Medicines Management Sub Committee

Medicines Management Joint Executive Team 1.30 – 3.30pm, Thursday, 19 September 2013 Meeting Room, Aylesbury Vale CCG, First Floor, The Gateway, Gatehouse Road, Aylesbury, HP19 8FF (01296 585900) MINUTES

1 Attendees: Dr Stuart Logan (SL) AV CCG Exec Clinical Lead for Chronic diseases, Medicines Management & End of Life Care. Dr Raj Bajwa (RB) (chair) Chiltern CCG Clinical Commissioning Director for LTC, End of Life & Prescribing Jane Butterworth (JB) Head of Medicines Management, AV & Chiltern CCGs Elaine Sharpe (ES) Prescribing Support Pharmacist, AV & Chiltern CCGs Rak Patel (RP) LPC Representative Sarah Crotty (SC) Interface Pharmacist, AV & Chiltern CCGs Alison Smith (AS) Prescribing Support Dietitian Julie Breakspear (JMB) Medicines Management Support Officer, AV & Chiltern CCGs

Apologies Julie Horslen (JH) LPC representative

MMJET_2013/135 Minutes of the previous meeting – 15 August 2013

It was pointed out that one of the minutes under item Aug13/124 regarding the back pain referral pathway had been slightly reworded after the draft minutes had been circulated. With this amendment the minutes of the last meeting held on Thursday, 15 August 2013 were approved as an accurate record.

Matters arising – SL commented that it had been discussed for next year that both CCGs should hold their exec meetings at the same time to enable video conferencing to be used for part of the meeting and this should be taken into account when setting the dates for the MMJET in 2014.

Items on the Action Update highlighted in yellow and listed on the agenda were reviewed.

 Jan13/003i – QIPP Analgesic review – It was agreed that it would still be worthwhile to carry out this review, particularly as there is continued pressure to prescribe pregabalin. ES would follow this through and would bring it back to the November MMJET.  Mar13/046b – Insulin Ready Reckoner – This had been piloted in six practices and had been rolled out in a few other practices as well, particularly those who had chosen diabetes as one of their targets under the incentive scheme. ES had also spoken to the Diabetic Specialist Nurses (DSNs) about the tool. There was some discussion about how to improve quality and governance and an agreed suggestion was that of a central resource for diabetes information. Possible ways of making the information available included using the Net-Formulary for guidelines, a possible intervention containing the links to key documents or a platform on the CCG members’ websites dedicated to diabetes, the latter being the favoured option. SL commented that Aylesbury Vale were looking at providing a central clinician’s resource on their intranet next year which could include diabetes, but it was reiterated that the MM team would only wish to upload to one site and for this to link into both CCG websites. ES will work with Gill Dunn to collate all the diabetes information for the central resource. JB commented that Diabetes and Long Term Conditions would always be a topic on the MMJET agenda.  Mar13/046f – Diabetes BGTS PIL – This was still outstanding but ES agreed to bring a draft to the October MMJET. Anything to do with diabetes should be added to the workplan including this PIL.  Jun13/087c – QIS – Pathology data – JB reported that she now has data from BHT by practice and cost and from HWP by test and by code for which there were 4 costs across codes. Unfortunately there is no data for Hillingdon yet but this is being worked on. JB can work with the data she has and believes it is robust so it should be possible to get this to practices by the end of the month. RB asked where queries should be directed to and it was decided that Raj Thakkar and Christine Campling should make this decision. JB should not get involved.  Jun13/090b – Diabetes LES review – A meeting had been arranged for 25 September and Simon Butcher was to attend for RB. The meeting would be looking at the insulin management service and whether a practice can fulfil the spec. Monitoring would also be built into the LES.  Jun13/096b – Supply issues letter – The drafting of a letter that can be given to patients about drug supply issues has not yet been done. SC agreed to take over this task.  Aug13/124e – ScriptSwitch comment for Forceval – AS is to look at prescribing data for Forceval and will bring a proposal to the October MMJET.  Aug13/125b – Document on baby milks which should not be prescribed – This document had not yet been taken to the Children’s JET for the attention of paediatricians. JB will follow through.  Aug13/125c – Support of dietitians at Oxford Radcliffe – AS has still to speak to dietitians at OR to gain their support regarding the prescribing of baby milks and hopes to do this within the next month.  Aug13/134a – Tamoxifen – This concerned NICE guidance that women at high risk of breast cancer be given tamoxifen. The guidance was not clear as to who should lead on this or who would be responsible. It was agreed that the relevant JETs would be responsible for Quality Standards issued by NICE for their particular areas of care but there was a need for the team to remain vigilant. Action 003i – ES to carry out QIPP analgesic review and bring to November MMJET Action 046b – This item is ongoing and will be reviewed in Mar 2014 Action 135a – ES will work with Gill Dunn to collate2 information for a diabetes central resource Action 135b – JMB to ensure that Diabetes/Long Term Conditions feature on every MMJET agenda. Action 046f – ES to bring draft BGTS PIL to October MMJET and ensure that anything to do with Date of Next Meeting: 17 October 2013 1.30pm – 3.30pm

Venue: Large Committee Room, Chiltern District Council