/ Gateshead Medicines Management Committee
10th April2013 0900-1200
Room 4, Education Centre
QEH
Attendees: / Consultant Anaesthetist, Gateshead Health NHS Foundation Trust (Chair)
Consultant Microbiologist, Gateshead Health NHS Foundation Trust
GP (Primary care prescriber)
Chief Pharmacist, Gateshead Health NHS Foundation Trust
Senior Pharmacist NECS
Medicines Governance Pharmacist, Gateshead Health NHS Foundation Trust (Secretary)
Community Pharmacist
Prescribing Representative, Gateshead Community Services
Regional Drug & Therapeutics Centre (Newcastle) Advisor
Primary Care Medicines Management Provider
Pharmacist NECS (Observer)
Apologies: (item 1) / Prescribing Lead, Gateshead Clinical Commissioning Group (Vice-Chair)
Item 2 / Declaration of Conflict of Interest With Any Agenda Items
Discussion:
No-one present had any interest to declare with today’s agenda items.
Item3 / Notes of meeting on 13th February 2013 & Decision Summary / Enc 1+2
Discussion:
Minutes & Decision Summary agreed as a true record.
Item4 / Ongoing Action Points / Enc 3
Discussion:
Circulated for information.
Palliative Care prescribing – agreed to remove as consultants in the process of being issued with a hospital FP10HP pad.
SC Methotrexate – agreed to remove as a business care and ask consultant to resubmit when patients are self-injecting.
Item 5 / Matters Arising / Enc 3b-3c
Discussion:
a)Gluten Free Product Supply–final policy circulated for discussion. GMMC agreed not to progress this workstream further as proposals around changing the supply arrangements for these products are not cost neutral.
b)Pramipexole MR New Drug Request – Dr Athey does not wish to progress the application any further at this stage.
c)Shared Care Prescribing Policy in SoTW – sub-group has meet to take forward implementation of this policy at the suggestion of the Joint Clinical Forum. The policy will be rolled out from 1st July 2013. Further work is to be done around rheumatology pathways as this is where the new policy will have the largest impact. NECS are leading on the development of new shared care protocols where one does not currently exist and are putting together a timetable for this. Until each shared care drug has an appropriate protocol in place a generic Appendix 2 form from the policy can be used a interim measure to facilitate the transfer of prescribing of shared care drug from secondary to primary care.
d)Needles for Insulin Pens – No further progress to report.njuries which may have cost implications, as such will need a formal request to GMMC bef
e)GMMC Revised New Drug Approval Process – Policy has now been ratified by Gateshead CCG but still awaiting final clarification about financial sign-off arrangements.
f)Buccolam Switch – no further progress to report.
g)Adrenaline Autoinjector contract – Both GHNFT and Gateshead CCG are going head with switch to Jext® device as planned as of 1st April 2013.
h)Jelonet Dressing New Drug Request – No further correspondence has been received from Mr Patterson, therefore request for Jelonet denied and he should use Atrauman dressings instead.
Item 6 / New Drug Requestsfor April 2013Meeting / Enc 4-6
Discussion:
Ranolazine
Requested by Dr Kearney
Requested for use in stable angina as a 2nd choice adjunctive therapy where symptoms are not adequately controlled with 1st line therapy (usually beta-blocker or other heart rate limiting agent).
Evidence presented as per application form.
Reviews:
  • NICE – included in NICE Clinical Guideline on angina
  • SMC – not recommended Nov 2012
  • AWMSG – approved Feb 2011
  • RDTC – not considered
  • LNDG – not considered
  • MTRAC – approved
  • NoT APC – approved.
Cetrorelix
Requested by Mr Aird for use in IVF.
Evidence presented as per application form. Noted already using on a non-formulary basis.
Linaclotide
Requested by Mr Mercer-Jones for treatment of moderate to severe Irritable Bowel Syndrome with Constipation in adults.
Evidence presented as per application form.
Reviews:
  • NICE – not considered
  • SMC – not considered
  • AWMSG – not consider
  • RDTC – not considered
  • LNDG – not considered
  • MTRAC – not considered
  • NETAG – not considered
  • NoT APC – not considered
Noted evidence against existing therapies is limited, all trial data to date is only against placebo. Also there no national reviews of the product available yet. Questions were also raised about its place in the current pathway of care for these patients compared to existing treatments.
Conclusion:
  • Ranolazine – approved as Green + drug as per licensed indication for 3rd line use.
  • Cetrorelix – approved as red drug for use in IVF only.
  • Linaclotide – decision deferred until further reviews of drug from nationally recognised NHS bodies available, and further information about place in therapy received.

Item 7 / New Drug Requests for June 2013
Discussion:
  • None received to date

Item 8 / Gateshead CCG Antimicrobial Update
Discussion:
Nothing to report.
Item 9 / NICE Guidance and Formulary Status of NICE Technology Appraised Drugs
Discussion:
Noted that both Gateshead CCG and GHFNT now have publically accessible websites containing the formulary and associated information about the GMMC available.
It was agreed to updates for formulary chapters would be added as an agenda item of the GMMC each meeting for approval/information as deemed appropriate.
Item 10 / Review of Current GMMC Terms of Reference / Enc 7a
Discussion:
Circulated for comment.
Terms of reference have been updated to included independent appeals panel to assess validity of appeals against GMMC formulary decisions, and suggested that this panel should consist of GHFNT Medical Director and an Executive Gateshead CGG representative.
Conclusion:
Updated Terms of Reference approved
Item 11 / GMMC Annual Report 2012/13 / Enc 7b
Discussion:
Circulated for comment.
Conclusion:
Annual Report approved and also agreed that sub-group to suggest further prescribing guidelines that need to be produced within Gateshead.
Item 12 / Combodart Complaint / Enc
Discussion:
The committee discussed acomplaint as been received from urology about confusion regarding the formulary status of Combodart® in Gateshead.
Noted that Newcastle Urology consultants are developing a guideline which will include a section on the appropriate use of Combodart®. This will largely replace the existing NHS South of Tyne Guideline in Gateshead which is now considered not fit for purpose within Gateshead.
Conclusion:
Agreed that if Urology wish to prescribe Combodart® in Gateshead then they should submit a New drug Request for consideration.
Item 13 / Community Services Guidelines & Formularies / Enc 8
Discussion:
As agreed previously decisions regarding community services guidelines & formularies are to be discussed and agreed at South Tyneside MMC unless there were issues of particular concern in a locality.
Noted that work is underway to roll-out a Dressing request form for District Nurses from 1st June 2013.
Conclusion:
Implementation of Dressing Request Form for District Nurses supported by GMMC.
Item 14 / Topical Loperamide in Palliative Care / Enc 20-23
Discussion:
There has been a request from Newcastle Palliative Care Team for topical loperamide for a Gateshead patient in primary care.
Rationale behind use - Loperamide is a potent µ-opioid receptor agonist and oral loperamide undergoes extensive first pass metabolism, hence little reaches the systemic circulation; furthermore the drug is actively removed from the central nervous system, so is associated with few, if any, central opioid side effects. Compared with using topical diamorphine, loperamide is easier to prescribe, safer and less than one-tenth of the cost of the alternative, topical diamorphine.
NuTH palliative care team are recommending the use of loperamide for the treatment of mucositis and painful skin lesions and have been in discussion with the palliative care team in Gateshead.
Problems have been encountered with a Gateshead patient initiated on this treatment but community nursing team is refusing to administer treatment due to lack of knowledge and limited evidence base for the treatment. They were also advised by the nursing team at St Oswalds to use vinegar on the wound. Please note this has only been used on 2 patients in St Oswalds but one of the patients is a Gateshead patient who was discharged.
In discussion with North of Tyne APC, topical loperamide was introduced as for internal use in the hospital ONLY and was only agreed if the use was in the form of a study protocol and the evaluation forms are submitted to NuTH pharmacy.
Conclusion:
Agreed that topical loperamide should only be used by Newcastle Palliative Care Team in the context agreed previously by North of Tyne APC. Therefore Gateshead GPs and community nursing team should not be involved in the prescription/supply/administration of topical loperamide. Also agreed that Gateshead Palliative Care Team/Consultants should not prescribe/use topical loperamide.
Item 15 / Passover Medicines List / Enc 24-25
Discussion:
There is a large Jewish community in Gateshead and in the past provision of medicines approved for Passover have been held in local clinic with supplies being made by a local GP resident in the Jewish Community.Following a review of the governance processes, this clinic was closed on recommendation of the PCT Medical Director.The Medicines Management Team received the 2013 list at short notice which did not allow enough time fro approval through this committee or to fully inform all stakeholders. Discussions are now underway to prepare the list for 2014 Passover.
Conclusion:
Agreed that in future GMMC should be involved in approving list of Passover Medicines.
GMMC Primary Care Pharmacy representatives will advise GATDOC and GHFNT each year of preparations which are suitable for use during Passover in more timely fashion.
Item 16 / Shared Care Guidelines for Approval
Discussion:
None received this month.
Item 17 / NHS SoTW PGDs For Approval
Conclusion:
None received this month.
Item 18 / Exceptional Case Requests
Discussion:
None received this month.
Item 19 / NICE Guidance November 2012, December 2012 & January 2013 / Enc 9-15
Discussion:
  • CG156 – Fertility - all relevant drugs on formulary.
  • CG157 – Hyperphosphataemia in chronic kidney disease - n/a to GHNFT as pts treated in Newcastle or Sunderland
  • CG158 – Conduct disorders in children & young people – n/a to GHNFT as pts receive treatment via NTW Mental Health Trust.
  • TA274 – Ranibizumab in macular oedema – approved as an option by NICE. n/a to GHFNT as pts treated in Newcastle or Sunderland
  • TA275 – Apixaban – stroke & PE prevention in AF – approved as an option by NICE. Approved for addition to formulary in line with NICE TAG. Though noted not a preferred option in the current pathway locally but is available on individual patient basis as per NICE Technology Appraisal.
  • TA276 – CF – Colistin & tobramycin – approved by NICE. n/a to GHFNT as pts treated in Newcastle.
  • TA277 – Methlynaltrexone – appraisal terminated by NICE. Drug not on formulary in Gateshead.
NICE guidance published in February and March can be found on the NICE website. The committee is asked to note any implications for prescribing guidance across Gateshead and any additional prescribing costs resulting from implementation of the guidance.
Item 20 / Drug Safety Updates Feb 2013 – March 2013 / Enc 16,17
Following MHRA Drug Safety Updates issued since last meeting:
  • Feb 2013Drug Safety Update
  • March 2013 Drug Safety Update
Following other Safety Updates of note:
  • None
The committee is asked not note any implications for prescribing across Gateshead and recommend any actions required.
Item 21 / Items from NETAG
Discussion:
NETAG now disbanded as of 31.3.2013 in current format and replaced by new regional treatment advisory group as part of NCB to compliment Northern Clinical Senate. This new group will have an advisory only status & is due to meet for the first time on the 16th April 2013.
Item 22 / Items from NECDAG
Discussion:
See NECDAG minutes – Group has now been disbanded and functions incorporated into NCB.
Item 23 / Items for Information Only / Enc 18,19,26,27
Discussion:
Items circulated were:-
  • NETAG Minutes 15.1.13
  • NECDAG Minutes 30.1.13
  • Final LVSD Guideline April 2013
  • Final Dermatology Specials Guidance

Item 24 / AOB
Discussion:
Calcitonin Nasal
Noted now withdrawn from UK Market.

Date of Next Meeting: Wednesday12th June 2013 9am-12noonRoom 4, QEH Education Centre