Minutes of the Meeting of the WPCT Clinical Effectiveness Group
held on 3rd June 2009 at 3-5pm in room 3in WBH
Present: / Nick Beavon – Chief Pharmacist, ChairDavid Finch – Joint Medical Director
Ross Anderson, St George’sMedicalSchool
Dr Rachel Hazeldene – VTS SHO
Donald Roy – Lay member
Alisi Mekatoa – Clinical Effectiveness Facilitator – Joining Aug 09
Crystal Stewart, Exceptional Circumstances Administrator
Joshua Bull, Service Improvement Management WPCT
Judith Nelson, Community DSN
Liz Frost – SMPCT Optometric Advisor
Linda Troy – Chair, Sutton, Merton, Wandsworth Local Optometric Committee
Satvinder Bansal – Wandsworth Rep, Local Optometric Committee
ACTION
09/01 /Welcome and Apologies for Absence
The group welcomed AM to the group in August when she comes to work in the department. Also welcomed LT, JN and LF who are attending to present item 5.Mick Sanders – Clinical Effectiveness Facilitator
Dr Stephen Farrow - Public Health Consultant
Norman Evans – Public Health Pharmacist
Amanda Cranston - Consultant in Public Health
Ken Abhayaratna – Non acute Commissioning Manager
David Selwyn, Lay member
Chris Gilleard St Georges MHT
Fiona Hicks, Clinical Governance Manager WPCT
Dr Josephine Ruwende- Consultant in Public Health Medicine
09/02 /
Minutes of the Previous Meeting and Matters arising
The minutes of the meeting held on 5th
February 2009 were agreed as a correct record.DR informed the group that he had contacted Ted Poulter concerning the mapping and audit of services of the Mental Health wellbeing in Older People.
NB had spoken to AC concerning the Baseline Assessment being done by the Mental Health Trust, we have not received any feedback. NB to check with JR spoke to Chris Gilleard from the MHT. / NB
09/03 /
Revised Terms of Reference and Membership
The group discussed the revised ToR and decided that it cannot be approved at this meeting. It was suggested that there is 4 medically qualified members required, only 1 need to attend each meeting. To be brought back to the next meeting for discussion when JR. ToR required from Trudi Kemp, St. George’s hospital; Chris Gilleard, Mental Health Trust Springfield Hospital and to check with JR quoracy, re. medically qualified person attendance at meetings.
09/04 /Latest NICE Guidance
TA170 Venous thromboembolism – rivaroxaban. NB informed the group that this is a very new drug used for knee replacement operations, not sure whether St George’s has approved the drug yet. NB to check.Also to check if the sector has approved.GPs may be reluctant to prescribe this drug, or many may not have heard about it yet. Implications are very significant, less side effects than warfain.CG84 Guidance on Diarrhoea and vomiting in children under 5 – To check whether GPs and WIC are adhering to these guidelines.
IPG296, IPG297, IPC298 are all guidelines for the procedures which are effected in secondary care. / NB
09/05 / Baseline Assessments – glaucoma Linda Troy
LT relayed to the group thatNICE has lowered the threshold for diagnosis of Occular Hypertension, not only will referrals increase but the number of patients who require ongoing management will also increase. These additional patients will have huge implications in terms of capacity within hospital eye
departments. The proposed pilot is for a low level of intraocular pressure and visual fields. If IOP is above the NICE threshold for ocular hypertension at routine sight test, the optometrist will use the gold standard Goldmann tonometry, and repeatif necessary. This will reduce the number of false positive referrals. The use of Goldmann tonometry is not a requirement of a General Ophthalmic Services sight test, although it is a core competency of optometrists. Similarly, if a suspicious visual field is detected at sight test, the visual field test
is repeated on a separate occasion.
The Royal College of Ophthalmologists estimates that 60% of glaucoma referrals are discharged following investigation. With the lowering of the IOP threshold, this figure is likely to increase.
It is thought likely that 35% of patients who have Goldmann tonometry will have IOP ≤ 21mmhg and will be discharged, and that a further 15% will be discharged following the second IOP reading.
For those who need repeat fields, we have assumed 60% will be referred to Hospital Eye Services.
Patients, who are diagnosed by secondary care or specialist
practitioner as having OHT which does not require treatment, will be referred for monitoring in the community at intervals specified by NICE. If there is no change in clinical status next appointment is booked as per NICE recommendations and if there is a change in clinical status patient will be referred back to specialist.
The only real set up cost to consider is that of the Goldmann tonometers, but the costs of these will be quickly recouped in the referral refinement pathways.
There will be the opportunity for full diagnostic clinics in the
community as optometrists become accredited to carry out techniques beyond core competencies such as gonioscopy.
09/06 / Off-label Prescribing of miconazole oral gel and fluconazole - Nick Beavon
NB presented this item. JR had collated the information NB presented previously. The group supported the guidelines for miconazole, however the use of fluconazole is restricted to babies over 4 months old, would need to look to capsticks for legal advice. The breast feeding Network have not produced a policy on the use of miconazole. DF stated that if the indemnity has been picked up by the PCT it could come to this group as long as the prescribing nurse has adhered to the policy/guidelines. Recommendations will need to be provided for independent prescribers as community pharmacists may refuse to provide Miconazole ‘off label’. Provider will be encouraged to seek advise from capsticks.
09/07 / Shared care protocols Mitta Bathia, Nick Beavon
Leflunomide –DR highlighted that this drug requires contraception drug given to both men and women, and has been placed on the SWL list for shared care, and the SWL Prescribing Committee agreed at the last Perscribing Committee that Leflunomide should go onto the shared care list. It has been prescribed by 25 GPs. Has been sent to Charlotte Levitt – practicing GP in Wandsworth and will be discussed at the next monthly review. The guidelines need to be altered – not to be given to males if considering fathering childern and not to be given to women if considering pregnancy within 3 months of stop taking the drug. Group will agree guidelines subject to these amendments.
09/08 / Tonsillectomy audit Katie Hunter/Mick Sanders
KH presented the audit completed for WPCT patients who are treated in St George’s hospital. Difficulties found when completing the audit that information was not complete for quarter 2 – quarter 3, April – October 2008, therefore it was difficult to read data effectively. KH suggested when collecting data a tick box questionnaire be set up. KH to double check what the dominator figure and run by JR. / KH
09/09 / Approved Research Projects – for information
Not discussed
09/10 /
Proposed dates for 2009
Date / Time / RoomFebruary 5th / 3-5pm / 1
April 1 / 3-5pm / 3
June 3 / 3-5pm / 3
August 5 / 3-5pm / 1
October 1 / 3-5pm / 1
December 2 / 3-5pm / 3
February 4th 2010 / 3-5pm / 1
09/11 /
Any Other Urgent Business
JN informed the group that the guidelines are to be used for diabetic patients presenting in both primary and secondary care. There has been a rise in patients presenting with Type 2 diabetes in secondary care, now these patients are going to be discharge into primary care. JN wished to ask the group to look through the guidelines to see if they meet the right criteria. The guidelines are a working document and will need updating regularly. NB suggested that documents like these need to be kept in a place where they are easily accessible. The Wandsworth Diabetes Implementation Group (WIG) have their own website, the document may be better placed there as well as the PCT website. NB suggested to bring back to the next meeting for approval. JN to send draft to DF
Approved as a correct record:
Signed:……………………………………………..
Chairman
Date:……………………………………………..
O:\Corporate\Public Health\Public Health Group\_NEW SYSTEM\CLINICAL EFFECTIVENESS\CLINICAL EFFECTIVENESS GROUP\Minutes\Draft minutes\2009\WPCT CEG Minutes 030609.doc
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