Gateshead Medicines Management Committee
12th June 2013 0900-1200
Room 4, Education Centre
QEH
Attendees:
Consultant Anaesthetist, Gateshead Health NHS Foundation Trust (Chair)
Consultant Microbiologist, Gateshead Health NHS Foundation Trust
GP (Primary care prescriber)
Chief Pharmacist, Gateshead Health NHS Foundation Trust
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
Prescribing Lead, Gateshead Clinical Commissioning Group (Vice-Chair)
Apologies: (item 1)
None received
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.
Item 3
Notes of meeting on 10th April 2013 & Decision
Summary
Enc 1+2
Discussion:
Minutes & Decision Summary agreed as a true record.
Item 4
Ongoing Action Points
Enc 3
Discussion:
Circulated for information.
Item 5
Matters Arising
Discussion:
a) Needles for Insulin Pens – been agreed within GHFNT that new safety needles are for staff use only not for
patient use. Community services currently producing guidance for community nurses. Noted that
implementation of HSE guidance on reducing needle stick injuries has been deferred until Nov 2013.
b) Buccolam Switch – no further progress by Newcastle to report. GMMC agreed to continue to progress
switch to licensed product in Gateshead. Also agreed to that to avoid confusion between different products
prescribing would need to be by brand name in future.
c) Linaclotide New Drug Request – noted now approved by SMC. Mr Mercer-Jones has responded to
questions raised by GMMC at last meeting. Agreed to approve Linaclotide as Red drug on the formulary for
use by Mr Mercer-Jones/Dr Johns only. The initial script will be for 1 month supply, and then subsequent
scripts will be until next review appointment. This decision will be reviewed in March 2014 with a view to
status changing to Green +.
New Drug Requests for June 2013 Meeting
Item 6
Enc 4-6
Discussion:
Abatacept for Rheumatoid Arthritis
Requested by Dr Kelly for use in rheumatoid arthritis
Expects 10 patients a year and will be used in patients who would otherwise have had an anti-TNF but is contraindicated.
Reviews:
 NICE – approved May 2013
 SMC – approved
 NoT APC – approved.
 NICE Bites May 2013
The GMMC agreed that the current NHS SoTW Policy for the Use of Cytokine Modulators in RA Feb 2011 should
be replaced the flowchart from NICE entitled “NICE Guidance on biologic drugs for the treatment of RA Feb 2012”
Pirfenidione for Pulmonary Fibrosis
Requested by Dr Allcock for use in IPF as now NICE approved.
Flutiform
Requested by Dr Allcock for treatment of asthma in those 12years and older.
Evidence presented as per application form.
Reviews:
 NICE – not considered
 SMC – approved Oct 2012
 AWMSG – not considered
 RDTC – not considered
 LNDG – not considered
 MTRAC – not considered
 NETAG – not considered
 NoT APC – approved
Noted is cheapest combination inhaler available for treatment of asthma.
Glycopyrronium bromide
Requested by Dr Allcock for treatment of COPD.
Evidence presented as per application form.
Reviews:
 NICE – not considered
 SMC – approved Jan 2013
 AWMSG – not consider
 RDTC – Nov 2012 – may be more cost-effective that alternatives but long-term date and direct comparator
trials lacking.
 LNDG – not considered
 MTRAC – approved Nov 2012
 NETAG – not considered
 NoT APC – approved
 DTB – June 2012 – insufficient evidence to recommend over existing product.
Fexofenadine
Requested for addition to formulary as on North of Tyne Formulary, and often used by specialists in preference to
other antihistamines.
Mycophenolate for Pulmonary Fibrosis
GMMC asked to confirm formulary status of mycophenolate when used for this indication. Noted that
mycophenolate is not licensed for this indication and evidence base is week. Also NICE are developing a CG on
Idiopathic Pulmonary Fibrosis and the current draft does not recommend use of mycophenolate.
Conclusion:

Abatacept for RA – approved as red drug as per NICE TA280.

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Pirfenidione -Approved for addition to formulary in line with NICE TAG as red drug. Noted will only be
available by clinics approved by Specialised Commissioning.
Flutiform – approved as Green drug for use in asthma only. Not expecting existing patients to be switched
to flutiform.
Glycopyrronium (Seebr®) – refused. The group noted that there are now three LAMAS available. The
GMMC felt that to accept a second LAMA onto the formulary it should offer differences to tiotropium (e.g.
design of inhaler), and Seebri® device is similar in design to Tiotropium.

Fexofenadine – approved as Green drug

Mycophenolate – should not be prescribed for idiopathic pulmonary fibrosis. It approved on the formulary
for shared care use in gastro, RA, transplant and dermatology only.
New Drug Requests for August 2013
Item 7
Discussion:

None received to date
Item 8
Discussion:
Nothing to report.
Antimicrobial Update
Item 9
Formulary Chapter Updates
Enc 9-14
Discussion:
The following chapters of the GHFNT formulary have been updated on the internet/intranet sites since the last
meeting:
 1 – Gastrointestinal
 2 – Cardiovascular
 3 – Respiratory
 4 – Central Nervous System
 5 – Infections
 6 – Endocrine
Conclusion:
Chapter updated approved.
Agreed in future to list changes since last version on page 1.
Noted that infections chapter needs further revisions and to ensure that when doing updates Red drugs are
appropriately annotated.
Item 10
Request for change of routine GCSF used in
Gateshead - routine use of Zarzio instead of
lenograstim
Enc 15
Discussion:
Enclosed briefing paper was discussed.
Conclusion:
Change to the formulary approved as follows:
Zarzio® – for majority of neutropenic patients
Lenograstim – for stem collection patients
Pegfligrastim – for oncology patients as Cancer Network says more cost-effective for this group of patients as single
dose rather than 3-5day dose so saves District Nurse time.
Alfentanil Guideline
Item 11
Enc 16
Discussion:
Request received from GHFNT Palliative Care team to adopt South Tyneside Alfentanil Information sheet for GPs
and Community Pharmacies in Gateshead. This would be send to relevant GP/Community Pharmacy by palliative
care team each time a patient is commenced on an alfentanil syringe driver, as has happens in South Tyneside.
Conclusion:
Guideline approved.
Item 12
Guidelines for approval
Enc 20
Discussion:
Following existing guidelines have been revised & updated:
 Osteoporosis Guideline – to follow
 Sip Feed Guideline – to follow
 Gluten Free Guideline – to follow
 Constipation Guideline
 ENT Guideline
Conclusion:





Osteoporosis Guideline – further meetings to be arranged to update
Sip Feed Guideline – agreed to review & update via email
Gluten Free Guideline – agreed to review & update via email
Constipation Guideline - approved
ENT Guideline – approved medicines aspects of this guideline only. Not for GMMC to approve/comment on
referral/treatment pathway of these patients
Rivaroxaban
Item 13
Discussion:
GMMC is asked to approve Rivaroxaban as a Green + drug for patients with DVT/PE whom the anticoagulant
service have identified as difficult to manage on warfarin and/or tinzaparin, and refer to haematologists for advice
on their management.
Would remain non-formulary for all newly diagnosed DVT/PE patients until DVT/PE referral/treatment pathway
redesigned.
Conclusion:
Approved.
Item 14
Denosumab
Discussion:
Denosumab was approved as a Green+ drug in Nov 2012. GHFNT are encountering problems in transferring
patients for primary care.
Conclusion:
This needs some pathway redesign with commissioners. Until such time as this in place prescribing of Denosumab
will largely remain in secondary care. CCG will inform GHFNT when patients can be transferred to primary care.
Item 15
Apomorphine injection for Parkinson’s disease
Discussion:
PD team would like to develop shared care guideline for apomorphine injection as it is classed as Amber on the
formulary. This should be ready for approval in Aug 2013
We will be only handful of patients.
There is one patient due to start in July 2013 and this will be on non-formulary basis with agreement of GP/CCG/PD
team.
Item 16
Formulary Choice of Emollients
Enc
Discussion:
Dermatology services in Gateshead are largely provided by Newcastle and therefore, it would make sense to have
a formulary for emollients that matches that of Newcastle. Noted that North of Tyne APC have recently rationalised
the list of emollients on their formulary.
Conclusion:
Agreed to change Gateshead formulary for emollients to match that of Newcastle.
District Nurse Dressing Request Form
Item 17
Enc
Discussion:
Form is to be used by DNs to request dressings from GP practices.
Aim is to reduce inappropriate prescribing and provide information to practices on the wound management plan for
the patient.
Conclusion:
Approved
Item 18
LMWH Information Sheets for Primary Care
Enc
Discussion:
LMWH information sheets have been developed as part of the NPSA alert on LMWH treatment doses to provide
information on monitoring requirements and doses per kg for patients.
Sheets will be distributed to all GP practices, OOH providers and community pharmacists
Conclusion:
Approved
Item 19
Shared Care Guidelines for Approval
Discussion:
None received this month.
Item 20
NHS SoTW PGDs For Approval
Conclusion:
None received this month.
Item 21
Exceptional Case Requests
Discussion:
None received this month.
Noted new online CCG IFR system has now gone live.
Item 22
NICE Guidance April 2013 & May 2013
Enc
Discussion:
 CG159 – Social anxiety disorder - all relevant drugs on formulary. n/a to GHNFT as pts treated in MTW
Mental Health Trust
 CG160 – Feverish illness in children – no specific drugs included
 TA278 – Asthma – Omalizumab (review of TA133 + TA201) – approved by NICE. Noted use extended &

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GHFNT signed up to PAS scheme.
TA280 – RA – abatacept (2nd line) – rapid review of TA234 - approved as an option by NICE. Approved for
addition to formulary in line with NICE TAG.
TA281 – Gout – canakinumab - appraisal terminated by NICE. Drug not on formulary in Gateshead.
TA282 – Idiopathic pulmonary fibrosis – pirfenidone – approved by NICE. Approved for addition to
formulary in line with NICE TAG. Noted will only be available by clinics approved by Specialised
Commissioning.
TA283 – Macular oedema – ranibizumab - approved by NICE. n/a to GHNFT as pts treated in Newcastle
or Sunderland.
TA284 – Bevacizumab with paclitaxel and carboplatin for advanced ovarian cancer – not approved by
NICE. Drug not on formulary in Gateshead.
TA285 – Bevacizumab - not approved by NICE. Drug not on formulary in Gateshead.
TA286 – inhaled loxapine - TA274 – appraisal terminated by NICE. Drug not on formulary in Gateshead.
NICE guidance published in April and May 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 23
Drug Safety Updates April & May 2013
Enc
Following MHRA Drug Safety Updates issued since last meeting:
 April 2013 Drug Safety Update
 May 2013 Drug Safety Update
Following other Safety Updates of note:
 None
The committee is asked not note any implications for prescribing across Gateshead and recommend any actions
required.
Item 24
Items for Information Only
Enc
Discussion:
Items circulated were: GHFNT Trust Drug Expenditure Report Q4 201213
 RDTC TNF inhibitor guidance
 NHS Gateshead CCG Prescribing Engagement Scheme
Item 25
AOB
Discussion:
Rotigotine Patches
Noted there has been a change to storage conditions for rotigotine patches and they can now be stored at room
temperature rather than in the fridge.
Unfortunately batches of the product which require fridge storage still remain in UK supply chain so to avoid
confusions manufacturer have confirmed all batches can be stored in the fridge until supplies of the old batches are
exhausted.
Ferrinject
There appears to have been an increased use in of IV iron in heart failure patients recently. Agreed that the Chair
will contact the cardiologists to understand if there has been a change in practice and the reasons behind this.
CCG Decision Approval Process
Discussions are ongoing with CCG Executive about ratification by CCG of decisions undertaken by GMMC.
GMMC Workplan 2013/14
This has been prepared and will be circulated to members via email.
Date of Next Meeting: Wednesday 14th August 2013 9am-12noon Room 4, QEH Education Centre