Minutes of the Cleveland Local Pharmaceutical Committee meeting held on 9th November 2011, Marton Pharmacy, Middlesbrough
Officers Present:
Michael Maguire, Chair
Kate McQuade, Vice Chair
Sanjay Nath, Treasurer
Members Present:
David Jarvis, Vaib Chhatwal, Ven Amerineni, Paul Pendergood, Chris Kendall,
Brent Foster, Geraint Morris, Mary Cronin,
Employed Officers present:
Brian Morgan, Secretary,
Greg Burke, Development Officer
PSNC Regional Representative:
Mark Burdonsubmitted his apologies.
Visitors
Philippa Walters, Community Pharmacy Lead – NHS Tees (morning session)
Lucy Wilson attended for her agenda item only
Pete Horrocks (Norchem)
Apologies received from:
Mark Burdon, Andy Wilson, Lorraine Crawford
18. Introduction
Attendees introduced themselves. MM welcomed the visitors and mentioned that we are hopeful that we will have more visitors in the future; in particular we are hoping that local MPs will attend LPC meetings. Action: GB
MM gave some background to the Healthy Living Pharmacy presentation to the Directors of Public Health on 4th October and informed members that MM and GB had attended a meeting of the Middlesbrough Health Scrutiny Panel on 12th October.
MM also mentioned the positive meeting with representatives of the other local representative committees on 29th September at Marton pharmacy.
18.1 Lucy Wilson, Locality Lead Prescribing Advisor, Redcar and Cleveland PCT.
LW explained that there are currently 5 CCGs in Cleveland, this will reduce to 4 in April 2012: Eston and Langbaurgh, Middlesbrough, Stockton and Hartlepool.
With effect from April 2012 CCGs will be shadowing PCTs, CCGs are already very interested in what is being spent on prescribing, a lot of emphasis now seems to be on cost, practices within each CCG area are monitoring each other as are CCGs.
CCGs have identified areas in which savings can be made on prescribing; these initiatives are now being evaluated to determine whether they have resulted in cost savings.
In total £1.2 million has to be saved across Tees.
LW reported that there is a Tees Medicines Committee, prescribing leads from each CCG attend that meeting and major decisions are made there. The leads report back to their own CCGs who hold their own prescribing meetings, each are different. LW felt that the LPC should engage with the CCGs about NMS via the individual prescribing meetings. Action: GB
LW also reported that these groups are picking up momentum and community pharmacy representation at them would be very useful.
LW stated that waste continues to be a big issue. In 2008 a waste audit was conducted in south Tees, it identified £1 million of waste; this would be approximately £2 million across the whole of Tees. The CCGs want to look at reducing medicines wastage; prescription intervals and synchronisation were identified as major factors contributing to the amount of waste medicines.
Particular emphasis was put on the issue of synchronisation. PW made the point that it may be a case of educating pharmacies about this issue in GP surgeries and vice versa that will help resolve the issue. Members made the point that when they try to talk directly to GPs about particular issues on many occasions they are not able to do so and have to talk instead to a member of the practice staff. LW recognised that this is an issue that definitely needs to be addressed. Action: LW.
LW and PW confirmed that each practice has a practice pharmacist; any issues that pharmacists would like to discuss with the practice can be discussed with those pharmacists. PW agreed to re send the list of practice pharmacists to GB. Action: PW
LW made the point that the future of practice pharmacists is uncertain, with this in mind GPs may look more and more to their local pharmacists for assistance with issues relating to medicines management.
Pete Horrocks mentioned that his pharmacy had received an invitation to attend medicines waste training; the invite had come from Pamela Willis. The training is during the day in early December and as such pharmacies will struggle to release staff to attend. PW and SR had noted the potential difficulties for pharmacies being offered the opportunity to attend training held during the working day. However on balance they had agreed that the opportunity to bring practice staff and care home staff together with pharmacies should not be missed for those who might be able to make suitable arrangements to attend. The PCT will monitor attendance, if it is low they will look at alternative ways of providing the service.
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There was a discussion about repeat ordering systems in community pharmacy; a sub group has been established as the system does not always work well. BM made the point that there are numerous reasons why pharmacy repeat ordering services do not always work as well as they could, LW recognised this and acknowledged that the fault is not always with the pharmacy.
BM pointed out that the New Medicine Service should begin to help with the problem of waste.
The committee thanked LW for her attendance.
18.2 PCT Update – PW
There was a discussion about Middlesbrough’s practice pharmacists involvement in promoting NMS to GPs, concern was expressed that practice pharmacists may be discussing NMS with the GPs instead of community pharmacies carrying out this role as had been agreed between the LPC and LMC. PW reported her full knowledge of the circumstances involving the particular pharmacy and practice pharmacist and it was clear that practice pharmacists may be talking to GPs about NMS but there was no PCT direction that this would replace the opportunity for community pharmacies discussions with practices directly. However pharmacies in densely populated urban areas would need to be mindful of the fact that many practices would be receiving such requests from several community pharmacies. It was noted that in some areas the pharmacies had worked together to provide information to the practice in a co ordinated fashion.
PW made a suggestion that community pharmacists may want to have another (or later) discussion with their local GPs in the January to March quarter, the service will have been running for a few months then and pharmacies and GPs may have a better idea of how the practicalities of the service can be organised in a way that best suits both parties.
KMcQ made the point that the NMS can be used to build good relations with the practice pharmacists.
An agreed action point was for an article to be placed in the newsletter advising community pharmacists to make contact with their practice pharmacists to discuss NMS and how the service can operate most effectively. Action: GB
Members had received a copy of PW’s paper on the decommissioning of the community pharmacy bulk dressing scheme in Hartlepool. The paper provided background to how the scheme was established and the reasons behind the move to decommission it.
PW stated that the service would be decommissioned in parallel with the development of a new dressings formulary in Hartlepool. The Acute Trust, now being the employing Trust of the community nursing teams, are aware of, and are supporting, the discontinuation of the existing scheme.
It is proposed that the scheme will end on 31st December 2011.
PW asked members whether there were any issues that the Trusts might be missing in seeking to decommission. PH stated that there is no broken bulk for dressings.
BM highlighted one potential problem i.e. if the formulary introduced on 1st January 2012 is radically different to the existing formulary then pharmacies will not hold the new stock unless they are given prior warning. PW suggested that the LPC should have input at this stage to the development of the dressings schemes in Hartlepool and Redcar and Cleveland. Alda Hummerlink is the contact in the pharmacy team at North Tees and Hartlepool Acute Trust. Action: GB to contact Alda Hummerlink.
MM agreed to report the content of this discussion to the Medicines Management Committee meeting on 10th November 2011. Action: MM
PW provided a brief update on the dressings scheme in Redcar and Cleveland.It is being extended into Redcar and is being done alongside the dressings formulary that PW had brought previously to the LPC. The scheme will continue until March 2012 when it hill be handed to the Acute Trust who will then make a decision on whether to continue with it. Hira Singh is currently leading formulary development in Redcar and Cleveland and Paul Brown will ultimately be the contact for this scheme. Action: LPC to contact Paul Brown to suggest LPC involvement in the evaluation of the scheme.
PW reported that the PNA implementation group will meet shortly, the aim is to conclude business in one all day meeting. Action: PW
Timescales for refreshing the PNAs are also to be looked at. Action: PW
PW reported that there is a move to reintroduce a more formal process for a smoking service voucher scheme. The smoking cessation SLA is being refreshed and PW hopes to bring a draft to the LPC in January for discussion. Action: PW
PW confirmed that all enhanced services are being handed back to the PCT’s medicines management team to manage;PW and SR will be the points of contact for these services.
In relation to the On Demand availability of Specialist Drugs Enhanced Service PW reported that 24 pharmacies have signed up for it, finance has been notified and payments to these pharmacies should have been made. If contractors don’t receive payment they should contact Sonia Rafferty. PW/SR will arrange for a remittance advice slip to be sent to pharmacies when payment is made. Action: PW
PW/SR are also talking to the PCT communications team about publicising the scheme.
SR had forwarded to the LPC a draft electronic claim form for the needle exchange service which she would like to pilot in some participating pharmacies. It can be completed and submitted securely via NHS mail, pharmacies that do not have NHS mail will have to continue to submit claims by post. The LPC agreed that this pilot could proceed and would not constitute a change requiring contract variation to the needle exchange service.
PW reported that herself and Sonia are trying to develop generic NHS mail accounts for each pharmacy. They could be used to cascade drug alerts for example. Currently these are cascaded by public health, if community pharmacies have any issues with the drug alerts e.g. length of them, timing of their circulation they should take them up with public health, SR/PW could facilitate.
It was agreed that an additional sentence should be added to the clinical governance section of the newsletter i.e. “community pharmacies must receive drug alerts and act accordingly in relation to the content of those alerts.” Action: GB
There was a discussion about Andy Wilson’s query in relation to training for supervised consumption i.e. can the PCT facilitate this training for those pharmacies who are not currently doing it but wish to do so? PW reported that it would not be sensible for the PCT to deliver training for this service at this stage as the SLA is out of date and is being reviewed. It is also likely that the provider for the service will change in the next few months. BM stated that there is genuine frustration amongst contractors who want to provide this service but can’t do so. PW did report that certain pharmacies who have pharmacies previously accredited at another pharmacy will in certain circumstances be able to offer the service via an interim SLA to March 2012. PW will try to put on a training event (evening) in early December.
18.3 Healthy Living Pharmacies (HLPs)
MM provided members with an update on progress made so far with HLPs i.e. presentation to Directors of Public Health on 4th October and estimated costings submitted to Edward Kunonga. The PCT has indicated that it is keen to have HLPs in Tees and plan to pilot them initially in Middlesbrough. PW confirmed that there are positive noises within the PCT about HLPs.
PW emphasised the importance of having a community pharmacist or somebody with excellent knowledge of community pharmacy in the role of project manager.
PW congratulated the LPC on the work it has done so far on HLPs.
18.4 Health Promotion Campaigns.
The content of the report was noted.
18.5 LPC Newsletter
Members noted the content of the draft newsletter. They also suggested some additional articles:
- changes to the tMUR requirements i.e. submission of quarterly reports
- Specials: there is a lot of information on the PSNC website that needs to be condensed for the newsletter. Also, for the time being certificates of conformity should be sent to Riverside House.
- changes to the emergency supply regulations
- revised endorsement requirements
- article about direction of prescriptions – driving force for dispensing should be patient choice. If patients are unhappy and feel that their choice has been compromised and they indicate that they want to complain pharmacist should provide them with the contact details for PALs.
- process for destruction of controlled drugs – pharmacies to contact the accountable officer’s representative (Sue Weatherhead). James Gossow is the accountable officer for Tees except in Redcar and Cleveland where Peter Kelly has that role.
- pharmacists to contact their local practice pharmacists to discuss NMS
Action: GB
18.6 CPPE Update
LC had given her apologies.
18.7 Minutes of the open section of the September meeting
The minutes were accepted as a true and accurate reflection of the meeting. In minute 16.2, in addition to the information already included PW suggested including the names of relevant contact details at the acute trusts Tees i.e. Alda Hummelink in the north and in the south the replacement for Alan Hall and Paul Brown. Action: GB
18.8. Matters arising from the open section of the September meeting.
The content of the report was noted. SN agreed to contact NPA about the requirement to obtain written patient consent prior to an EOHC consultation. Action: SN
18.9 Any other Business
PW informed the meeting that Richard Morris was leaving the PCT to join Tees, Esk and Wear Valley NHS Trust with effect from 1 December 2012.
There was a discussion about directed prescriptions, this resulted from a telephone call BM received from a pharmacist in Billingham concerned about reports he had received from patients suggesting that they had been “directed” to a pharmacy to have their prescription dispensed. PW reported that the community pharmacy team had also been made aware of this and had advised the pharmacist to log all similar reports from patients.
It was agreed that the LPC should write to the LMC reminding them about the inappropriateness of direction of prescriptions. Action: BM
Pete Horrocks informed the meeting that he had been made aware of patients who have attended the out of hours service, been issued with a prescription and had been directed to Billingham to have them dispensed. PW stated that the PCT also needs to be made aware formally of incidents of this happening.
KMcQ queried the process for requesting the destruction of controlled drugs. PW confirmed that pharmacists can make requests for this service at any time. Some large organisations have an in house process but if pharmacies need the PCT to so this they should request a visit by contacting the accountable officers’ appointed representative, Sue Weatherhead or Louise Dunn.Action: GB to include an article in the newsletter.
PW left at this point. The open section of the meeting concluded.
Carl Arnott from Lilly Diabetes gave a presentation.
19. PCLs 090/11 Market Entry by means of PNAs
The content of the report was noted. It was agreed that BM will lead on a small LPC working group which will compile a LPC response on the consultation to be submitted before 27th January. The LPC response will be based on the PSNC submission.
BM, GM, VA, PP will form the sub group, it will meet in early January (NB: GM will not be available in the first week in January). Action: BM
19.1 Healthy Living Pharmacies (HLPs)
Members had received a copy of the draft costings report submitted to Edward Kunonga on 4th November. GB explained that it had to be submitted to the PCT before the LPC meeting as bids for funding for the 2012/13 financial year had to be submitted by 14th November.
MM went through the report and explained how the sub group of GB, MM and LC had arrived at the figures quoted.
MM mentioned the possibility of industry sponsorship for the Excellence in Practice meetings and also its possible involvement in the role of project manager. BM stated that when selling this approach to the PCT the LPC would have to emphasise the cost savings generated for the NHS and that the national drive is for the involvement of industry where it benefits patients.
There was a discussion about the potential cost of PR/communications; BM suggested that the LPC should approach Sue Weatherhead to ask her how much it cost to advertise on TFM for the consultation element of the PNAs. Action: GB.