Bedfordshire Local Pharmaceutical Committee

Unit 8, The Weltech Centre, Ridgeway, Welwyn Garden City, Hertfordshire, AL7 2AA Tel: 01707 390095 Mobile: 07800 764717 Fax: 01707 390124 email: [email protected]

Chief Officer Chair Vice Chair Treasurer Gerald Zeidman FRPharmS Coll Michaels MRPharmS Samir Patel MRPharmS Paul Fearon MRPharmS

MINUTES

An Open meeting of Bedfordshire Local Pharmaceutical Committee was held on Thursday 18th September 2014 at AstraZeneca’s Head Office, Horizon Place, 600 Capability Green, Luton, LU1 3LU.

Present: Members Coll Michaels (Chair) Samir Patel (Vice Chair) Rafica Ahmed Farwaj Chaudhuri Amit Lakhani Nazlin Meghji Kiran Patel Pinesh Patel Madhu Puvvada Carol Rose Rupal Sagoo Mahesh Shah Sundip Sheth

Bedfordshire LPC Office Gerald Zeidman (Chief Officer) Ethel Shaw (PA to Chief Officer)

Bedfordshire LPC Treasurer Paul Fearon

Guests Jacki Collett, Assistant Pharmacy Contracts Manager, Herts & South Midlands Area Team Tess Dawoud, Assistant Head of Medicines Optimisation, Luton CCG Belinda Ekuban, Chiltern Vale Locality, Pharmaceutical Lead, Beds CCG Carl Raybold, Beds & Herts LMC Ltd Jackie Smith, Care Homes Lead Pharmacist, Bedfordshire CCG Zara Mehra, Regional Tutor, East of England, CPPE Janice Jones, Northamptonshire Healthcare NHS FT, pharmacist advising the CAN partnership Mithun Mawkani, Professional Development Pharmacist, Avicenna

18.09.14 Bedfordshire LPC Open Minutes No. Agenda Item Action

845 Welcome by Chair The Chair welcomed members and guests to the meeting.

846 Apologies for Absence Carol Hill, Chief Officer, Luton CCG David Foord, Director of Quality & Clinical Governance, Luton CCG Richard Jones, Head of Medicines Optimisation, Luton CCG Healthwatch, Luton Healthwatch, Bedford Borough Healthwatch, Central Bedfordshire

847 Declarations of Interest None Declared

848 Minutes Approved The committee approved the Open meeting minutes from 12th June 2014 as proposed by Mahesh Shah and seconded by Carol Rose.

849 Matters Arising from Minutes 831 – Belinda advised there are three clinical services the CCG will be On-going procuring by April 2015 that are relevant to community pharmacists. She will send an email to confirm contacts for further information  Anti- coagulation  Phlebotomy  Dementia

ACTION – Belinda to send an email containing contact information Closed for the three suggested services.

801 – See above response from Belinda. Closed

804 – Meeting between Beds & Herts LMC and Beds LPC was held on On-going Monday 14th July 2014. A follow-up meeting is planned for January 20th 2015.

807 - John Hooper to provide an update regarding the DoH Winter Closed Pressure’s three priorities, minor ailments, flu immunisation and the supply of emergency medications within the NHS. He will then engage with Beds LPC.

819 – Problems with payments to community pharmacies who provided Closed an NHS flu vaccination service for 2013/14 have now been rectified. Any outstanding queries or issues are being processed.

820 –Sandra James, Head of Sexual Health Services Bedfordshire, has Closed confirmed that service level specifications and PGDs have been rolled over for 2014/15. Page 2 18.09.14 Bedfordshire LPC Open Minutes 823 – A meeting with Gerald and Central Bedfordshire Healthwatch is to On-going be arranged.

834 – Gerald to arrange Beds LPC representation at LiveWell Luton Closed Smoking contract discussions.

841 – Luton Public Health to continue to seek clarity regarding the On-going exclusivity of the services provided by Thrive Tribe. The LPC wished to know if the services can be recommissioned into community pharmacy.

850 Area Team update Jacki Collett gave the update.

Community Pharmacists had been commissioned to provide an NHS Flu vaccination service for 2014/2015 The Area Team confirmed that the service was commission for the at risk population from 12 years up to 65. Pregnant women were also included in the cohort of people that pharmacies were able to vaccinate.

So far 215 pharmacies within the Area Team had expressed an interest in providing the NHS flu vaccination service; approximately 57 of these were from Bedfordshire and Luton.

LPC members voiced concern that they were not able to vaccine over 65s as was the case for the 2013/14 season.

Jacki informed the meeting that Sonar Informatics had been commissioned to provide the administrative and IT back-up for the service.

LPC members highlighted there had been a number of teething problems with the service provided by Sonar and there were communication difficulties in contacting the flu leads at the Area Team. This was acknowledged by the Area Team and it will be included in the lessons learned.

Feedback from Beds LPC and contractors was requested by the Area team as part of their on-going lessons learned exercise in preparation for commissioning the service.

It was pointed out that the service will only be commissioned to community pharmacists for 2015/16 and future years if they successfully demonstrate that they add value to the service.

Public Health campaigns The Public Health campaign for August 2014 was Alcohol Awareness. This focused on messages for members of the public to be aware of how much alcohol they are drinking. The campaign slogan was “Don’t let Drink Sneak up on You, Catch it out and Cut Back”. Page 3 18.09.14 Bedfordshire LPC Open Minutes The Health promotion campaign for September/October 2014 is Seasonal Flu. The promotional material should been been sent out to all pharmacies in the week commencing 8th September 2014. Beds LPC were requested to feedback if any pharmacies did not receive the notification.

Kiran pointed out that it has been difficult to obtain display material for the campaigns. Jacki replied that public health is working with colleagues in other local Public Health teams in Herts, Milton Keynes and Northamptonshire to provide promotional materials to all pharmacies.

LPN Chair update As a result of the retirement of Heather Gray from the LPN post the Area team are carrying out a review to identify potential options for filling the post. It should also be noted there is a high level of re-organisation within NHS England due to be implemented from April 2015 and the future recruitment for this post may need to be viewed.

Practice Audit It is expected that a national NHS England practice audit will be rolled out during the course of the year but no confirmation of a date has been given as yet. As a result a local audit may be made available to Beds LPC to comment on should the national timescales not meet the Area Team’s aspirations.

CPAF update CPAF requests for 2014/2015 will only be sent to newly opened or change of ownership pharmacies. This is estimated to be 18 pharmacies across the AT area.

The current CPAF submissions are in the process of being reviewed. NHS England will be asking for clarity on areas of perceived non- compliance i.e in areas such as clinical governance, SOPs, patient safety (SI’s reported) MURs, owing arrangements, audit completion and safeguarding policies. Any shortfalls found on CPAF will be followed up with individual pharmacies. Outstanding annual returns will also be chased up by emailed to all pharmacies during the next month.

Christmas and New Year 2014 Pharmacies are expected to open for their contractual core hours over the festive period. Supplementary hours can be changed and/or relaxed provided pharmacies give the required 90 day notification.

Essential small pharmacies NHS England’s annual review of essential small pharmacy local pharmaceutical services ESPLPS contracts has taken place and a further three pharmacies have been served notice in line with the national directions that offer the contractors the opportunity to join the pharmaceutical list. All those currently affected have been contacted and Page 4 18.09.14 Bedfordshire LPC Open Minutes the Area Team is supporting them.

Beds LPC were reminded to note and update provisional plans for all other ESPLPS pharmacies that have contracts expiring 31st March 2015.

MUR update Nine Bedfordshire pharmacies over claimed and £2072 will be recovered. Four of the pharmacies are repeat offenders.

In Luton seven over claimed and £1820 will be recovered.

All pharmacies concerned have now received a formal letter asking for reasons and the majority have responded to confirm their over claim and repayment has been authorised by them. The recoveries of over payments will be made from pharmacies in October.

It was noted that a small number of pharmacies have significantly over performed or repeatedly over claimed for two consecutive years. The Area Team will be seeking their comments prior to considering any further steps. Beds LPC will be made aware of any formal action that may be taken.

The Chair thanked Jacki for her update.

851 Luton CCG update Tess Dawoud gave the update.

A presentation was given on behalf of David Foord, Director of Quality & Clinical Governance, Luton CCG.

The presentation outlined a five-year Strategic Plan for Luton CCG which included the following local outcome priorities  Every child and young person has a healthy start in life  Reduced health inequalities in Luton  Healthier and more independent adults and older people

The delivery plans include  Better Care fund two year plan 2014/15 – 2015/16  CCG two year Operating Plan 2014/15 – 2015/16  CCG two and five year Financial Plans  Area Team Two year Direct Commissioning Plan 2014/15 – 2015/16  Provider Two Year Plans 2014/15 – 2015/16  CCG Primary Care Strategy (which is in development)  Joint Mental Health Strategy

The health challenge in Luton was highlighted as it presents unique areas that need to be addressed. A summary of the key programmes to address the issues are

18.09.14 Bedfordshire LPC Open Minutes  Better Together – Integration of Health and Social Care  Transforming Primary care  Reconfiguring Mental Health and Community Services  Transforming Urgent Care Note - the result of the bidding for the Mental Health Service will be announced on 30th September.

It was pointed out that Luton CCG and NHS England are working together to develop a local Primary Care Strategy. This will include four clusters groups with the aim to reduce variation in health outcomes –  Medics United Cluster (7 practices)  Larkside Cluster (8 practices)  Kingsway Cluster (9 practices)  South East Luton Cluster (7 practices).

In relation to the 2013/14 financial performance, the original allocation was £225.2m however the year finished with a total expenditure of £230.5m – an over-spend of £5.3m. It was noted that the CCG historically £7 million underfunded.

Luton CCG has been formally identified as being in financial recovery. The current deficit forecast of -£6.9m could be as high as -£16.2m based on current activity trends.

The main areas of overspend were  Emergency admissions – particularly in the second half of the year  A&E – where the plan was set at 20% less than the previous year  Significant increase in outpatient first appointments and follow-ups  Outpatient procedures - high levels of growth in particular procedures

A recovery plan has been put in place to drive short, medium and long term resolution.

ACTION: Gerald to request overspend actuals from the CCG GZ

Committee members asked how access to GP’s will to be improved and if there was an opportunity to work with pharmacy to help alleviate GP workload.

Tess replied that access to GPs is covered in one of the work streams and possible pharmacy involvement will be investigated by the clusters.

The Chair thanked Tess for her update.

852 Luton Healthwatch update Kay Kokabi was unable to attend the meeting so this update will be given at November’s LPC meeting. Page 6 18.09.14 Bedfordshire LPC Open Minutes 853 LMC update Carl Raybold gave the update.

The workforce issues highlighted in June’s LPC meeting are being addressed. There have been an unprecedented number of practices wanting to merge or collaborate. The LMC has set up processes to assist with this this.

Out of Area Registrations Patients form outside the area will be eligible for registration at GP practices from 1st October 2014. This is still in the design stage at present. There has been no communication from NHS England so this date may slip.

Family Initiative A new Family Initiative will see patients being consulted regarding their opinion of their GP practice with questions such as  Would you recommend your GP practice for similar treatment

Feedback will be given at the end of the exercise.

Prescription Direction A new bypass number for pharmacists to contact GP practices when there is an urgent need is being put into place.

LPC members stated they were not aware of this initiative.

ACTION: Carl to chase this as pharmacy contractors have not CR received the number as yet.

Jackie Smith asked if pharmacists were notified of “at risk” patients. Carl advised that they aren’t as yet. Jackie asked for this to be considered as it would prevent A+ E admissions.

ACTION: Carl to request that pharmacists are notified of At Risk CR patients.

The Chair thanked Carl for his update.

854 Bedfordshire CCG update Belinda Ekuban gave the update.

Bedfordshire CCG is informally in financial recovery. The projected outturn for 2014/15 is a balanced budget. Work has started to address the position for a possible shortfall of in 2015/16.

Issues that the Medicines Optimisation Team were keeping under review included –

18.09.14 Bedfordshire LPC Open Minutes  Safe prescribing in community setting (use of PINCER software)  Support for patients with LTC (10 QOF indicators)  QIPP prescribing indicators (NSAIDs, Cephalasporins and quins, abx items)  Community based support for patients taking medicines (NMS & MUR - % participation, volume)  Access to Repeat medicines (repeat dispensing, electronic dispensing)  Medication safety in the hospital setting  Ensuring availability of novel NICE approved medicines (uptake of dabigatran)

It was noted that the two Bedfordshire Pharmaceutical Needs Assessments (PNAs) that were being rewritten.

Gerald reminded Belinda that a community pharmacy minor ailment scheme would help reduce pressure on both A&Es and GP practices. Farwaj agreed suggesting a pharmacy led minor illness programme should be commissioned.

EPS2 Four out of ten pharmacies are now EPS2 live in Bedfordshire.

Pharmacy Contractor Event A community pharmacy contractor event is scheduled for 12th November 2014 at Silsoe. Invitations have been sent out to Bedfordshire pharmacies informing them of the event.

The Chair thanked Belinda for her update. 855 Extra Care Housing with Community Pharmacy Initiative update Jackie Smith gave the update

Community Pharmacy Dementia Pilot The pilot required pharmacist to carry out a domiciliary MUR in patients homes’.

Out of the 50 patients initially required for the pilot only a small number took part, with just one pharmacy engaging throughout the life of the pilot. As a result findings were not as conclusive as initially hoped with insufficient evidence to go to CCG for further funding.

Details of the pilot will be included in the PNA.

It was noted that for future such initiatives there is a need to liaise closer with Beds LPC due to their ability to work closely with community pharmacies.

18.09.14 Bedfordshire LPC Open Minutes Extra Care Housing All residents are self-supported and as such can choose a pharmacy of their choice.

The initiative was deemed necessary as it was noted that staff delivering the care were not clinicians and therefore there had been instances of incorrect reporting which resulted in incorrect medicines and dosages being issued. It was identified as a staff training issue which is being addressed and is resulting in fewer errors and better trained staff.

The Chair thanked Jackie for her update.

856 CAN Partnership update Janice Jones gave the update.

It was noted that the work of the Partnership only covered Bedfordshire pharmacies, not Luton.

The finalising and updating the supervised methadone and needle exchange SLAs is in progress. It was noted that Mid Bedfordshire lacked sufficient pharmacies providing the service. This will then need the input of Beds LPC. Once approved it will be sent to all Bedfordshire pharmacists.

ACTION: Gerald and Janice to arrange meeting to discuss SLA GZ/JJ

A query was raised regarding if buprenorphine can be crushed in order to administer to some patients. It was noted that this would be out of licence although it was standard practice in prisons.

The Chair stated that pharmacists would need to check if their insurance liability would cover them to crush buprenorphine.

It was agreed that lines of communication between community pharmacies and CAN is poor and needed to be improved.

LPC members highlighted that alcohol abuse is a big problem and asked how an alcohol awareness service could be added to CAN’s commissioning intentions.

Janice replied that such a service would be considered in the future.

The Chair thanked Janice for her update.

857 CPPE training and development update Zara Mehra gave the update

Zara is working with Hertfordshire LPC on a dementia project.

All available training dates are available on the CPPE website. Page 9 18.09.14 Bedfordshire LPC Open Minutes Depression is a new focal point for CPPE.

CPPE is also now running Dementia Friendly sessions for pharmacists helping them become dementia friends.

Jackie Smith pointed out that the Dementia Virtual Tours should also be part of these sessions.

ACTION: Jackie to send link to the dementia training virtual tour to JS Beds LPC office

Consultation Skills workshops are also available. Event on November 4th in Luton.

858 To Note the evaluation from the Beds LPC’s General Pharmaceutical Council Inspection training which was held in the Rufus Centre, Flitwick on June 26th The evaluation from the well-attended and successful event was noted.

859 Healthy Living Pharmacy update Gerald gave the update.

Of the twenty pharmacies that participated in the first wave, ten have now returned their paperwork and received their accreditation visits.

Five pharmacies are now accredited – four in Luton and one in Central Bedfordshire. Another five pharmacies are completing their paperwork resulting from Beds LPC visits. An additional pharmacy is due to have an accreditation visit at the end of November.

The remaining nine pharmacies have received their paperwork and their accreditation visit will be arranged over the coming months.

An accreditation launch event is being planned for later in the year.

860 Community Pharmacy Commissioned Services update Gerald gave the update.

All three PNAs – Luton, Bedford Borough and Central Bedfordshire - are in progress. Steering groups have been set up including Beds LPC representation and regular meetings are being held.

It was noted that the revised Luton Stop Smoking service commissioned by Thrive Tribe will only be available for Luton pharmacies that have reached their four week quit targets.

ACTION: Gerald to take this up with Thrive Tribe and report to the GZ November LPC meeting. Page 10 18.09.14 Bedfordshire LPC Open Minutes The Sexual Health Services SLA for Bedfordshire has been sent to contractors. Luton’s revised Sexual Health SLA is in being reviewed with input from Beds LPC.

ACTION: Gerald to report at the November Beds LPC meeting on GZ progress to renegotiate the Community Pharmacy Luton Sexual Health SLA.

861 Any other business of a non-confidential nature None.

862 Date of next open meeting The next Open meeting will be held at AstraZeneca on Thursday 27th November 2014 at 1.45pm.

The meeting closed at 4:30pm

18.09.14 Bedfordshire LPC Open Minutes