All Wales Chief Pharmacists Committee

Friday 25th November, 2016

WCPPE, Cardiff

1 / Welcome and Apologies / Present:
Judith Vincent (Chair)
Darrell Baker (Vice Chair)
Andrew Evans
Cheryl Way / Roger Williams
Jonathan Simms
Jenny Pugh-Jones
Kevin Smith
Karen Fitzgerald / Brian Hawkins
Suzanne Scott-Thomas
Karen Samuel
Berwyn Owen
Sharon James (minute taker) / Apologies:
Bethan Tranter
Louise Howard-Baker
Colin Powell
Sian Evans
In attendance / Daniel Jones– Business Psychology Hub (item 2)
Jane Fitzpatrick (Director of Lymphoedema Services Strategy for Wales), Karen Morgan (Lymphoedema Education and Research) and Gill Bailey (Category Manager for Procurement Services)(item 6)
2 / AWCP development / NeoNavitas proposals–Dan was welcomed to the meeting towhich he had been invited to present proposals for further training modules that the company (now called Business Psychology Hub) could offer the group. Dan reminded the group of the 3 previous modules, which had been piloted on this group, and offered a further series of 6 psychology-based training modules for 2017, which would be based around feeling energised, feeling resilient, feeling connected and feeling creative. Each module would cost £1500 and suit up to 12 attendees. It was felt that 6 full days might be too much so Dan was asked if there could be some negotiation around timings. He suggested that the group consider how much time it wants to invest and the company will try to work around this.
The discussion led to further suggestions to use outputs from staff surveys, action learning and needs analysis into future training plans. Although there was some interest, there was also some hesitancy in committing to the training at this time.
Dan also provided information on a series of 6 modules based on skills training that the company can offer, designed for emerging leaders. The modules include personal engagement, managing conflict, developing performance, leading to succeed and developing negotiation skills (and one other). The training is not accredited but DJ does have a database of collated feedback, which he could summarise and share. These modules would be ½ day sessions and could be offered initially as taster sessions (just charging for expenses). Costs for further sessions could then be negotiated.
DJ was thanked for attending the meeting. He was advised that the committee will need to have a conversationand then come back to him.
3 / To agree way forward for Chief Pharmacist and senior team development / During the development day on 24th November Pharmacy Management delivered a presentation on its Clinical Leadership in Pharmacy programme. The programme is a structured course that has been tested and is being evaluated. The price is a nominal commitment of £100 per person (with sponsorship support), which was felt to be acceptable. The committee discussed the pros and cons of engaging with this programme. Whilst it was felt that the application process was attractive and the opportunity for group bonding was evident, there were concerns of working with the industry, although the representatives had been keen to assure transparency and good governance. Assurance would be needed that the industry was not out to unduly influence theparticipants. Further assurances can be given through the updated AWMSG document “Partnership Working with Industry”. If satisfied it could be pushed through as an exemplar. The consensus of those present was that the committee is interested. JVi proposed to send an email to Pharmacy Management to express interest and request further discussion.
Before making any decisions the committee was asked to consider other development schemes:
  1. Further discussions with Dan Jones. Although today’s presentation did not convince the group, the psychology approach is worth pursuing, but with shorter sessions.
  2. RPS leadership –which is aimed at a lower level and would be useful to map.
  3. Academi Wales.
  4. Staff surveys/needs assessment.
Advised to bring someone from workforce development group into the discussion.
4 / Pharmacy Technical Services Strategy / Business case development –This was not discussed asBTr was unable to attend the meeting. However, BTr has provided an assurance that a written document will be circulated within 2 weeks.
5 / Chief Pharmaceutical Officer report / Pregabalin – on 13th October, the Court of Appeal gave the final decision that the patent is invalid in respect of pain generally (there are exceptions). AE has been in conversation with Pfizer. The previous guidance is to be updated but will need to be endorsed by the High Court. In the meantime care should be taken on how prescribed, though it is not expected that individual practices will be targeted by Pfizer. Currently, a large amount of money is invested in Lyrica, and the tariff price is not expected to change until the new guidance is released. A question was raisedconcerning branded generics and AE will discuss this with Mark Francis.
Health Education Wales – on 10th November the Cabinet Secretary announced a decision that a new body is to be developed and will be operational by April 2018; this will be similar to bodies in England (HEE) and Scotland (NES). The body will make commissioning decisions re health development training. WEDS and Deanery funding will move to HEW. No detail has been set out yet and the TOR is currently being looked at, so it is not yet known where AWCP will sit around the table. There is an expectation that the funding pot will become much more competitive, and there are concerns that the post-graduate diploma may not be so favourably supported. There are risks around removal of nurse bursaries, and also transference of boundaries between North Wales and England. AE advised AWCP to consider a clear and compelling strategy of what money is needed and why. Workforce planning needs to be a real focus and needs to be passed to the workforce subgroup. Also need to consider more engagement between that group and TESC.
New Treatment Fund – the cabinet secretary has committed to release a statement by 12th/13th December. AE shared restricted information on 3 objectives to be addressed. Funding has been limited to £16m per annum. It will relate to AWMSG & NICE medicines, more consistency and faster access. Allocation will be shared between sites, depending on a set of criteria still to be agreed. Medicines will be identified. The 90-day rule will remain, but it is to be clarified as it is being misinterpreted at the moment. Further information will be included in a circular expected to be released the beginning of the new year.
IPFR – the independent review panel has recently held stakeholder events around Wales. There has been a lot of engagement and widespread support of the review. It has addressed issues such as commissioning, inconsistencies across Wales and clarity around exceptionality. Some indications of findings are expected in January. Health Boards have discussed how they address concerns re access whilst working through local procedures. DB has agreed to pull findings together to address inconsistencies.
Community Pharmacy Contractual Funding– new package to be implemented in England 1st December. AE provided details of the main changes. The cabinet secretary has announced that cuts are not to be made in Wales this year or next year. Beyond that an agreed level of funding to be committed to Wales is to be determined. There is a commitment to a new way of doing things from 17/18 and £20m will be committed. A meeting is to be held on 5th January, which will include representatives from AWCP, Primary Care Directors, 1000 lives and NWIS, to discuss proposals on how to use the £20m. The plan is to have a clear framework by March 2017. JVi will be representing AWCP. AE asked the committee to reflect and feed thoughts into that meeting.
Allocation letters to community pharmacy – an allocation of £140m has been ring-fenced. Further details will follow later next year.
Everolimus– agreement with Novartis. Has now been approved for breast cancer, so terms will be changing. Will no longer be a rebate but might have discounts. Agreement likely to come to an end beginning of the New Year. Also expecting a new agreement with Novartis on tuberous sclerosis.
6 / Redesigning supply systems / Lymphoedema – JF & KM were welcomed to the meeting. JF summarised the report outlining proposals for service redesign, explaining the need to change the service in order to avoid delays in patients receiving their garments, and to ensure the service has the best possible products, at the best possible price, and with the best outcomes for the patient. They asked for AWCP agreement to the choice of Option C. If supported they will then put together a paper to be presented to Chief Executives. Questions were raised such as would contract prices change (would need to seek advice from procurement colleagues), would patient visits increase (the service is able to reach the community by holding clinics in the Tenovus mobile), also would each health board require a band 4 assistant (these are just ideas at this stage). They are keen to pilot in C&V and Powys. If the concept is approved, they would be able to model costs and activity, and gain evidence for a proper business case.
Option C was supported with a view to once completed, the business case will be shared with the committee.
Stoma products–GB was welcomed to the meeting. She provided some background to the paper outlining proposals for a redesign of the stoma service. A business case has been put forward; GB feels that it is not in the procurement remit to lead the project forward, but it would underpin the project. A project manager is being sought with NWIS also providing support. A pilot is planned to be carried out in Cwm Taf and Hywel Dda. The current contract is due to end September 2017 so would need to renew now. There is an issue in health boards that the top supplier in each HB is the sponsoring supplier, therefore it is difficult to get changes agreed by stoma nurses. Local conversations would be needed. It was suggested that Health Boards could approach this as an Invest to Save opportunity. JSi advised that Aneurin Bevan has piloted a change in its Catheter service and has been looking at taking it forward to consider all stoma options. SST informed the group that Cwm Taf‘s remodelling of the Catheter Service has generated savings and improved patient satisfaction.
Enteral feeding services – a briefing paper has been submitted to the cabinet secretary, suggesting continuing as present until the stoma products have been reviewed.
GB was thanked for attending the meeting and AWCP agreed to share any further outcomes with her. The committee then discussed where this would best sit, e.g. Logistics delivery group? Also should health boards contribute to the project manager role, using pay underspend? Would need to consider what does the stoma service feel and are there likely to be any barriers. It was decided to look at a bigger model – a hub – including Lymphoedema, catheter, stoma and possibly dietetics, and take to joint group with DoFs for discussion, suggesting approaching as an Invest to Save, using JSi’s paper and experiences.
7 / Items for discussion/ approval / i)Technician training/accreditation– CP was not at the meeting but proposed that the committee agreed to the recommendations in the reports, and any concerns should be picked up with localrepresentation on the T&F group. A concern was noted at the meeting referred to Recommendation 1 - removal of the 2-years qualified period and also the emphasis between primary and secondary care technicians.
ii)Robot replacement programme– the committee was reminded of the need to do a piece of work for WG on benefits realisation. DB has asked for a volunteer from each Health Board involved in 2016-17.
iii)On call services – a one-off review meeting was recently held (3 years post agreement). The meeting concentrated on three key areas and JPJ provided a brief summary. The meeting highlighted that not all health boards were complying to the original agreement and the following further actions were advised:
  1. Betsi and Velindre to look at payments
  2. ABMU to look at TOIL
  3. The original format for calculations should still be used.
It was agreed that the meeting had been useful as it indicated that health boards are not implementing the agreement in the same way. All health boards should be doing the same thing as this is an All Wales agreement.
8 / Notes of last meeting / The minutes from the last meeting were accepted as an accurate record, except for incorrect information relating the PH Falls campaign which will actually run in February not up until Christmas.
Matters arising:
  1. GPhC presentation to be forwarded to JPJ
  2. Choosing Wisely Wales – BH & Paul Flynn to meet with JV/DB
  3. Updated TOR to be brought to next meeting
  4. AWPPET role – JVi has discussed with SGr and a decision will be made in January.
  5. WAO report – final proposals not received to date.

9 / Executive report / i)Team Wales Event (5th December) –confirmed. AWCP has been given a market place spot to promote Define, Homecare & Biosimilars. AE agreed to send a group email setting out what needs to be done.
ii)Community Pharmacy Public Health campaigns–SE has confirmed that she is continuing to work with Tim Banner on the Falls Campaign, and is keen to be informed of any further ideas. AE has provided her with details of WG interests. AWCP to suggest that Tim Banner liaises with Community Pharmacist leads to propose further topic areas. SE will then review. It was reiterated that the campaign should focus on Health Improvement. SE had received some topics that are not HI focused and asked where should they go? SE to be advised to send them to TB to coordinate for discussion at a future meeting. DB to discuss with TB.
iii)Consultant Pharmacists Approval Panel–JVi is meeting with MS to discuss the AWCP strategy on Consultant Pharmacists. Further work is needed on the application and decision process and then this needs to be brought back to this committee for further discussion re detail around application and strategy.
iv)Wales Pharmacy Partnership – following difficulty in getting meetings in diaries, from Jan 2017 all meetings have been booked for the second Monday of every month. Chatham House rules are being maintained but the group has agreed that key messages may be shared. DB shared some of the key messages. The template for the vision for pharmacy in Wales is still deemed to be appropriate. The RPS education document has not been published but is available on the RPS website.
v)ETTF proposal – this has been completed and signed by C&V as host. DB thanked contributors. There has been massive interest in the fund. Colin Richman has agreed that free access to Define will continue until the end of December.
vi)RPS QA of Aseptic Prep Services: Standards 5th Ed–This is quite a substantial revision. A large number of responsibilities now sit with Chief Pharmacists. Concerns need to be fed back in to the author of the document, as it is not considered fit for purpose, though it does have good points. SST volunteered to feedback.
10 / Any other business / i)Clinical reference group for HEPMA project – the project group has agreed to the forming of reference groups, but the type of membership is uncertain. SST & BH’s emails to be forwarded to CWay.
ii)Resource mapping exercise– not completed during November due to other priorities. It was decided to resurrect this in the Spring and SST will start the process in March. There is no decision to change it at this stage, though it was suggested that the Carter report be referred to. SST will re-establish the steering group. (SST)
iii)Delivery of research strategy implementation group– it was requested that details be brought to next meeting (KSm).
iv)Invest to Save – PAS – JPJ has attended a preliminary meeting. To update at next meeting. (JPJ)
v)Error reporting T&F group– this was held at Cwm Taf earlier this week(SST). The group looked at the initial results of the survey. There were 129 respondents. AWCP agreed to pick up the following issues:
  1. An indication of low morale in secondary care
  2. Concerns re staffing numbers
vi)RPS Publication of Standards for reporting learning and sharing of errors – RPS is looking at presenting throughquality road shows (SST)
vii)ETTF - CWa informed of another ETTF bid for rolling out Choose Pharmacy (CWa)
viii)Consultation on changes of legislation – to be out before Christmas.(AE)
ix)As this as SJ’s last meeting as minute taker, she was thanked for her contribution to the meetings and wished well for the future. SJ thanked everyone for the gifts she was given at the meeting.
Dates of next meetings / 2017: 27th January; 24th March; 9th June; 28th July; 29th September; 24th November

Action Log from September meeting

Item / Action / By / Date
Choosing Wisely Wales / BH to meet with Paul Flynn / BHa / ASAP
For discussion / Updated ToR - to be brought to next meeting / JVi / 25/1/17

Action Long from November meeting