/ Gateshead Medicines Management Committee
15thJanuary 2014 0900-1200
Room 4, Education Centre
QEH
Attendees: / Prescribing Lead, Gateshead Clinical Commissioning Group (Vice-Chair)
Consultant Microbiologist, Gateshead Health NHS Foundation Trust
GP (Primary care prescriber)
Chief Pharmacist, Gateshead Health NHS Foundation Trust
Medicines Governance Pharmacist, Gateshead Health NHS Foundation Trust (Secretary)
Regional Drug & Therapeutics Centre (Newcastle) Advisor
Primary Care Medicines Management Provider
Community Pharmacist
Senior Pharmacist NECS
Pharmacist NECS
Apologies: (item 1) / Consultant Anaesthetist, Gateshead Health NHS Foundation Trust (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 11th December 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.
Item 5 / Matters Arising
Discussion:
a)Apomorphine in Parkinson’s disease Shared Care Guideline– no further input required from GMMC as this stage. Guideline was approved at October GMMC meeting but problems remain with implementation and who is responsible for what for identified patient requiring treatment. Parkinson’s disease Team to arrange meeting with GP practice concerned and drug company to resolve outstanding issues.
b)Granisetron Patch New Drug Request–still awaiting decision from Cancer Network.
c)Vitamin D Guidelines – still waiting to hear back from QEH consultants on suggested changes to guideline.
d)Erectile Dysfunction Guidelines – has been referred back to authors for re-drafting.
Item 6 / New Drug Requestsfor January 2014Meeting / Enc 4-8
Discussion:
Artiss Fibrin Sealant
Application not yet received,
Fidaxomicin
Requested by Dr Horne
Requested for use in treatment of recurrent C.difficile.
Evidence as per application form.
Reviews:
  • NICE – not considered
  • SMC – approvedJuly 2012 for 1st recurrence of C.difficile. Not to be used 1st line.
  • AWMSG – approved 14.11.12
  • RDTC – not considered
  • NoT APC – approved for hospital use only in 3rd line treatment of C.difficile
  • LNDG – June 2012 – only use for recurrence
  • Included in Public Health England Guideline for management of C.difficile.
Pivmecillinam
Requested by Dr Horne
Requested for use in treatment of multi-drug resistant uncomplicated UTI.
Evidence as per application form.
Reviews:
  • NICE – not considered
  • SMC – not considered
  • AWMSG – not considered
  • RDTC – not considered
  • NoT APC – approved.
  • LNDG – not considered
Osigraft
Requested by Orthopaedic Surgeons
Requested for Treatment of non-union of long bones of at least 9 month duration, secondary to trauma, in skeletally mature patients, in cases where previous treatment with autograft has failed or use of autograft is unfeasible.
Noted CCG funded drug exclusion.
Evidence as per application form.
Reviews:
  • NICE – not considered
  • SMC – not considered
  • AWMSG – not considered
  • RDTC – not considered
  • NoT APC – approved as hospital only drug
  • LNDG – not considered

Conclusion:
  • Artiss Fibrin Sealant – application process on hold pending receipt of completed New Drug Request Form from surgeons.
  • Fidaxomicin – approved as Red drug to be used on advice of Consultant Microbiologist only.
  • Pivmecillinan –approved as Green + drug for treatment of multi-drug resistant uncomplicated UTI based on micro sensitivities.
  • Osigraft – approved as Red drug.

Item 7 / New Drug Requests for March 2014
Discussion:
  • Darifenacin
  • Atorvastatin chewable

Item 8 / Antimicrobial Update
Discussion:
Nothing to report
Item 9 / Formulary Chapter Updates / Enc 9-13
Discussion:
The following chapters of the GHFNT formulary have been updated on the internet/intranet sites since the last meeting:
  • 1 – Gastrointestinal
  • 2 – Cardiovascular
  • 8 – Malignant disease & immunosuppression
  • 9 - Nutrition & Blood
  • 10 - Musculoskeletal

Conclusion:
Chapter updates approved.
Item 10 / Horizon Scanning / Enc
Discussion:
Received for information.
Item 11 / Gateshead CCG Laxative Prescribing Report / Enc
Discussion:
Paper received for information.
  • Gateshead CCG is currently one of the highest spending CCGs in the North East and Cumbria on laxative prescribing, with costs significantly higher than the NHS England and North East & Cumbria average.
  • Laxative prescribing accounted for 2.3% of all prescribing costs in Gateshead CCG in quarter 2 2013/14, with costs increasing by 40% from £118,990 in quarter 2 2012/13 to £201,556 in quarter 2 2013/14, mainly
driven by the increased Drug Tariff price for senna.
  • Practices are working on laxative prescribing as part of the CCG prescribing engagement scheme for 2013/14, requiring practices to achieve a reduction in laxative prescribing, however currently few
practices are achieving the required reduction, with prescribing volumesgenerally increasing.
  • Also working with Public health to address this issue

Item 12 / C.Difficile Risk Assessment Tool for Primary Care / Enc
Discussion:
  • Updated version of NHS South of Tyne and Wear risk assessmenttool for CDI.
  • Updated to include information on severity of CDI from Public Health England’s guidance on the management and treatment of Clostridium Difficile infection (May 2013).

Conclusion:
Approved.
Item 13 / Guidelines for Approval / Enc 14
Discussion:
Following guidelines have been revised & updated:
  • Gout
  • Constipation in Children

Conclusion:
  • Gout – approved with suggest changed to colchicine dose.
  • Constipation in Children - approved

Item 16 / Shared Care Guidelines for Approval
Discussion:
None received this month.
Item 17 / Primary Care PGDs For Approval
Conclusion:
None received this month.
Item 18 / Exceptional Case Requests
Discussion:
None received this month.
Item 19 / NICE Guidance December 2013 / Enc
Discussion:
  • CG174 – Intravenous fluid therapy in adults in hospital
NICE guidance published in December 2013 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 December 2013 / Enc
Following MHRA Drug Safety Updates issued since last meeting:
  • December 2013 Drug Safety Update
Following other Safety Updates of note:
  • None
The committee is asked to note any implications for prescribing across Gateshead and recommend any actions required.
Item 21 / Items for Information Only / Enc
Discussion:
Items circulated were:-
  • Gateshead CCG Prescribing Report Q2 2013/14 – increasing costs being driven by increases in Drug Tariff prices e.g. senna, temazepam, sertraline.

Item 22 / AOB / Enc
Discussion:
Monitored Dosage Systems
Paper put together by LPC on future management of MDS was discussed. It is requests from Social Services/Carers that are fueling the growth.
Gateshead Council Medication Policy states that carers can administer medicines from normal boxes/bottles, and this need to be enforced and addressed by Council before the proposals in the LPC paper can be approved.

Date of Next Meeting: Wednesday12th March 2014 9am-12noonRoom 4, QEH Education Centre