Northampton East/South Prescribing Locality Group
Minutes of the meeting held on Wednesday 21st September
2011 at
Weston Favell Medical Centre
Present
Syed Abbas
Catherine Blackman
Stephen Blackman
Nishan Boteju
Martin Coombs
Syed Hassan
R Jameel
Natasha Kerrigan
Kris Kuczera
Azim Lakha
Shashi Patel
Hilary Penfold
George Takla
Tania Vaskovic
John Nicholls
Nina Frost
GP Dr Lakha, Abbas, Takla
GP Earls Barton
Practice Manager Earls Barton
GP Woodview Medical Centre
GP Danes Camp Medical Centre
GP Dr Hassan/Jameel
GP Dr Hassan/Jameel
Senior Locality Manager
Practice Manager Dr Molla/Kesani Practice
GP Dr Lakha, Abbas, Takla
GP Penvale Medical Centre
GP Wootton Medical Centre
GP Dr Lakha, Abbas, Takla
GP Moulton Surgery
Prescribing Advisor
Prescribing Support Technician
Apologies
Rick Byrne
Krishna Rao
Brook Medical Centre
Rillwood Medical Centre
Minutes from the last meeting
No comments
Matters Arising
JN asked the group if there had been any further issues relating to appliance
contractors, following the recent problems and the PCT requesting for a
change in policy. The group had not had any recent issues.
JN highlighted to the group that locality prescribing savings generated from
switches had now reached the £200,000 for the period January 2011 to
September 2011.
JN was still trying to initiate meeting with practice asthma nurses to discuss
asthma audits.
Quality and productivity QOF (QP2) Discussion
Baseline and most recent QP1 prescribing data were circulated. The group
discussed the markers and all practices present were happy with the data. JN
explained the prescribing team would be monitoring each practice on a
regular basis and would highlight any areas of concern. JN informed the
group of the documentation required for QP2 and that the prescribing team
would collect copies when they were ready. All practices were required to
submit their QP2 forms by 30th September 2011. Another QP2 discussion will
take place at the next prescribing locality meeting to allow all practices to
qualify for the QP QOF payments.
The group expressed concern that ferrous fumarate (Fersamal) was not
available. JN explained that if a supply problem caused a practice not to
achieve a stated QP target then this would have to be taken into account.
Quarter 1 Prescribing report
JN distributed copies of the report highlighting the following points.
 The prescribing team had generated prescribing savings so far in the
region of £1.927million against a QIPP target of £2million by March
2012.
 Scriptswitch, during quarter 1 had saved roughly twice return on
investment. Savings generated varied across localities.
 At the end of quarter 1 the PCT was predicting an under-spend of
£550,223 against the prescribing budget. The locality was presently
around £250,000 under spent.
 During quarter 1 the locality had improved on the prescribing incentive
scheme with a points drop equating to 9.02%. Although this % drop
was less than other localities it should be remembered that due to the
locality starting work quickly at the start of the year, a number of
markers had already improved before baseline data had been
calculated. Therefore the points drop was closer to 15%.
Prescribing Incentive Scheme 2011-12 (Q1 Data)
Copies of quarter 1 Prescribing Incentive Scheme data were distributed to the
group. JN was confident most practices would achieve green. The prescribing
teams work for the next few months would be to concentrate on assisting
practices achieve green on the prescribing scheme and away from simple
cost saving switches.
Scripswitch – Locality breakdown
Details of Scriptswitch savings per locality and practice were distributed for
discussion. These showed that the locality was savings roughly 3 times return
on cost. The locality had 4 practices that were generating less than their
individual Scriptswitch contract cost. The group agreed that individual practice
data would be useful for making a decision later in the year on whether to
retain Scriptswitch or not. JN to email individual practice data out, and the
locality to make a decision on whether to retain scriptswitch following release
of quarter 2 data at a future locality commissioning meeting.
GLP-1 Agonist – Problems with adherence to SCP
JN explained he had recently carried out an audit of exenatide (Byetta) and
liraglutide (Victoza) prescribing across the locality that had shown data being
received from NGH often missed important details (e.g. HbA1c and/or
weight/BMI). In addition NGH appeared reluctant to stop patients receiving
these drugs in line with the shared care protocol. JN highlighted that newly
initiated prescribing should be retained within secondary care if the patient
was also on insulin. JN also explained that the patient should reach
predefined HbA1c and weight targets to continue on the medication. If the
patient failed to reach these targets then documentation should be sent to
secondary care either explaining the drug had been stopped or asking for an
opinion. The group asked for clarification on the predefined targets at 6
months 12 months and long term. MC asked for a HbA1c converter to be sent
to all practices. JN to send these out to all practice via email. MC also
requested that some form of agreement be signed by the patient that
specified agreed HbA1c and weight targets prior to initiation of treatment.
(Giles Owen to discuss this with Kish Patel KGH).
Caresens – Practice usage
Copies of Caresens usage by practice were distributed. JN noted that 7 out of
14 practices were using high levels of Caresens which was encouraging. JN
requested that the other locality practices look to increase their Caresens use
and ensure their diabetic nurses are aware of the PCT policy to use
Caresens. The group asked if patients could be switched across. JN stated
that the annual diabetes review would be a good opportunity to switch
patients across. SH asked how to obtain more meters. JN to send out details
via email.
Tablet Press
JN highlighted the following from recent Tablet Press articles:
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Pioglitazone (Actos) and bladder cancer – Do not use in patients with
recent history of bladder cancer, assess risk factors for bladder cancer,
balance risks and benefits in the elderly and review treatment after 3 to
6 months to ensure patient receiving benefits.
Ranitidine Liquid – EMIS practices to be aware a new formulation of
Ranitidine liquid 5mg/5ml has been added to the formulary. This should
not be used as it is unlicensed and the usual formulation used is
75mg/5ml.
Timoptol 0.25% PF and Trusopt PF supply problems – Local
ophthalmologists have advised using preservative free Saflutan,
Travatan or Cosopt eye drops.
Atorvastatin (Lipitor) patent expiry – Atorvastatin has received a patent
extension until May 2012.
MHRA Safety alerts
JN highlighted the following recent MHRA articles
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Bisphosphonates and atypical fractures – Atypical femoral fractures
have been reported with long term bisphosphonate therapy. Clinicians
should be aware that patients may present initially with thigh or groin
pain weeks to months before fracture. Patients need for
bisphosphonate therapy should be reviewed after 5 years of treatment.
Reboxetine – Previous evidence suggested that reboxetine was
“ineffective and potentially harmful”, this evidence has been reviewed
and withdrawn. With the MHRA stating “Overall the balance of benefits
and risks for reboxetine remains positive in its authorised indication”.
NPAG decisions
Recent NPAG decisions were circulated, JN explained the following.
Retigabine
 New category of anti-epileptic drug
 Used for partial onset seizures in over 18’s only after previous
treatment with carbamazepine, clobazam, gabapentin, lamotrigine,
leveltiracetam, oxcarbamazepine, sodium valproate, topiramate
 NPAG categorised as amber 2 but monitoring to stay in secondary
care for 3 months
Exenatide once-weekly
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Newly licensed 2mg once weekly subcutaneous injection
FDA have requested more details investigating possible prolongation of
QT interval
NPAG categorised as grey until safety concerns addressed
Actikerall topical solution (salicyclic acid and fluourouracil)
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Used for slightly palpable and/or slightly think hyperkeratotic actinic
keratosis (grade 1/11) in immunocompetent patients
NPAG categorised as grey whilst place in treatment clarified by
dermatologists
Efracea (Doxycyline m/r capsules 40mg)
 Used for papulopustular lesions in adults with facial rosacea
 No advantage over existing tetracycline products
 NPAG categorised as double red
Maxepa
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NPAG categorised as double red to be consistent with Omacor
decision
A.O.B.
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SB – Informed the group that the LMC had written to the SHA with
regards to recent proposals to reduce the NHS prescribing team. JN
thanked SB for this encouraging news.
Date of next meeting Wednesday 9th November 2011 12.30pm venue
Weston Favell Medical Centre