DUDLEY LOCAL PHARMACEUTICAL COMMITTEE

Chairman: Dan Attry MRPharmS, Clin. Dip., MIoD 8 Abbotts Mews, Withymoor Village, Brierley Hill, West Midlands, DY5 3DG Tel: 0797363258 E-mail: [email protected]

Chief Officer: Pete Szczepanski MRPharmS, Clin. Dip., IP 22 Lindford Way, Kings Norton, Birmingham, West Midlands B38 0BD Tel: 07774719508 E-mail: [email protected] http://psnc.org.uk/dudley-lpc/

Minutes of the LPC Committee Meeting on 8 th June 2015

Present:- Pete Szczepanski, Dan Attry, Diane Walker, Lynn Rees, Stephen Noble, Vijay Lad, Mohammed Mahroof, Abul Kashem, Scot Taylor, Dinesh Patel, Julie Sheldon, Matthew Cox, Thomas Thomik.

In attendance:- Jag Sangha; Office of Public Health/Medicines Management, Michelle Dyoss; Dudley CPDO, Paresh Patel, Dudley CCG; Colin McIntosh, MSD

1. Welcome – DA welcomed the members and guests before opening the meeting at 19.00.

2. Apologies - Amjid Iqbal.

3. Declarations of Interests – There were no declarations of interests for this meeting.

4. ETPR2 Rollout – Paresh Patel

PP primary care IT manager for Dudley CCG gave a brief overview of ETPr2 within the borough.

Despite delays roll out of epsr2 in Dudley has begun. The working group; including PP, PS and JS have met on a few occasions and PP reports back to Dudley IT strategy board on a monthly basis. To maximize benefits from day 1, they have secured funding for resource to allow for some of the prerequisites to roll out to be undertaken. Initially a meeting is held with the practice going live and each pharmacy aligned to that practice. PP then visits pharmacies to ensure everything is in place and invites are given for all parties to attend a change workshop approximately 2 weeks before go live to make sure both teams are aware of the change in process. On go live date, an emis trainer is on site to train and assist the practice. Whilst on site, the first set up prescriptions are chased with pharmacy to ensure everything is in order.

Kingswinford Medical Practice was the first to go live on 3rd June and on the whole was successful. The next surgery is High Oak followed by Stepping Stones, Meadowbrook, Coseley and Ridgeway and dates are being finalized for Bath Street and Stourview. As mentioned, PS is on the working group so will be kept informed of future go live dates and changes and will keep contractors up to date.

VL asked about the expected speed of roll out throughout the borough. PP commented that it is anticipated to be 1 practice per week and there are currently 47 in the region. However, some sites are more hesitant than others although they will be supported to work towards a go live date. To conclude, PP expects that it will take between 12 to 18 months for all surgeries to switch.

ACTION: PP to keep contractors and LPC members up to date with information regarding ETPr2 rollout.

5. Helping Hypoglycaemic Patients in the Community – Colin McIntosh

MSD is passionate about developing and providing service solutions to the NHS that meet customers’ needs so that they can deliver the best care and outcomes possible for patients. CM specialist in Diabetes and Lipids general medicine from MSD met with PS a few weeks ago to determine how MSD can support the LPC to benefit practice and patients. MSD have developed a pack designed to provide additional skills and resources to pharmacists and their teams to help them identify if patients are at risk or, or suffering from hypoglycaemia. This tool kit provides a variety of materials that will enable pharmacy teams to improve their knowledge of hypoglycaemia and identify ways that they can support patients who may be experiencing hypoglycaemia. CM bought along the pack to get feedback from LPC representatives as a core group to assess useability and consider using it as a basis for an educational event for all contractors.

LPC representatives commented that the pack was very structured and informative and could definitely see a benefit for use in practice to engage patients with their treatment. All were keen to use it in practice and AK offered to give some feedback. There was discussion about MSD possibly supporting the AGM in September that PS will address. CM is willing to support any contractors and can be contacted on [email protected] or 07779706531.

6. PHP-P Report - Michelle Dyoss

MD forwarded her report to LPC representatives prior to the meeting and briefly covered the important points:

Sun Awareness  Held training session attended by 10 pharmacy staff.

 Talk from skin cancer nurse from RHH – skin cancer being the most common form in Dudley.

 Pharmacies wanting to do promotional work are being followed up by Parminder Sogi.

Events  Attended Black Country Talent Match event for young people

o Talked to over 200 young people giving out alcohol scratch cards, chlamydia tests etc

 Attended alcohol event at Halesowen College

o Attended with alcohol lead and noted that website hits increased during/after event – had 80 hits.

 Need support for following events:

o Do it Right Dudley (as below)

o Get Connected Wordsley event 9am – 3pm

o HLP roadshows (as below)

ACTION: PS to send email to contractors regarding supporting the upcoming events.

Do it Right Dudley Events need pharmacist representation from 10-2 on each following initial feedback from the campaign (see below).  Friday 12th June 2015 – Dudley College

 Friday 19th June 2015 – Stourbridge Town

 Friday 26th June 2015 – Dudley Town ‘Do It Right Dudley!’ Campaign Feedback 12th May 2015 Table 1  Pharmacists don’t do as much as they could

 The title doesn’t give recognition of NHS

 We need to get back to people only using A&E for emergencies

 People should be told when they are in the right place. Otherwise how will they learn

 If there were more GPs and appointments – these may be less of an issue

 Wouldn’t make me change my behaviour – I don’t feel like I do the wrong thing

 PPI with LTC’s should be prioritised

 We shouldn’t be telling people the NHS is free! It costs us all something

 Maybe people should be allocated a certain budget

 Maybe PPI should be charged for non-attendees at GP

 A&E should charge for inappropriate use

 Title – should be NHS – not free

Table 2  Good idea

 Road shows good idea – take the message out on the road

 Pharmacies need to work harder and offer their services more

 People should definitely be told when they are in the wrong place

 Like the title

 Cost of pharmacy contact and GP contact comparison

 Get children involved – so they understand as they grow and can educate their parents

 WHAT DOES THIS SAY? Conveniences services should be better advertised

Table 3  Getting an appointment with GP is a problem and is getting worse

 Continuity of care with GPs is an issue

 Pharmacists need to promote services better and what they can do and other

 Not posters – maybe give leaflets in with medications of what’s on offer and what they can access

 Touch points – cost implications. Patients to be told

Table 4  Letter – tone uncomfortable

 People are not comfortable taking their problems to pharmacy

o Need to address this

 Need to share figures and facts to increase confidence

 Using pharmacy is an advantage

 Need to include messages about DNA’s

o State the important of cancelling if you cannot attend

 Pharmacy first ailment scheme – needs more promotion

 Pharmacy should be giving more information – this campaign should be in Pharmacy

 Charges should be applied

Did the title grab your attention?  If you fail to attend an appointment at your GP you should be asked to pay a fee

 Will there be a GP appointment available

 The title grabs my attentions as Dudley is in the title. From a health perspective it doesn’t immediately attract

 Listing the fees provides information to allow for accountability for users of the service

 Need more personal responsibility

How did the letter make you feel?  Letter raised awareness of cost impact  Targeting service users

 Intervention service

 Raising awareness via family members

 Working with preventative services

 Educating carers

 The information received today would make me make a different choice

Do you think there was anything missing?  NHS111 is a waste of space

 Show difference in cost between doctors and going to the chemist

 Advertise some medications can be received free of charge at pharmacies rather than have to always go to GP as people think they always have to pay for medication in pharmacy

 Triage nurse to answer phone calls to decide whether an appointment with a GP is necessary rather than NHS 111 as patients are reluctant to talk to receptionists about illnesses

 GPs themselves hand out leaflets with advice on alternative services and suggest to their patient they need not see the GP next time

 Large posters needed in GP and pharmacy waiting rooms advertising ‘new’ ways of dealing with certain illnesses

 Can pharmacies ask people if they require top ups of basic medication e.g. paracetamol rather like being asked in card shops, if you want stamps?

 Use back of bus advert

Did anything surprise you?  The cost

 Saving care & providers on cost impact of other services

 The cost of overnight hospital stay

 Show bus to visit schools and do stands

 Can we see nurses instead? HLP roadshows need cover all day  Tuesday 7th July

o Halesowen town centre

 Thursday 9th July

o Dudley town centre

 Tuesday 14th July

o Stourbridge town centre

Sexual Health Consultation paper An independent consultation conducted recently showed:  The role of pharmacy should be maximised and include at minimum HIV point of care and ‘quick start’ with integrated pathways to other relevant services

 “Staff were very friendly and helpful in central clinic and doctor’s surgery Pharmacy services were local to me and gave me useful information. Pharmacist was also helpful when I rang back to ask about whether it was safe to take the morning after pill after an ectopic pregnancy”

 38% stated they would access a service at a main pharmacy, 61% at a GPs (not necessarily their own), 73% a hospital and 34% Dudley Town Centre

 Also in the survey, 67% of young people reported they would access services via their GP, 52% their local hospital, 42% a main pharmacy, 36% college and just over 30% Dudley town centre

 Community Pharmacy o There is a real opportunity and desire to expand pharmacy provision in the Borough. For example; o Offering the contraceptive pill ‘quick start’ with link to follow up using PharmOutcomes (i.e. notifying practice for follow up appointment) o Offering Ella one as well as Levonelle o More sexual health screening in pharmacy for other sexually transmitted infections (chlamydia/HIV/Gonorrhea/Syphilis o Implant insertion/removal o HPV provision  “community pharmacy can not only complete chlamydia as a sexual health service as screening and testing but also HIV screening very well in all locations and then other STI's such as syphilis and gonorrhea. There is a great opportunity for mini pill provision in community pharmacy after the EHC service (first supply) and even implant insertion or removal in the community. HPV provision could also be delivered in the community pharmacy successfully (and a school provision developed if desirable). Free condom provision”  The 2014 Youth survey shows that young people value accessing services via community pharmacy, although it was again noted that this may be beneficial and increase coverage for all groups. There would be a training implication and pharmacy staff would benefit from increased confidence and skills in asking difficult questions regarding sexual health and LGBT issues. Extended services in pharmacy could increase access, however it would require confidential consultation areas to ensure privacy and confidentiality. It would also require that pharmacy options are promoted and detailed in any single point of access of information resources, and the participants at the workshop stressed the importance of making sure young people are aware of their options within pharmacy utilising resources such as Plan B and “Derek sent me” cards.

MD reported that a sexual health meeting would be coming up so will keep LPC members informed although bear in mind that these are just recommendations at present and not necessarily going to be implemented.

ACTION: MC to inform MD of any resource he can provide for Do it Right Dudley events.

7. Medicines Management/Office of Public Health Report – Jag Sangha

JS gave a brief update on the current situation regarding third party ordering. He has been writing a paper for the subcommittee meeting regarding recent concerns with third party ordering contributing to medicines waste which is to be presented at the next meeting on Thursday 18th June. JS will circulate the paper although he commented that it was imperative to ensure LPC representation at the subcommittee meeting to balance some of the arguments.

JS highlighted that one of the up and coming work programmes for practice based pharmacists is looking at reviewing insulin pen needles so contractors need to be informed regarding stock of needles. JS will forward info to DA and PS to ensure contractors are aware of what is going on.

8. Committee Meetings

a. ACE Subcommittee Meeting – Vijay Lad

VL attended the Dudley Area Clinical Effectiveness Committee (ACE) on Thursday 14th May 2015 and forwarded his report to committee members prior to the meeting. He gave a brief overview of the main points.

FORMULARY SECTION a) Dermatology Guidelines and Formulary. Committee in the process of approving dermatology formula which was developed across the country for use by healthcare professionals involved in the management and assessment of skin conditions. 1a Acne- Topical antibiotic use Clindamycin 1% other additions are Zineryt Lotion and Duac gel (5+1%). 1b Emollients- First line emollient is Cetraben Cream , established that a range of other emollients should be on the formulae e.g Zerobase cream as an alternative, Zeroderm Ointment alternative to Epaderm ointment. Still prescribe Liquid Paraffin/WSP (50:50) . Hydromol Intensive Urea 10% proposed as a cheaper alternative to Flexitol Balm. 1c Flexural Psoriasis- Proposed Timodine, Daktacort and Canestan HC as Trimovate still stock issues. 1d Scalp Psoriasis- Capasal as Polytar is unavailable. 1e Soap Substitutes- ZeroAQS cream is proposed instead of Aqueous cream as more cost effective in primary care costings. £3.29 as appose to £4.50 . 1f Topical Corticosteriods- Fucidin H cream rather than plain Hydrocortisone 1% although more expensive £5.02 compared to £2.08 in primary care.

SIMBRINZA Formulary application : Brinzolamide/Brimonidine eye drops as a suspension. There is no significant additional costs with the combination product compared with the individual components.Advantage is better patient compliance as only twice daily dosage and one less burden for the patient. LPC- Better to prescribe this product by brand name to minimise the risk of errors with other combination eye drops.

GUIDELINES & POLICIES. Lower Urinary Tract symptoms (LUT's) Urologist Dr Chakravarti did a presentation. Concluded that a combination product such as Vesomi (Tamsulosin 0.4mg and Solifenacin 6mg) would achieve better clinical results than single line product e.g Tamsulosin, Oxybutynin with an Anticholinergic. Impact of incontinence in public health is very high 1 in 4 women and 1 in 8 men . Subject bit of a taboo -embarrasing etc. Dudley Adult Continence Service is well establised across the borough with good links between primary and secondary care. Pathway is formulated as a guideline prescribing for Dudley Borough (See attachment). Dementia Assessment- ESCA progress update on dementia drugs . Currently patient referred for Dementia assessment either by a SSSFT (specialist dementia nurse) or DWMHT-Older adult Psychiatrist. Once diagnosis is confirmed only then referred to GP for ongoing treatments. Vitamin D Pathway- Current Dudley recommended pdt . Is Osteocaps D3 20,000iu for adults and PRO D3 Oral Solution for children. (£3.99 for 30 caps and £9.80 for 20ml). Proposed product is Invita D3 25.000 Oral Solution which is a licensed product and the advantage of easy to use for both adults and chil;dren. Cost ; Comparable.

Insulin Pen Needle Guideline- Aprox. 0.25 million spenditure on all pen needles in Dudley. Dudley CCG advice only to use Mylife (most expensive) in cases where there is a high risk of needle stick injury e.g third party administration by nurses.Most commonly prescribed is BD Microfine cost £9.69 and Omnican fine which is the cheapest at £5.95.

Wound Care – Wound Management Sub group conducted a graft document . Proposed to use Kerralite Cool instead of ActiForm Cool. Also KerraPro is more effective and requested for a product switch. Concerns raised to the overprescribing by GP's over a 3 month period of Silver dressings (10K.)

ACE ratified Terms of Reference -confirmed LPC representation along with 12 other sub-groups. Five members need to be present for the meeting to be quorate.One GP (chair or vice chair) “ GP's must be Locality Prescribing leads. One Public health Pharmacist and one from Dudley Group NHS Foudation Trust .

New Product Assessment Request- Draft document complied by Duncan Jenkins for the commitee's perusal.This will be used for drugs not on existing formulary , a drug already on the formulary for another application , a new formulation of an existing drug or a drug to replace a current one.

ACTION: Ensure LPC representation at the next meeting to be held on Thursday 23rd July 2015 , Purple Room, Falcon House. 1-3pm as VL on holiday and unable to attend.

b. Prescribing Subcommittee Meeting – Vijay Lad

The prescribing subcommittee meeting was cancelled and rescheduled for Thursday18th June 1-3pm.

ACTION: Imperative that we get representation on this meeting

c. Primary Care Development Committee – Thomas Thomik

The next meting is being held on Friday 19th June ; the first since reforming of the committee so need to ensure LPC representation. ACTION: TT to attend next meeting and forward agenda to PS and DA once received.

d. ETPR2 Steering Group – Pete Szczepanski

Covered earlier by JS.

9. A.O.B.

Members said goodbye to Julie Sheldon and thanked her for her work with Dudley LPC as she moves out of the area to Worcester.

Signed by the Chairman ......

Date: 13th July 2015 ......