EAST LANCASHIRE HEALTH ECONOMY MEDICINES MANAGEMENT BOARD IN SEMINAR ROOM 9, LEARNING & DEVELOPMENT CENTRE, ROYAL BLACKBURN HOSPITAL

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1 EAST LANCASHIRE HEALTH ECONOMY MEDICINES MANAGEMENT BOARD MINUTES OF THE MEETING HELD ON WEDNESDAY 20 th APRIL 2016 AT 12.30pm IN SEMINAR ROOM 9, LEARNING & DEVELOPMENT CENTRE, ROYAL BLACKBURN HOSPITAL PRESENT: Dr D Gavan (DG) Mr N Fletcher (NF) Dr L Rogan (LR) Mrs C Woffindin (CW) Mr V Goodey (VG) Dr S Jackson (SJ) Mrs C Dugdale (CD) Ms A Atkinson (AA) Ms K Disley (KD) In Attendance Mr J Vaughan Elizabeth White Wendy Lyons Consultant Radiologist ELHT (Chairman) Director of Pharmacy ELHT Head of Medicines Commissioning NHS EL CCG Medicines Information Manager, ELHT Assistant Director of Pharmacy, Clin Service ELHT Clinical Commissioning Group MM Lead, GP EL Meds Management Pharmacist NHS BwD CCG Pharmacist LCFT (representing Mrs C Harding) Finance Department ELHT Commissioning Support Pharmacist NHS EL/BwD Tissue Viability Nurse Specialist, ELHT Tissue Viability Nurse Specialist, EL CCG 2016/038: APOLOGIES: Dr K Burch (KB) Mr A Gray (AG) Dr J Randall (JR) Dr S Davies (SD) Mrs D Hogg (DH) Consultant Microbiologist ELHT Clinical Pharmacist, ELHT GP, NHS BwD CCG GP, NHS EL CCG Non-Medical Prescribing Lead, ELHT 2016/039: DECLARATION OF INTEREST None declared relevant to agenda items. 2016/040: MINUTES OF MARCH MEETING: Accepted as a correct record. Lancs Hospitals Trust (ELHT) 1 of 6

2 2016/041: MATTERS ARISING: 2015/101: NOAC s and Elective Surgery - VG to follow up progress. 2015/132: Formulary Updates: Oxycodone VG is trying to identify someone to prepare the leaflet for patient/carer information that will guide the reader through the issues relating to availability of branded generics and avoiding double dosing. VG discussed contracting but not able to amend at present. Remove from action sheet. 2015/164: Palliative Care Guidelines: Pennine Lancs and Lancs & South Cumbria CD discussed with Dr Leith. Awaiting updated network guidance and will then align the two documents. For now use the Pennine Lancs guidelines for the care of the dying section and the Lancs & Cumbria for other sections. Note to be put on L & C to refer to Pennine Lancs for care of the dying section. 2016/010: ELHE Respiratory Guideline COPD completed and uploaded to website. 2016/023: LMMG Recommendations (from Jan): Updated Oral Anticoagulants for Stroke Prevention Consensus Statement comments sent to LMMG. No comments received from cardiologists. 2016/027: LMWH Documents on ELMMB - ELHE document is on website as primary one to use. No response back from specialised commissioning with regard to tariff position for oncology. Keep as amber for now. 2016/028: DVT Primary Care Prescribing Guidance it is recommended by ELMMB that a quality assurance assessment for the sensitivity of the D-dimer kits is carried out. 2016/042: WOUND CARE FORMULARY - UPDATED The layout has changed to include indications for use and non-formulary equivalents. First and second line order forms have been developed which are more user friendly. LCfT has selected to retain a separate formulary however, the authors have offered to share the revised version with them. Concern was expressed that prices are included and that these may change. Authors will bring back for amendment if there are significant changes. Accepted for use in ELHE. Resolved: Wound Care Formulary - Updated accepted for use in ELHE. 2016/042: NEW PRODUCT REQUEST INDOCYANINE GREEN Requested by Mr Subar, Consultant Surgeon, for use to assess pre-operative hepatic function in patients undergoing liver resection. It provides more information before making decisions regarding patient suitability for liver resection. ELMMB approved the use form a clinical perspective. The directorate needs to consider the financial implications prior to approval for use within the trust. Resolved: Indocyanine green approved clinically for assessment of pre-op hepatic function. Costs to be discussed in directorate. Traffic light: RED Lancs Hospitals Trust (ELHT) 2 of 6

3 2016/043: NEW PRODUCT REQUEST ENALAPRIL FOR PAEDIATRICS Enalapril requested for inclusion on formulary by paediatricians, as this ACE inhibitor is licensed for use in children with doses in the BNFc. Approved for inclusion on formulary. Resolved: Enalapril included on formulary for paediatric use. Traffic Light: AMBER 2016/044: LMMG CONSULTATIONS (for May LMMG) Stoma and Incontinence products CCG like the document. No comments from trust and no further comments from ELMMB. Sequential Anti TNF s in Crohns and Ulcerative Colitis no comments from consultants, query should biosimilars be included. Liothyronine no comments from consultants, ELMMB agree with consultation. Ulipristal for uterine fibroids the CCGs support the recommendation. Consultants consider that it could be amber traffic light with guidance. Resolved: CW to send responses to LMMG. 2016/045: LMMG RECOMMENDATIONS (from March) Insulin Glargine 300 u/ml for T1DM recommended as an option with Amber traffic light. ELHE to wait for information sheet before accepting. Insulin Glargine 300 u/ml for T2DM recommended as an option with Amber traffic light. ELHE to wait for information sheet before accepting. Tadalafil once daily - recommended for prescribing within sexual health service in specific defined circumstances. Traffic light: RED Not recommended for prescribing in primary care or outside of specific defined circumstances. Traffic light: BLACK LMMG recommendations accepted as written for ELHE. Biosimilars of Infliximab Position Statement updated recommended as an option for use. LMMG statement accepted as written for ELHE. Traffic light: RED Biosimilars of Etanercept Position Statement recommended as an option for use. LMMG statement accepted as written for ELHE. Traffic light: RED Neuropathic Pain Guidance - updated. LMMG recommendation accepted as written for ELHE. Anticoagulation Decision Support Tool - updated LMMG recommendation accepted as written for ELHE. To be combined with NOACs in AF prescribing guide at a later date. NOACs in AF Prescribing Guide - updated LMMG recommendation accepted as written for ELHE. To be combined with Anticoagulation Decision support tool at a later date. Lancs Hospitals Trust (ELHT) 3 of 6

4 Riluzole Shared Care Guideline LMMG guideline accepted as written for ELHE. 2016/046: FORMULARY UPDATES None for April 2016/047: ANTIMICROBIAL GUIDELINES Endoscopy Unit Prophylaxis Guidelines agreed with microbiology and endoscopy. Accepted for use. Resolved: Endoscopy Unit Prophylaxis guidelines accepted for use. 2016/049: ANTIBIOTIC SUPPLIES FOR PAEDIATRICS Request received from paediatrics, for the current practice of offering parents of young children discharged from the children s unit or out patients, on longer than 7 days of an oral antibiotic liquid to return to the hospital or go to GP for further supplies to complete the course. ELMMB endorsed this practice and recommend development of an information leaflet that parents should be given to take to GP. Resolved: Further supplies of antibiotic required as above can be requested from GP. Information sheet to be developed. 2016/050: SODIUM VALPROATE AND PREGNANCY There are new support materials available for healthcare professionals and female patients taking or considering treatment with sodium valproate. The use of these materials to be encouraged to help ensure all are aware of potential issues. Support materials to be put on website. Resolved: Encourage use of support materials for Sodium Valproate in females. 2016/051: BLOOD GLUCOSE TESTING STRIP EVALUATION A comprehensive evaluation of blood glucose meters and testing strips has been undertaken through the Greater Manchester Medicines Management Group(MGGGM). The group engaged with patients and reviewed a whole range of meters according to NICE guidance and ISO standards. Meters were scored using a predetermined set of quality criteria and the meter that scored the highest in terms of quality was the Tee2 meter. ELMMB supported adding the TEE2 meter to formulary as a third choice meter for patients.. Resolved: GMMMG Blood glucose testing strips document approved and TEE2 meter added to formulary. Lancs Hospitals Trust (ELHT) 4 of 6

5 2016/052: EAMS- EARLY ACCESS TO MEDICINES SCHEME A brief discussion to raise awareness of EAMS was held. They are therapies with MHRA approval to be included in the scheme to allow access to them when there is a clear unmet need before they are licensed. 2016/053: NICE RECOMMENDATIONS (from March) Guidance on the use of temozolomide for the treatment of recurrent malignant glioma (brain cancer) updated wording of recommendation in TAG 23. Approved in line with NICE. Traffic Light: RED Ruxolitinib for treating disease-related splenomegaly or symptoms in adults with myelofibrosis (TAG 386) is recommended as an option by NICE. Approved in line with NICE. Traffic Light: RED STANDING ITEMS 2016/054: FOR ACTION/INFORMATION: LANCASHIRE MEDICINES MANAGEMENT GROUP MINUTES March 2016 Minutes acknowledged 2016/055: FOR ACTION/INFORMATION: ANTIMICROBIAL STEWARDSHIP COMMITTEE MINUTES Feb 2016 Minutes acknowledged 2016/056: FOR ACTION/INFORMATION: LANCASHIRE CARE FT D & T MINUTES March 2016 Minutes acknowledged DATE OF NEXT MEETING Next meeting is Wednesday 18 TH May pm, Seminar Room 9, Learning and Development Centre, RBH. Lancs Hospitals Trust (ELHT) 5 of 6

6 ACTION SHEET FROM EAST LANCASHIRE HEALTH ECONOMY MEDICINES MANAGEMENT BOARD WEDNESDAY 20 TH APRIL 2016 MINUTE DECSRIPTION ACTION DATE NUMBER 2015/101 NOAC s And Elective Surgery follow up progress VG May /132 Formulary Updates Oxycodone patient leaflet for brands/generics of opioids to be prepared VG Apr /023 LMMG Recommendations (from January): Updated Oral Anticoagulants for Stroke Prevention Consensus Statement Discuss with cardiologists VG Apr /027 LMWH documents on ELMMB Check tariff position in oncology NF Apr /049 Antibiotic Supplies for Paediatrics to develop an information leaflet for supplies to take to GP AA Jun 16 Lancs Hospitals Trust (ELHT) 6 of 6