Shared Medicines Management Team (SMMT)

Work Programme 2016-17– Quarter 2

Executive Summary

The following outlines theSMMT work completed during the 2nd quarter of 2016/17.

Strategic Priority
Ensure the shared medicines management team is fit for purpose, to deliver services to its stakeholders that are responsive, timely and accessible.
-SMMT PRDs completed for all staff in line with 16-17 work programme.
-SPA (APC Manager) post in SMMT left the NHS at the end of September. Paper outlining their current roles and responsibilities was circulated with future post options detailed.
-Work completed as part of SPA handover processincluded high cost drugs assurance
Priority 1
Identify and link with local, regional and national partner organisations to ensure a
coordinated and consistent approach to medicines usage and service delivery to CCGs.
-Continued working with NHS England to support community pharmacy agenda through Local Professional Network and new CCG Liaison group.
-Provision of MM representation at local health community prescribing meetings with feedback via the Primary Care Prescribing Group (PCPG)e.g.PrescQIPP, East Midlands Medicines Management Group (EMMMG), Health Care Acquired Infections (HCAI),STP Pharmacy workforce and High cost drugs.
-SPA input and attendance at HCAI 5 year strategy task and finish group. Presentation to Rushcliffe patient support group on antimicrobial resistance with planned roll out across health community.
-Support to out of hour’s provider with their PGD authorisation process.
-SMMT website updated for stakeholders.
-Eleven Freedom of Information requests related to medicines management were processed.
Priority 2
Support CCGs with the delivery of their Quality, Innovation, Productivity and Prevention (QIPP) 2016-17 agenda in relation to prescribing, medicines usage and procurement to enable CCG medicines management staff to achieve their prescribing QIPP targets.
-Continued analyst work to determine QIPP cost saving projections for 16/17 and attendance at CCG finance, adviser and team meetings.
-Stoma Prescription Service is now fully operational with all data now transferred. Stoma team continue to work through the data cleansing and are scoping ideas for further improvement
-Pharmaceutical Waste Management group met in July and September. Repeat prescribing audits and initiatives have been shared and continue to be scoped and patient facing materials such as posters and leaflets are also being developed. Representatives from community pharmacy also attended and are keen to be involved going forward
Priority 3
Support CCGs with integrated clinical and corporate governance, providing assurance of control and safety in the use of medicines
-Statutory Controlled Drugs (CD)occurrence report submitted on behalf of CCGs and presented to CD Local Intelligence Network (CDLIN). CCG CD Annual report also presented.
-CCG statutory CD prescribing data reviewed and outliers identified.
-Continued managerialsupport toMedicines Safety Officers meeting network, delivery of wrong route serious incident learning via national webinar.
-A review of the Controlled Stationery Policy and CD guidelines in GP Practices iscurrently underway.
-Support to CCG practice police investigation
Priority 4
Identify & link with local, regional and national partner organisations,ensuring a co-ordinated approach to medicines usage & service delivery across health & social care.
-Ninecare home (4North, 4 South and 1 Bassetlaw) medication audits undertaken due to performance issues.
-Production of Care about Medicines newsletter for social care establishments
-Care Home feedback audit results from 6 homes.
-NCC Guidance on Medicines Management in Social Care establishments completed
-NCC Shared Lives medication policy reviewed.
-SPA attendance at Nottingham University Hospitals (NUH), Sherwood Forest Hospitals (SFH) and Nottingham Treatment Centre DTC/MM meetings.
-Three safeguarding investigations linked to medication incidents in south care homes undertaken
-Attendance at 2 CCG AGMs.
Priority 5
Provide a robust process for the commissioning of medicines via the management and administration of the Nottinghamshire Area Prescribing Committee and Nottinghamshire Joint Formulary Group. This enables an integrated approach to prescribing within the Notts Healthcare Community resulting in continuity of care for patients.
Provide medicine management support to the commissioning processes of specialised and non-specialised medicines for Providers of NHS Services to ensure providers are prescribing cost effectively, safely and to best practice.
-The NUH SIFP post has now been recruited to with the post holder starting in November.The impact of the vacancy has been managed internally within the interface team.
-The APC has held twocommittee meetings with the approval of one new guideline (Gynaecomastia) and the update of 2 more (Cow’s milk allergy and alcohol withdrawal). A position statement on prescribing for transgender patients was also approved.
-15 medicines were considered for inclusion in the Nottinghamshire Joint Formulary. Horizon scanning was carried out to maintain the formulary and ensure managed introduction of new drugs into the health economy. Formulary compliance with NICE TAs was assured.
-Implementation of shared care protocols by primary care continues to be a challenge within the Mid Notts CCGs. Both CCGs are in principle supportive of developing a basket LES to resource primary care for the extra workload associated with monitoring and prescribing these medicines. However there is no progress in this area.
-GP representationcontinues to be an issue as the north GP rep has stepped down. A Rushcliffe CCG GP has now become a member. The lack of representation has been highlighted with the CCG Prescribing Advisors.
-The High Cost Drugs Pharmacist within NHS Nottingham Treatment Centre (Circle)has provided an update to the CCG advisors and CCG finance teams as to progress in line with agreed objectives. Rheumatology clinicians have started to use the etanacept biosimilar for newly diagnosed RA patients. A benefit share proposal has been agreedandclinicianswill begin to implement from autumn 2016. This needs to be replicated with SFHT clinicians, however currently there is no high cost drugs pharmacist within that trust.
-The use of the infliximab biosimilarsfor gastro indications had been agreed in line with the NHSE principles for benefit sharing, patients have begun to be counselled about the switch.
Priority 6
Manage and administer the CCG Individual Funding Request Panel (IFR).
Triage and approve requests for Cosmetic Procedures (all ages) and any requests for other collaborative CCG policies e.g. Hip Arthroscopy, Procedures of Limited Clinical Value, Orthotic Functional Electrical Stimulation (FES) for Foot Drop of Neurological origin, Treatment Abroad. This ensures a transparent and fair process for patients whichever CCG their practice is located in.
-There has been one IFR panel meeting during this quarter.
-Five IFR applications have been received in the second quarter. Two applications were screened and declined as they did not meet the IFR eligibility criteria. Two were returned as the patient was not registered with an NHS Nottinghamshire County CCG. The remaining one was approved as the requested treatment was routinely available within Tariff.
-No requests were considered by the IFR Panel, where clinical exceptionality was not demonstrated.
-The team has responded to three Freedom of Information requests, in relation to eligibility criteria for NHS funded procedures i.e. all those included in the Policy for Procedures of Limited Clinical Value (PLCV), Commissioning of Neurorehabilitation Placements for Adults, and criteria for the use of collagenase injections in patients with Dupuytrens Contracture. NB responses are now received and have been sent to 4 different governance/GEM FOI teams.
-Twenty Onefunding requests were for treatments where there is a CCG policy in place e.g. removal of tonsils/adenoids, FES, IVF/ICSI, Varicose veins. Prior approval requests were also received for second opinions in providers out of area.
-Five requests were received in relation to assessments for Autism/Asperger’s which are passed routinely to the mental health commissioning team.
-Four requests for funding were received from the Cross Border Healthcare Team in relation to patients that have had treatment in the EU.
-No formal complaints have been received in relation to funding decisions made on behalf of the 5 CCGs.
-From 1 September 2016, Mansfield & Ashfield and Newark & Sherwood CCG’s have introduced a 100% prior-approval process for procedures and services covered by the Procedures of Limited Clinical Value Policy (2015) and the Cosmetics policy (2015). The IFR Team are currently receiving and processing Prior Approval requests for ENT, General Surgery, Urology, and a proportion of musculoskeletal requests.
Priority 7
Provide a strategic service that identifies and accesses prescribing data, interpreting it in order to plan, monitor, audit and manage medicines usage and expenditure.
-Epact 16/17 work programme updated as part of consultation with 5 CCGs
-Support to North and South CCGs Optimise Rx training sessions
-Development and implementation of Optimise Rx savings reports inc Acceptance and Rejection data
-Update of stoma service provision reports
-Update of continence reports for 16/17 and 17/18
-Reproduced all prescribing reports for 2016/17
-Updated the Joint formulary tags on epact
-Updated and created new data work books for new switches in 16/17 and 17/18
-Continued attendance at QIPP meetings
-Continued production of monthly and quarterly production reports
-Continued liaison with CCG prescribing and finance teams to recuperate monies due to mischarged FP10s.
Priority 8
Support staff working in medicines optimisation roles to maintain their professional practice, standards, skills and knowledge to enable staff to carry out their roles effectively.
-Epact training provided by Senior Prescribing Analyst for new starters.
-Training session for SMMT staff on diabetes by SPA.
-Training events facilitated by the SMMT for CCG Medicine Management teams on the Electronic Prescription Service.
-Provision of medicines management training sessions to Notts County Council START staff

Coral Osborn, Senior Prescribing & Governance Advisor

Laura Catt, Prescribing Interface Advisor

November2016

The Shared Medicines Management Team is hosted by NHS Mansfield & Ashfield CCG on behalf of NHS Newark & Sherwood CCG, NHS Nottingham North & East CCG,NHS Nottingham West CCG and NHS Rushcliffe CCG.

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