Gateshead Medicines Management
Committee
28th November 2012 0930-1130
Room 4, Education Centre
QEH
Attendees:
Consultant Anaesthetist, Gateshead Health NHS Foundation Trust (Chair)
Consultant Microbiologist, Gateshead Health NHS Foundation Trust
Prescribing Lead, Gateshead Clinical Commissioning Group (Vice-Chair)
GP (Primary care prescriber)
Chief Pharmacist, Gateshead Health NHS Foundation Trust
Head of Commissioning Medicines Management, NHS SoTW
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
Apologies: (item 1)
Item 2
Prescribing Interface Lead Pharmacist, NTW Mental Health Trust
Declaration of Conflict of Interest With Any Agenda
Items
Discussion:
No-one present had any interest to declare with today’s agenda items.
Item 3
Notes of meeting on 26th September 2012
Enc 1
Discussion:
Minutes agreed as a true record.
Item 4
Ongoing Action Points
Enc 2
Discussion:
Circulated for information.
Item 5
Matters Arising
Enc 3 & 4
Discussion:
a) Dekristol to ProD3 switch – no further progress.
b) Goserelin for Gynaecology Indications – no further progress. Referred to shared care group to progress.
Item to be removed from GMMC agenda.
c) Collagenase (Xiapex®) – has now received commissioning approval so has now been added to the
formulary as a Tariff inclusion.
d) Pramipexole MR New Drug Request – no further progress to report.
e) Shared Care Prescribing Policy in SoTW – attached paper discussed. Agreed that proposal around opt-in
of drugs covered by LES scheme unworkable as difficult to know practices have signed up to LES.
Therefore concluded that far safer for all drugs on shared care to by opt-in by GPs via letter for individual
patients signposting to full guideline on the GIN – this the same as what other areas currently do. Chair to
share revised policy with GHFNT consultants and Vice-Chair to gain CCG approval of policy.
f) Ropivacaine New Drug Request – has now been confirmed that this request does not need to go to GHFNT
New Interventional Procedures Committee so use has now be extended on the formulary to include
shoulder & upper limb procedures under regional anaesthesia.
g) GMMC Revised New Drug Approval Process – discussed under Item 9.
h) Denosumab – response from LMC discussed. GMMC/CCG in agreement that for osteoporosis Denosumab
is classed as a Green+ drug and no LES as requested by LMC is required. Therefore Denosumab has
been classed as Green+ on the formulary with the expectation that GPs will now pick up repeat prescribing.
Denosumab remains a Red drug when used for bone mets in cancer treatment.
Item 6
New Drug Requests for November Meeting
Discussion:
None received.
Item 7
New Drug Requests for February 2013 Meeting
Discussion:


Inadine dressing – requested for use in orthopaedics by Mr Patterson
Jelonet dressing – requested for use in orthopaedics by Mr Patterson
Gateshead CCG Antimicrobial Update
Item 8
Discussion:
The SOTW Antimicrobial Committee which continue to meet twice a year or as needed. The local prescribing
committees will keep oversight with minutes and agendas being a standing agenda item.
The management of C.Difficle remains a high priority locally.
Item 9
NICE Guidance and Formulary Status of NICE
Technology Appraised Drugs
Enc presented on day
Discussion:
Subgroup has met and enclosed paper has been put together for discussion at GMMC, CCG and GHFNT.
Future formulary needs to state which drugs CCG will fund. This different to the current formulary which for primary
care is list of drugs GPs can prescribe and for secondary care a list of products stock by hospital.
Local New Drugs Approvals Policy will need updating once way forward is clear.
Number of options proposed for future structure of Local Decision Making around Medicines, including possibility of
merging with North of Tyne APC. All are clear that this is no reflection on GMMC currently; it is about the most
efficient way of doing things. Concerns expressed re complete takeover of GMMC by NoT APC, and the need to
maintain good working relationships within Gateshead between primary and secondary care.
Conclusion:



Comments on 1st draft of paper to AMB.
Await steer from Gateshead CCG
FM/JH to speak with GHFNT Medical Director – Does GHFNT wish to get involved with a North of Tyne
Committee driven formulary.
SoTW Dermatology Specials Guidance
Item 10
Enc 5 & 6
Discussion:
Paul Hardy in attendance.
Attached enclosures were discussed.
Conclusion:
GMMC supports comments from Sunderland Prescribing Committee.
GMMC feels only products on BAD list should be prescribed. Where a product is not listed on BAD list it should be
replaced by the closet available product that is listed on the BAD list.
Item 11
Gluten Free Product Supply
Enc 7
Discussion:
Paul Hardy in attendance.
Has been agreed to go ahead with “Off FP10” model for supply of Gluten Free products. Working Group currently
producing a pathway and list of products/quantities to be supplied which will come back to GMMC for approval once
finalised.
Item 12
Guidelines for Lipid Management (FATS6)
Enc 8 & 9
Discussion:
Revised local guidelines for lipid management presented for approval. These have been produced with North of
Tyne APC.
Conclusion:
Guideline approved.
Item 13
Primary Care Rebate Schemes
Enc 10
Discussion:
Attached paper discussed. Primary care are getting more requests from industry to participate in rebate schemes.
Currently three such schemes are in operation: Degarelix, Dabigatran and Rivaroxaban.
Paper highlights that schemes should be looked at on a regional basis with involvement of the regional pharmacy
procurement specialist, who is developing a framework for the management of such schemes within the region.
Conclusion:
Paper endorsed by GMMC.
Item 14
Role of Specialist Advice from Secondary Care
Enc 11a-11b
Discussion:
Letter received from Dr Razvi discussed.
Felt main specialities affected by such issues are pain, endocrine and Parkinson’s.
Often misunderstanding by specialists about product licensing and what unlicensed means, and thus the potential
implications for prescribers is a factor.
Conclusion:
Issue referred to Joint Clinical Forum for resolution.
Update on Use of Rifaximin
Item 15
Enc 12
Discussion:
Attached journal publication by Dr Reddy on use of Rifaximin circulated for info.
Medicines Management Information on CCG
Websites
Item 16
Discussion:
Attached enclosure circulated for information.
Gateshead CCG Prescribing Report Q1 2012-13
Item 17
Enc
Enc
Discussion:
Report circulated for information.
Highlights prescribing trends in primary care and how this relates to decisions taken by GMMC.
Noted that increase in pregabalin spend relates mainly to use in Mental Health.
Work underway to understand reasons for increase in spend on solifenacin.
Shared Care Guidelines for Approval
Item 18
Discussion:
None received this month.
NHS SoTW PGDs For Approval
Item 19
Enc 21,22
Conclusion:
 MMR Vaccine - approved
Exceptional Case Requests
Item 20
Discussion:
None received this month.
NICE Guidance September & October 2012
Item 21
Enc 13
Discussion:
 CG150 – Headaches – relevant drugs on formulary
 CG151 – Neutropenic Sepsis – Martin Young to review GHFNT guidance. Relevant drugs on formulary.
 CG152 – Psoriasis – n/a to GHFNT as patients treated elsewhere
 TA264 – Stroke (acute ischaemic) – alteplase – on formulary
 TA265 – Bone mets with solid tumours – denosumab – NECDAG approved as red drug
NICE guidance published in September and October 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.
Drug Safety Updates September and October 2012
Item 22
Enc 14-16
Following MHRA Drug Safety Updates issued since last meeting:
 Sept 2012 Drug Safety Update
 Oct 2012 Drug Safety Update
Following other Safety Updates of note:
 Denosumab
The committee is asked not note any implications for prescribing across Gateshead and recommend any actions
required.
Items from NETAG
Item 23
Discussion:

Perampanel (Fycompa®) for focal epilepsy – approved by NETAG for specialist use only. GHNFT does not
have a specialist neurology service.

Bevacizumab (Avastin®) for hereditary haemorrhagic telangiectasia – not approved by NETAG.
Item 24
Items from NECDAG
Enc 17
Discussion:
See NECDAG minutes
Item 25
Items for Information Only
Enc 18-20
Discussion:
Items circulated were: NETAG Minutes 10.7.12 – not yet available
 NECDAG Minutes 26.9.12
 GMMC Meeting Schedule 2013
 Changes to Prescribing & Availability of Epanutin®
AOB
Item 26
Discussion:
Boceprevir & Telaprevir for Hep C
Agreed that as GHFNT is now commissioned by CCG to provide treatment for Hep C that these two drugs can now
be added to the formulary in line with their NICE Technology Appraisals. And also prescribers need to provide
robust audit of use to demonstrate compliance with NICE TA.
Humulin I Kwikpen and Innolet Insulatard Insulin
Agreed to add these two disposable insulin pen devices to the formulary as other forms for Humulin I and Insulatard
are already on the formulary.
Needles of Insulin Pens
Has come to light that Diabetes Specialist Nurses have begun switching patients from 12 & 8mm needles to 6 &
4mm needles. This results a 30% cost increase for primary care. This has not been discussed with primary care for
GMMC. All agreed that where any decision has an implication for the primary care prescribing budget it needs to
come to GMMC for approval. The chair will take this issue up with Diabetes Specialists Nurses.
Date of Next Meeting: Wednesday 13th February 2013 9am-12noon Room 6, QEH Education Centre