by the MMG in relation to Tapentadol prolonged release (Palexia SR ) which was recommended by AWMSG as an option for restricted use, but only within the subpopulation as specified within its licensed indication. It was agreed that guidance produced by Dr. Harish Ravindra, Consultant Anaesthetist and pain specialist at HDHB would be presented to the Clinical Formulary Group. County Leads for P & MM to share reports with GP leads within their counties. Guidance document for Tapentadol to be presented to the Clinical Formulary Group 9. 10. 11. Medicines Management Strategy Update HD Prescribing Newsletter December 2011 Circulated for information. Recovery Plan Jenny Pugh-Jones provided a slide presentation on the recovery plan, and updated the MMG that at the recent stock take meeting the HDHB Chair had congratulated Carmarthenshire and in particular Gareth Lewis on their progress and achievements. Jenny Pugh Jones explained that good progress has been made in a number of areas such as rosuvastatin and ezetimibe. However there are key clinical areas where expenditure is increasing e.g. pain and respiratory. Further work is required to determine the factors influencing this increase such as activity or lack of appropriately funded pathways which support non therapeutic interventions. Stoma and dietetics prescribing were discussed, along with issues concerning resource to address both waste and motivation and awareness regarding incentive schemes within both primary and secondary care. Risk Register Moderate & High Risks Following a full review of the risks undertaken at a recent Prescribing Workstream meeting, Jenny Pugh-Jones informed the group that the risk register had now been thoroughly updated. The pathway for circulation was queried by the MMG Chair and it was agreed that this would now be circulated to County Leads, County Associate Medical Directors and the County Directors. JPJ to circulate RR to County Management Teams. Page 4 of 6

12. 13. 14. Prescribing Guidance Hywel Dda Health Board guidance for Accuracy checking Technicians (ACTs) This agenda item was deferred until the April 2012 MMG meeting. Hywel Dda Health Board Pharmacist Enabling Policy It was noted by Delyth Simons that this policy had been devised by Dave Morgan, Lead Clinical Pharmacist, Withybush General Hospital and was based on a similar policy used within Aneurin Bevan Health Board. It was agreed that on occasion a pharmacist required the freedom to act, and this policy was fairly straight forward, non controversial and was heavily evidence based. It was therefore agreed that following the amendments of the comments received, it would be re-presented at the April MMG meeting for ratification. Polypharmacy guidance for prescribing in frail adults. Jenny Pugh-Jones presented the MMG with draft Polypharmacy guidance for prescribing in frail adults which was based on a document received from NHS Highland, who had agreed to share it as good practice. She proposed that Hywel Dda adopt and use the guidance as it appeared to be sensible and pragmatic and added that feedback to date had been totally positive. MMG approved the guidance, and it was therefore agreed that it be circulated accordingly. Chris Hayes also proposed the guidance be presented to the Chronic Conditions Board and the MMG members agreed. DS to present at the next MMG meeting DS/DM to amend policy and represent at the April MMG mtg. JPJ to circulate Polypharmacy guidance. 15. 16. Minutes of Health Board Groups Local Intelligence Network (LIN) Minutes Circulated for information Thrombosis Committee minutes Support for the Thrombosis Committee was discussed and it was agreed that Natalie Vanderlinden would liaise further with Jenny Pugh-Jones on this matter. Natalie Vanderlinden to liaise with JPJ 17. Interface Medication report summary Sarah Isaac advised that the Electronic Formulary had been circulated and feedback was ongoing. 18. Drug Safety MERG update Despite the declining number of Medical representatives attending MERG meetings, MMG agreed that MERG was important and should reconvene as sharing learning from SI to ask Stuart Rees to reconvene MERG & produce a report for the Page 5 of 6

medication incidents which occur in Hywel Dda was deemed as imperative. The MMG therefore recommended that a summary of the medication incidents should be highlighted at the Hospital Audit meetings and County Quality and Safety meetings. Hospital Audit & County Q&S meetings 19. 19a, 19b & 19c Shared Care Shared Care Guidelines for Mental Health Acetylcholinesterase inhibitors Memantine Lithium Sarah Isaac updated the MMG that the shared care guidelines were developed with involvement from secondary care Mental Health clinicians, GPs and the Corporate Medicine Management team. She further advised that the LMC had approved the Lithium shared care guideline in principal, however negotiations were still ongoing. SI/jJPJ to speak to the HB Dementia group Re: GP Cog Any Other Business 20. Mr Sam Dentten thanked the MMG for the invitation to attend the meeting on behalf of the CHC, and advised that Dr. Elizabeth David would be representing the CHC at future meetings. Jenny Pugh-Jones requested that any agenda item papers for MMG were to be submitted to Sarah at least one week prior to the meeting. Dr. Liam Cassidy gave his apologies for the next MMG meeting, thus providing notice for Sarah to obtain alternate substitute GP representation. All - Any papers for MMG to be sent to Sarah at least one week prior to the meeting SI to invite substitute GP representative to next MMG Date and Time Of Next Meeting 21. Wednesday 18 th April 2012 1.30pm in the Boardroom, Glangwili Hospital, Carmarthen. Page 6 of 6