Meeting of the Area Prescribing Group (APG)
Held on 7th October 2011
Board Room 2, Anglesey House, Rugeley
Hosted by: Mark Seaton (MS),
Head of Medicines Management for the Commissioning Support Service
17/5/11 / 19/8/11 / 7/1011 / 2/12/11 / 3/2/12Mark Seaton (MS) Chair / Head of Medicines Management- Staffordshire CSS / ü / ü / ü / ü
Susan Bamford (SB) / East Staffs CCG Pharmaceutical Adviser / ü / A / ü / ü
Samantha Buckingham (SJB) / Stafford & Surrounds CCG Pharmaceutical Adviser / ü / ü / A / A
Tania Carruthers (TC) / Chief Pharmacist Heart of England NHS Trust / A / A / ü / A
Peter Cooke (PC) / Chief Pharmacist Mid Staffs NHS Trust / ü / ü / ü / ü
Chris Curtis (CC) / Chief Pharmacist Burton Hospitals NHS Trust / A / ü / ü / ü
Richard Dean (RD) / South Staffs LPC / ü / A / ü / ü
Dr Tim Dukes (DrTD) / GP Gravel Hill Surgery / X / X / X / X
Dr Adel El-Alfy (DrAE) / GP John Amery / ü / X / X / A
Amanda Evans (AE) / Head of Medicines Management- Community Services Staffordshire and Stoke on Trent Partnership (SSOTP) / ü / A / ü / ü
Ruth Goldstein (RG) / Service Development Manager for Community Pharmacy- SS LPC / ü / ü / A / ü
Jacqui Harrison (JH) / - CC CCG rep. / ü / ü / ü / X
Dr John Hearn (DrJH) / S&S CCG GO rep / X / X / A / X
Dr Anna Onabolu (DrAO) / CC CCG GP rep. / A / ü / ü / ü
Dr Clare Pilkington (DrCP) / SES CCG GP Rep / ü / A / A / X
Cathy Riley (CR) / Chief Pharmacist- South Staffordshire & Shropshire Healthcare FT / ü / A / A / A
Genine Riley (GR) / Senior Pharmaceutical Adviser SES CCG / ü / ü / A / ü
Dr Mark Stone (DrMS) / S&S CCG GP rep / A / ü / ü / A
Dr John Cleary (DrJC) / ES CCG GP rep. / ü / A / ü / ü
Dr Judith Crosse (DrJCr) / ES CCG GP pre / ü / A / A / X
Sharuna Reddy (SR) / Pharmaceutical Adviser- CC CCG / ü / ü / ü / A
Teresa Froggatt / Nursing Home Pharmacist – SSOTP / ü
Mr. Ted Lowe (TL) In Attendance / Consultant Cardiologist Mid-Staffs NHS Trust / ü
Lesley Arnold (LA) / Medicines Management Support Officer- Staffordshire CSS / ü / ü / A / ü
Key: ü = Attended
A = Apologies X = Not Attended
South Staffordshire Area Prescribing Group
Friday 2nd December, 12.00pm
Board Room 2, Anglesey House, Rugeley
Minutes:
1. / Welcome and ApologiesApologies noted as above
2. / Minutes from previous meeting (19th August 2011)
Minutes approved subject to following amendments:-
Date of last meeting recorded incorrectly in header and date of previous meeting had not been updated.
3. / Matters arising/ actions not covered by Agenda
Mercaptopurine & Azathioprine ESCAs for Inflammatory Bowel Disease- SB had spoken to Amanda Alamanos regarding the revision of the LES and is going to have a meeting with DrJC and DrJCr as this needs reviewing before April 2012 and then again in 2013.
Promixin – GR advised that she is still waiting to hear from Birmingham Children’s Hospital and Birmingham Cluster. Will update at the next meeting.
APG Managerial Framework
AE announced that she has now set up a Medicines Management Working Group.
Antimicrobial Guidelines 2011
These are now printed and are in the process of being sent out to GP Practices and Community Pharmacies. AE asked if SSOTP could have some copies.
4.1
4.2
4.3
5.1
5.2
5.3
5.4 / Dabigatran and Ticagrelor
Dabigatran – This drug has potential compliance issues and would discourage GPs from prescribing until it gets NICE approval. GR tabled algorrhythm which showed Dabigatran v Warfarin. Dabigatran has no reversal like Warfarin. Mr. Ted Lowe produced a business case for using Dabigatran stating it would be used for patients on Warfarin who had not had a stroke, patients who have prostrate problems. MS queried the feasibility of clinicians being able to determine the time in therapeutic range (TTR) In Stafford hospital the Sister telephones the patients each week to obtain their INR. Stafford hospital use a piece of software called D.A.W.N. to record results and take any necessary action. It was agreed that identifying patients with a TTR below 50% was feasible across all acute providers.
MS said that we are not in a position to approve the proposal at this stage due to the funding needed. NICE appear to be moving towards making Dabigatran an option, it will be for the network, commissioners and providers to reach a consensus as to when the option should be used. Once the NICE guidelines were out would discuss again at APG.
TL raised a number if individual patients that he felt might be appropriate for this treatment- MS advised that they be dealt with outside the meeting.
Action: Mr. Ted Lowe to raise individual cases with locality advisers.
Ticagrelor – This drug has got NICE approval and GR is attending a meeting with Cardiologists next week to discuss. CC had not had any requests at Burton Hospital Trust. Agreed to be Cardiology prescribed only.
Ranolazine –. CC said that Cardiologists at Glenfields Hospital were using. The application was discussed as was the advice relating to this drug incorporated in the NICE clinical guideline.
APG supported the use of ranolozine who cannot tolerate or are contraindicated to Calcium channel blockers and beta blockers and for whom long acting nitrates and nicorandil are either ineffective or not tolerated.
Retigabine – Agreed to inclusion onto the South Staffordshire Joint formulary. Agreed to support use in accordance with the NICE Tag.
Buccolam – Is a brand of midozolam formulated for buccal administration to control seizures. It is therefore expected to largely replace the use of unlicensed midozolam products which have recently been included in the “specials tariff”.. GPs to be encouraged to prescribe by Brand name. AE said that this is used a lot in the Prisons. MS pointed out that it is licensed for patients 18 years and under. GPs to be requested to meet with patients on 1:1 basis before prescribing. , due to the new product being a different strength and patients being advised to use the correct volume.
DrJC raised concern as to whether GPs would be happy with the workload issue of seeing all patients, but this was not felt to be a major problem.
Action: APG support this proposal. DrJC to check with other GPs in the East CCG. DrAO to speak to SR about circulating something to GPs in the CCCCG. SB agreed to circulate something to GPs in the East CCG.
NICE Tags
Mifamurtide for the treatment of osteosarcoma – This drug has been approved by NICE. This is a relatively rare condition and it is estimated that the cost of implementation will be £114K pa. MS proposed that this needs to be on prior approval only. CC, PC and TC agreed.
Action: MS to contact all Contract Managers
MTRAC Exenatide (once weekly) – NICE are due to consider this in February 2012. AE confirmed that Specialist nurses are using this. DrAO agreed to discuss at the next CCCCG Medicines Management Forum. TC had had a request at HoE but there were restrictions. PC and CC were not aware of any use of this.
Concern was expressed that specialist nurse teams in SSOTP did not appear to operate under the same “rules” as Acute Trust consultants, with regarding using treatments that hadn’t been agreed with commissioners. MS pointed out that the contractual elements for each provider were the same.
Action: MS to address through new medicines forum. MS to also do a letter on behalf of the APG committee to send to SSOTP on behalf of commissioning CCGs.
MHRA Drug & Safety Update
Dronedarone – Increased safety concerns noted, which is reflected in falling use. Shared Care Policy needed. HoE has one and TC will forward to LA.
5.5 / Burton Drug & Therapeutics Committee Minutes 14.11.11 – SB still concerned about the prescribing of Diclofenac and SB and CC have emailed all Consultants and will feedback with any responses.
5.6 / Derbyshire Joint APC Minutes 11.10.11 – received by APG- no issues were raised.
6.1 / NPSA Loading Doses – raised the actions required in the NPSA alert, and need to know what commissioners expected with regards action no. 4. “Healthcare professionals in the community know when to challenge abnormal doses of the identified critical medicines.” Various drugs requiring loading doses were discussed, and it was agreed that all loading doses would be prescribed by Acute Trust, thereby GPs would only be required to prescribe maintenance doses. Acute Trust representatives did not report any problem in delivering this.
6.2 / Hypertension clinical Guidelines – SB presented a paper relating to the new Nice guideline, which advocated the use of 24 hour ambulatory BP monitoring. Many practices do not have access to this equipment and as a result were referring to Queens Hospital. SB suggested that all CCGs get together to purchase the ambulatory equipment needed and may be able to get cheaper if bought in bulk. The APG felt that routinely referring patients to an acute Trust for ambulatory BP monitoring would be inappropriate. MS pointed out that as a clinical guideline the guidance was not mandatory, but might reasonably be expected to be incorporated into services over time.
Action: SB to look into this for ES
6.3 / Using “trial size” dermatology products to cut down on waste in South Staffordshire – AE reported that the former Burntwood and Lichfield locality were trialling a situation whereby they had identified a lot of waste in Dermatology. The Specialist Nurses had found that they could obtain samples of GSL formulary cream or emollient products to trial so patients can decide from the samples which product they would prefer before a larger quantity is prescribed. RD asked AE to check with the ABPI (Association of British Pharmaceutical Industry) and then to go with their response, as it wasn’t clear as to whether samples would continue to be available. The APG approved the use of trial samples if they continue to be available, subject to providers only issuing formulary products..
ACTION- AE to confirm position with ABPI
6.4 / Monitoring South Staffordshire Prescribing for PPD Changing Errors – MS explained that the Medicines Management Team are looking at Identifying Charging Errors by looking at some many practices a month by generating a Prescriber-Dispenser report in epact.net. Practices will be unaware that this is going on.
Action: This was approved by the APG. RD asked for an electronic copy of this document. / LA
6.5 / Any Other Business:
Minutes – SB asked if the minutes could be sent out a little sooner. / LA
7. / Date of Next Meeting: Friday 3rd February 2012 12pm – 2.30pm
In Boardroom 2, Anglesey House, Wheelhouse Road, Rugeley
Please note that Lunch is no longer provided; please feel free to bring your own.
5
For Agenda Items contact Lesley Arnold, Medicines Management Support Officer, SSPCT
Tel 01889 571741
Fax 01889 571795