GREATER MANCHESTER MEDICINES MANAGEMENT GROUP. Date: Thursday 19 th November 2015

Transcription

1 GREATER MANCHESTER MEDICINES MANAGEMENT GROUP Date: Thursday 19 th November 2015 Time: 1pm 3pm Venue: Board Room, New Century House, Denton. M34 2GP Present: Name Designation Organisation CCG members Dr Helen Burgess (HB) GP Prescribing Lead and GMMMG South Manchester CCG (Chair) Simon Wootton (SWo) Chief Operating Officer (Vice Chair) North Manchester CCG Dr Richard Darling (RD) Gp Prescribing Lead and Chair of Interface HMR CCG Prescribing Subgroup Sue Gough (SG) Lead medicines optimisation Pharmacist North Manchester CCG Peter Howarth (PH) Head of Medicines Management Tameside and Glossop CCG Mary Crabb (MC) Senior Medicines Management Advisor Central Manchester CCG Dr Anne Harrison (AH) GP Prescribing Lead Trafford CCG Dr Sanjay Wahie (SW) Medicines Management Clinical Director Wigan CCG Dr Heather Proctor (HP) Prescribing Lead Stockport CCG Claire Vaughan (CV) Head of Medicines optimisation Salford CCG Ben Woodhouse (BW) Head of Medicines Management Bolton CCG Dr Alison Lyon (AL) GP Clinical Lead Bolton CCG Nigel Dunkerley (ND) Locality Medicines Optimisation Lead Pharmacist Greater Manchester Shared Services (representing Oldham CCG) Liz Bailey (LB) Medicines Optimisation Lead Stockport CCG Secondary Care and Regional members Jane Brown (JB) Chair local pharmacy professional network NHS England Rachel MacDonald (RM) Pharmacist Community Pharmacy Support Jimmy Cheung (JC) Medicines Optimisation Pharmacist Greater Manchester Shared Services Bhavana Reddy (BR) Head of Prescribing Support RDTC Andrew White (AW) Head of Medicines Optimisation Greater Manchester Shared Services Monica Mason (MM) Principal Pharmacist Medicines Management Gavin Mankin (GM) Principal Pharmacist Medicines Management RDTC RDTC Minutes by: Gavin Mankin, RDTC Chair: Helen Burgess, South Manchester CCG 1 General Business 1.1 Apologies for Absence M Beecroft, P Brown, J Tilstone, J Bartlett, M Woodhead, C Skitterall, A Martin, J McDonald, L Lord. 1.2 Conflicts of interest declarations Two declarations were made regarding agenda item 2.1. Both members

2 2 were excluded from commenting on the agenda item. A standing declaration was made regarding agenda item 2.4; Two members had attended an advisory board for edoxaban - these members were excluded from taking part in the discussions for this agenda item. One declaration was made regarding agenda item 2.2; One member had attended an advisory board for Roche and therefore was excluded from commenting on the agenda item. 1.3 Minutes of the Previous Meeting The group approved the minutes of the last meeting. 1.4 Matters Arising from Key s The group discussed the matters arising from the previous meeting and the matters arising document. Items not on the agenda were discussed as below: RDTC to publish on website Review of Gluten Free Policy AW has contacted Norfolk CCG and they no longer prescribe Gluten free products at all, however this is still a new policy and it may be useful to see if they have had any feedback in three to six months time. AK was still to forward a list of products that would not incur out of pocket expenses to CCGs for information. AK to forward list of products. GMMMG prescriber decision support of New Oral Anti-Coagulants (NOACs) This has been approved via chairs action and will now be published on the website. JC fed back that this document now included the NICE definition of NOAC i.e. non-vitamin K antagonist oral anticoagulants. All other matters arising were on the agenda or were due to be discussed at a later date. 2 Medicines Optimisation 2.1 Wet Age-Related Macular Degeneration (wamd) A comprehensive update paper regarding all issues relating to the use of bevacizumab in wet AMD had been prepared and presented to the group. This included the latest legal advice, MHRA and Government position as well as the clinical efficacy data. The group was informed that the GM Association of CCGs Governing Group (AGG) had requested that GMMMG provide a clinical view on the use of bevacizumab in wet AMD in terms of efficacy and safety only. All other considerations are outside the remit of GMMMG and would need to be made and discussed in more detail by commissioners. Document to be published on website. BR to update previous GMMMG statement on use of Bevacizumab in wamd. The RDTC & GM Shared Service highlighted to the group that guidance from the Department of Health, MHRA and GMC remains unchanged in that an unlicensed medicine should not be supplied where an equivalent licensed medicine can meet the specials needs of the patient. Under current UK and EU law cost alone is not a special need.

3 3 The group also discussed the related issues around the tariff costs for wamd. It was felt there is scope to look at cost savings relating to the use of licensed products before considering the use of an unlicensed medicine. After discussion it was agreed to update the previous GMMMG statement on use of Bevacizumab in Wet Age Related Macular Degeneration from September 2011 with the updated clinical evidence. This would then be send to AGG for further discussion. It was agreed that this item would be brought back to the next meeting for sign off before going to AGG. 2.2 Updated GMMMG Blood Glucose Test Strip (BGTS) Evaluation Results The final draft updated report and results following the review of Blood Glucose Testing Strips was presented to and approved the by the Group. The GMMMG approved the changes to the evaluation process and confirmed that the updated scoring mechanism was appropriate to enable a factual document to be produced and allow CCGs to make an appropriate local choice. JC to bring final report back to GMMMG for information. It was noted that following approval of the changes to the evaluation process and updated scoring mechanism JC will now re-contact manufacturers/distributors that did not respond to the request for information to ensure that they have not self-excluded themselves based on criteria that may not be essential. Once manufacturers have been contacted this can then be finalised and published. 2.3 Prescribing Guidance in the Self-Monitoring of Blood Glucose (SMBG) The final draft subject to the publication of the NICE CG on Type 2 diabetes was presented to the group for comment. This has already been out to consultation across Greater Manchester and with Diabetes UK. It was suggested at a patient information leaflet covering this guidance for community pharmacies would be also useful. The group agreed it was a useful document. JC proposed that this could be published once the NICE diabetes CG is published so that it incorporates any new recommendations. This is due imminently. 2.4 Rebate Schemes for Noting Cetraben Cream, bath additive and lotion Oxycodone hydrochloride prolonged release tablets Edoxaban JC to bring final guidance to GMMMG for approval once NICE guidance is published. JC to develop a PIL to support this guidance. This item was for information for CCGs. The above rebate schemes had met the GMMMG ethical framework criteria. 3. Strategic Direction 3.1 Beyond Medicines Paper Next Steps SW provided an update to the group. The following points were highlighted: AGG has approved GMMMG to become a Clinical Standards Board. Work is underway on the changes to GMMMG structure and Subgroups. There is a December deadline for paper to go to Board for bids from

4 4 transformation fund so help was needed from other CCG leads to input into this process. JB provided an update to the group on Practice Pharmacists NHSE Pilot. It was agreed that the dates of any future teleconferences regarding the paper/bid would be shared with others so they could input into the process. 3.2 Accelerated Access Review Interim Report The national Accelerated Access Review: Interim Report from the Wellcome Trust was presented to the group for information. The group noted that a lot of the report s recommendations are being incorporated into the current changes to the GMMMG structure. The need for the patient to be at the centre was also highlighted and discussions are ongoing as to how patients and patient groups should be best included in the decision making structures of GMMMG. 3.3 Greater Manchester EUR Policy Statement: Experimental and Unproven Treatments draft for GMMMG discussion This policy is currently out for consultation. It was noted that it is not intended to cover medicines but that its title and scope could be misinterpreted to include unlicensed medicines, when this wasn t the intention. AW and LB to suggest a form of words to cover the use of unlicensed medicines. It was suggested that the policy needs to include a specific line to exclude its application to the use unlicensed use of medicines or a line to say use of unlicensed medicines will be considered locally. It was agreed that AW and LB would agree a paragraph for inclusion which would cover this. 4. Safety 4.1 GMMMG GP Resource Pack: Antipsychotics in Dementia Patients for Approval Following 1 month Consultation This was approved by the group following a month long consultation. It was suggested that a sentence be included to state that the mortality information relates mainly to the first 12 weeks of treatment. The group agreed that this should be verified and added if a reference could be found. 5. Managed introduction of New Drugs and Formulary Development 5.1 Formulary Sub-group BR to verify information and make proposed change then publish on website Minutes of the October meeting The minutes of the October meeting were noted and approved Formulary amendments for approval GMMMG noted the MHRA and NICE updates to the formulary. These were all approved by the group. Removal of soluble prednisolone tablets Removal of dicycloverine tablets Removal of topiramate capsules Colief will be added to the DNP list Dosulepin will be added to the DNP list Topical gabapentin will be added to the DNP list Edoxaban will be added with link to NICE TA To be published on website

5 5 Pembrolizumab will be added with link to NICE TA Tolvaptan will be added with link to NICE TA Idealisib will be added with link to NICE TA Matoride XL will be added to chapter 4 alongside Concerta XL. GMMMG noted that Greater Manchester pathways for COPD and asthma are currently in development under the auspices of the FSG. 5.2 New Therapies Sub-group NTS recommendations for approval: a) Apremilast for psoriatic arthritis This recommendation was developed in conjunction with the Specialists at Salford Royal prior to the NICE guidance to enable the region to take advantage of the patient access schemes that are available. SMC have approved use in the licensed indication. The NTS recommendation specifies a particular patient group in whom biologics are not suitable so this is a narrower indication than the current SMC or NICE guidance. The NTS recommends the use of apremilast in those patients that have failed conventional systemic therapy but are not eligible for treatment with a biologic due to contraindications and/or potential safety concerns. To be published on website GMMMG approved the above recommendation. b) Linaclotide for IBS-C re-review NTS was asked to review the previous recommendation which proposed specialist initiation following a letter from both the manufacturers and a group of specialists from across GM. The group considered the request and noted that current pathways don t easily allow for primary care initiation. The NICE guidance does not specify who should initiate the drug however the group did note that if IBS patients were better managed in primary care there would be savings associated with this, however this was outside the remit of NTS. The NTS recommendation has been updated as follows to reflect this. GMMMG approved the above recommendation. a) Airsonett - a temperature controlled laminar airflow medical device, for use in children, with poorly controlled persistent atopic asthma This recommendation was developed in conjunction with the specialists at CMFT. The numbers of patients likely to be eligible are low hence the financial impact is likely to be small. The group recommends the use of Airsonett for those children who are not eligible or suitable for treatment with omalizumab and have demonstrated symptom improvements (using the PACLQ questionnaire) following a three month trial of Airsonett. Primary care funding will only be approved following a successful 3 month trial showing symptom improvements. GMMMG approved the above recommendation. 5.3 Interface Prescribing Sub-group

6 Minutes of September meeting The minutes of the September meeting were noted and approved Update paper for October The group noted the update paper for September with the proposed RAG list changes, in particular the new RAG status for the use of tamoxifen and raloxifene for chemoprevention in women at moderate to high risk of breast cancer. RAG list updates to be published on the website GMMMG approved the proposed RAG decisions as per the October update paper from the Interface Prescribing Subgroup Approval of shared care guidelines: It was noted that a standard shared care protocol checklist had been completed covering each drug class. These had been completed to highlight to GMMMG any potential commissioning issues as well as who has been consulted on the development of the protocol. The related shared care protocols are embedded within this document so it was stressed that it was important for membership to read these prior to the meeting as the intention was for them to be signed off at the meeting and not for the group to go through them in detail. a) SCP for ethinylestradiol for induction of delayed puberty in female patients aged 12 years and over. The group approved this shared care protocol after the provision of further information clinically information around choice of product and why the patches or cheaper alternative were not suitable for use. Publish on website. b) Nalmefene GP Information sheet The group approved the leaflet for addition to the website which has been prepared to support the RAG status and GP prescribing of nalmefene for alcohol dependence c) SCP for Adult ADHD d) SCP for Lithium in Adults e) SCP for Melatonin for Sleep disturbance in patients with learning disability or are CAHMS graduates where continued treatment is desirable. f) SCP for Riluzole 6. Reports from Associated Committees

7 7 6.1 GM CCG lead Pharmacists Meeting PH updated the group on the last CCG lead pharmacists meeting. The following items had been discussed: - Variations in prescribing of biologics - CRP testing prior to prescribing antibiotics Salford and Oldham CCGs to pilot - Gluten Free Policy discussions. - DNP list emollients. - Decommissioning drugs on the DNP list. - Enteral feeds. - PrescQIPP Manchester CCGs and Salford CCG currently trialling - Best practice around antibiotic prescribing & current QIPP indicators. GM Chief Pharmacists No report available as no Chief Pharmacist was present. Procurement AW gave feed-back on a recent meeting of the NW Procurement group. Local Professional Network JB fed back on the LPN. The two year plan and engagement event had now been circulated. The primary care summit has now taken place. JB also fed back that work was ongoing in rolling out the Healthy Living Advice Pharmacy programme in Salford, Stockport and Tameside & Glossop CCGs. 7. Items for Information 7.1 AOB Infant Feed Guidelines this will be brought to December meeting for discussion/approval. 6.2 Date, time and venue of next meeting The next meeting will be 17 th December 2015, Salford Suite, St James House, Salford, M6 5FW The meeting will have a mental health focus.