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JPG Minutes Page 1 of 12 17/07/2017
City and Hackney Clinical Commissioning Group Homerton University Hospital Foundation Trust
Joint Prescribing & Medicines Management Group (JPG) Minutes
Date: Monday 9th November 2015 Time: 12.30pm – 2.00pm Venue: Trust Offices Meeting Room, HUHFT
Chair: Richard Bull
Present: Dr Haren Patel, Prescribing Lead GP, Joint Chairperson; City and Hackney CCG (HaP) Dr Richard Bull, Consultant Dermatologist, Joint Chairperson, HUHFT – (RB) Michael Vidal, Patient & Public Involvement Representative (MV) Rozalia Enti, Medicines Management Lead City and Hackney CCG – (RE) Iola Williams, Homerton Chief Pharmacist, HUHFT –(IW) Dr Raja Rajakulasingam, Respiratory Consultant, HUHFT – (RR) Dr Lewis Caplin, Prescribing Lead GP, City & Hackney CCG-(LC) Laura Morgan, Lead Pharmacist for Operational Services, HUHFT – (LM) Rhian Holland, Lead Pharmacist for Clinical Services, HUHFT – (RH) Elizabeth Ozogolu, Senior Prescribing Advisor for City and Hackney CCG – (EO) Sagal Hashi, Joint Formulary Pharmacist HUHFT & City & Hackney CCG, JPG Secretary (SaH) Katti Nwosu, Prescribing Advisor for City and Hackney CCG – (KN) Dr Francesco Medici, Consultant Endocrinologist, HUHFT –(FM) Dr Tammy Rothenberg, Consultant Pediatrician HUHFT- (TR) Dr Louise Abrams, Consultant Clinical Pharmacologist, HUHFT- (LA) Dr Lawrence Bloomberg, , Prescribing Lead GP, GP City &Hackney CCG -(LB) Dr Francesco Medici, Consultant Endocrinologist, HUHFT- (FM) Hitesh Patel, Pharmacist CEO City & Hackney LPC- (HiP)
Guests:
1.0 Minutes & Matters Arising 1.1 10/2015
Apologies, welcome and introductions Apologies:
1.2 10/2015
Declaration of Interests (DOI) The group was informed that the CCG are conducting their quarterly update. All members were asked to update their quarterly D.O.I forms. In addition to this all JPG members were given the opportunity to declare any D.O.I for any of the meeting’s agenda items.
1.3 10/2015
Minutes Minutes from the 12th of November were reviewed. A typing error was noted on page 8. All
other sections of the minutes agreed as accurate. Redacted minutes agreed as accurate.
1.4 10/2015
Actions from Previous meetings
JPG Minutes Page 2 of 12 17/07/2017
Financing of JPG away day Finance at City and Hackney CCG had been unable to get funding from HUHFT and asked for this to be escalated. The group had agreed before the away day to share the costs between the two organisations. The JPG were informed that HUHFT colleagues were still continuing to try and obtain funding for the JPG away day. Relevant paperwork had been circulated to the necessary departments at least a week prior to the JPG meeting. Action: Homerton team to continue to pursue this funding and to inform JPG of progress for the December meeting. 2.7 Application for Botox Pharmacy team at the Homerton to continue to liaise with pharmacy team at C&H CCG regarding the Botox application process.
2.0 Agenda Items 2.1 10/2015
NICE update: June 2015 – October 2015 The JPG were informed that feedback from lead gastroenterology team at HUHFT regarding vedolizumab for Crohn’s disease was received. The JPG are still awaiting feedbacks regarding the NICE TAs for Edoxaban and Naloxegol that had been circulated to the various clinical teams. The following NICE TA’s were reviewed in the meeting: Ruxolitinib for treating polycythaemia vera (terminated appraisal) TA356 Ruxolitinib for treating polycythaemia vera (terminated appraisal) The JPG agreed not to approve this medicine as currently NICE cannot recommend its use. Tolvaptan for treating autosomal dominant polycystic kidney disease TA358
Tolvaptan (Jinarc®) is recommended as a possible treatment for people with autosomal dominant polycystic kidney disease if:
they have chronic kidney disease stage 2 or 3 at the start of treatment
There is evidence of rapidly progressing disease. The JPG were informed that she had contacted consultant nephrologist who works at Bart’s Health, but also offers a service to the Homerton hospital. The JPG were informed that this consultant had stated that Homerton patients requiring this treatment will be treated at the RLH in a specialist PKD clinic. The consultant also stated that tolvaptan is not an agent that he would be using at Homerton but there would be C&H residents that would be prescribed this drug from RLH. Considering the information provided by the nephrology consultant: The JPG agreed not to approve this medicine for use at the Homerton University Hospital, Foundation Trust as the trust does not provide this specialist service. The JPG recommends that funding of this medicine be made available to enable City and Hackney patients to be prescribed the medication at specialist hospitals accredited to provide this medicine, provided it is used in accordance with NICE TA349. Hospital only prescribing (formulary status BLUE). PbR status to be confirmed.
JPG Minutes Page 3 of 12 17/07/2017
Simeprevir in combination with sofosbuvir for treating genotype 1 or 4 chronic hepatitis C (terminated appraisal) TA361 Simeprevir in combination with sofosbuvir for treating genotype 1 or 4 chronic hepatitis C no evidence submission was received from Janssen The JPG agreed not to approve this medicine as currently NICE cannot recommend its use. Pembrolizumab for treating advanced melanoma after disease progression with ipilimumab TA357 Pembrolizumab (Keytruda) is recommended. This drug is a possible treatment for adults with melanoma that:
Can’t be completely removed by surgery Has spread to other parts of the body has been treated with ipilimumab (melanoma
that is BRAF V600 mutation-positive must also have had treatment with vemurafenib, dabrafenib, or trametinib).
The JPG agreed not to approve this medicine for use at the Homerton University Hospital, Foundation Trust as the trust does not provide this specialist service. The JPG recommends that funding of this medicine be made available to enable City and Hackney patients to be prescribed the medication at specialist hospitals accredited to provide this medicine, provided it is used in accordance with NICE TA349. Hospital only prescribing (formulary status BLUE). Paclitaxel as albumin-bound nanoparticles with carboplatin for untreated non-small-cell lung cancer (terminated appraisal) TA362 NICE is unable to make a recommendation about the use in the NHS of paclitaxel as albumin-bound nanoparticles with carboplatin for adults with untreated non-small-cell lung cancer when potentially curative surgery or radiation therapy or both are unsuitable, because no evidence submission was received from Celgene technology. The JPG agreed not to approve this medicine as currently NICE cannot recommend its use. Paclitaxel as albumin-bound nanoparticles in combination with gemcitabine for previously untreated metastatic pancreatic cancer TA360 Nab-paclitaxel (Abraxane) with gemcitabine (Gemzar) is not recommended for adults with metastatic adenocarcinoma of the pancreas that has not been treated before. The JPG agreed not to approve this medicine as currently NICE cannot recommend its use. All medications with a positive NICE appraisal were formally accepted onto the formulary.
2.2 9/11/15
Chapter 3-BNF review Chapter 3-respiratory was circulated to all JPG members and relevant clinicians at HUHFT. Following this a respiratory subgroup was formed to review chapter 3 of the eBNF. The status of the medication in this chapter was reviewed by the JPG. Items that needed further discussion were then highlighted for discussion at the JPG meeting. The JPG reviewed the
JPG Minutes Page 4 of 12 17/07/2017
respiratory chapter of the BNF. The following decisions were agreed:
• Emerade® has not been reviewed by the JPG. The proposal by the respiratory subgroup was to submit a fast track application for the use of Emerade® as 1st line. This recommendation was based on the fact that Emerade® is supplied in the recommended adult dose (500 mcg) and it is cheaper than current first line EpiPen®Auto-injector (300 mcg). This will have implications on both primary care and secondary HD informed the JPG that there might be a difference in the excipients present in Emerade® and it might not be as simple as having a direct switch.
• . It was agreed that the addition of Pollinex® onto the formulary would need a full new drug business case to be presented to the JPG.
• The group discussed that currently in the eBNF choices are not ranked with 1st 2nd or 3rd line options.
• A JPG member stated that he would like Alvesco® to be considered in selected patients. It was agreed that this would need a full new drug business case to be presented to the JPG.
• The group was informed that currently theophylline is stated as an amber specialist knowledge drug. The respiratory subgroup wanted to know if GPs felt confident enough to initiate prescribing theophylline and to find out if this is something that GPs initiate in their standard practice when managing COPD patients. The consensus was that GPs do initiate theophylline and request levels when necessary. It was emphaised that theophylline needs to be monitored carefully, as patients will respond to theophylline therapy differently. In particular some patients will not benefit from treatment at all, thus it will need to be stopped.
• The JPG agreed to remove salbutamol oral tablets from the adult eBNF as there is not much evidence of benefit and it is rarely used in practice.
• The JPG reviewed oladaterol’s formulary status. Currently in the eBNF it has no status. The JPG were informed that evidence for its use is not strong and that it is rarely used in practice. The JPG agreed to give oladaterol a non-formulary status on the joint prescribing formulary.
• It was highlighted to the JPG that currently there are two ipratropium nebulisers available on the formulary. One is significantly more expensive than the other. The JPG agreed to remove Ipratropium Steri-Neb® (~£15.99) and keep Respontin® (~£5.60) as 1st choice.
• The mucolytics section of the eBNF was agreed as accurate • The JPG discussed the use of cough suppressants. It was explained that these
medications are not currently approved but are commonly used. A JPG member informed the JPG that the use of simple linctus is discouraged in primary care. It was noted that these medications are drugs of low clinical value. The JPG had a discussion on the appropriateness of having these medications added onto the formulary given the fact that they are not evidence based medicines and their use is associated with a placebo effect. It was noted that for some patients it was beneficial to have an option of giving a medication with a placebo effect. The JPG agreed that these medications would be available on the formulary; however a note should be added to state that they are of limited clinical benefit.
2.3 11/2015
Budesonide/formoterol (DuoResp Spiromax®) Fast track drug application
Decision Responsibility for Prescribing
Approved Green Joint
Formulary Choice
Primary and Secondary care.
JPG Minutes Page 5 of 12 17/07/2017
Applicants to develop a
patient focus group and
report back to JPG in a
year.
A JPG member declared that she has previously attended an advisory board for Teva.
Budesonide/formoterol (DuoResp Spiromax®) is a combination inhaler containing an inhaled
corticosteroid (ICS) and a long-acting beta2 agonist (LABA). This device is made by TEVA
Currently no clinical trial data is available. As a branded generic, Marketing Authorisation (MA)
has been granted by the European Medicines Agency (EMA) on the basis of demonstrating
pharmacokinetic equivalence to Symbicort® (budesonide/formoterol), As such, it is indicated
for the same patient groups as Symbicort®: Pharmacokinetic equivalence was not proved in the
lowest ICS/LABA combination that is equivalent to Symbicort® 100/6: Therefore DuoResp
Spiromax® is available in only the 160/4.5mcg dose (equivalent to 200/6 Symbicort®) and
320/9mcg dose (equivalent to 400/12 Symbicort®). The application is for use in both COPD and
asthma patients. This product is not licensed in patients under 18 years of age.
Discussion
The JPG were informed that there is a cost saving but only compared to Symbicort® (DuoResp
Spiromax® is £8 cheaper than Symbicort®), but there are not many patients that are on
Symbicort®. The applicant stated that she did not advise the mass switching of patients who
are currently on Symbicort® on to this inhaler; however it would be a useful cheaper
alternative for new patients requiring new initiation on a budesonide/formoterol inhaler. HD
informed the group that all patients started on this device and those switched would need
counselling as it is a significantly different device compared to Symbicort®.
The group were reminded about the importance of prescribing inhalers by brand to ensure
patients obtain the correct inhaler. The group were also informed that patients started on a
new inhaler were eligible for review by community pharmacists under the New Medicine
Service (NMS). The group were also informed that education and training sessions was taking
place with community pharmacists, nurses, GPs etc.
A JPG member asked if there were any difference between the different devices and asked if all
these new inhaler devices were needed. It was explained to the group that in general
establishing patient compliance with inhalers is very difficult. In addition to this when patients
don't agree with a device, it was explained that it is important to have are range of different
options available for patients to try. It was then stated that BTS and SIGN guidelines emphasise
that it’s important to have the availability of different inhaler choices to improve compliance.
The group were informed that Practice Support Pharmacists have found patients don't
understand the role of the ICS in managing their condition. This often then affects their
compliance as they do not feel that they need to take ICS. A JPG member explained that
compliance to steroid inhalers was not solely based on device choice. This was reiterated by
the applicant by stating that during counselling it was essential to emphasise that the ICS would
JPG Minutes Page 6 of 12 17/07/2017
be working as a preventer and that patients were informed that by using their ICS they would
improve their overall symptom control. It was further explained that adherence is generally
better in patients with COPD compared to asthma, as the nature of asthma means that
symptoms are not always present. Therefore a common problem with many asthmatics is that
they only use inhalers when they are having exacerbations and do not use their inhalers
regularly at other times. The group were informed that that there is not that much difference
between the devices in terms of clinical effectiveness, however different devices provided
patients with better usability. Therefore, additional patient choice could be crucial to
improving adherence and reducing exacerbations.
The applicant explained that it was important to give respiratory specialist and patients the
opportunity to trial the new devices. A JPG member recommended reviewing the changes in
prescribing rates of different inhalers in primary care.
The JPG agreed to approve the use of budesonide/formoterol (DuoResp Spiromax®) onto the
formulary.
2.4 11/15
Beclomethasone/formoterol 100/6 inhaler (Fostair®) Fast track drug application
Decision Responsibility for Prescribing
Approved Green Joint
Formulary Choice
Primary and Secondary care.
Fostair® is an MDI device. It contains beclometasone and formoterol which is licensed for
asthma and COPD. It is on the joint formulary for asthma. Currently there are only licensed dry
powder inhalers available for COPD. Seretide® 250 MDI has generally been used for COPD if
patients are unable to use a dry powder, but this is an unlicensed alternative. Fostair® is the
only licensed MDI for COPD. HD recommended that patients who are started on an MDI should
be given an aero chamber to aid administration.
September 15 BNF Cost of Seretide 250 evohaler: £59.48 per device
September 15 BNF Cost of Fostair® £29.32 per device
Calverley et al 2010: A randomised controlled trial beclometasone/formoterol in the
management of COPD (n= 718): Fostair® was shown to be non-inferior to
budesonide/formoterol in improving pre-dose morning lung function in people with severe
COPD over 48 weeks. There was no significant difference between the treatments in the rate of
COPD exacerbations/patient per year. The incidence of adverse events was similar between the
treatments.
Singh et al 2014: A randomised controlled trial extrafine beclometasone/formoterol compared
to fluticasone/salmeterol combination thearpy in COPD (n=419). Beclometasone/formoterol
was shown to statistically significantly improve the onset of bronchodilation in people with
JPG Minutes Page 7 of 12 17/07/2017
moderate-to-severe COPD compared with fluticasone/salmeterol. The clinical significance of
improvement in the onset of bronchodilation was unclear. Although, the treatments were
equivalent in improving dyspnoea over 12 weeks. Serious adverse events were statistically
significantly more common with fluticasone/salmeterol.
A NICE new evidence summary stated that: ‘From the published data,
beclometasone/formoterol appears to work as well in COPD as the 2 commonly used ICS/LABA
combinations, its constituent ingredients have been available for many years so their safety
profile is known, it costs less than most alternatives and it can be used with a spacer, which
many people with COPD need’.
The JPG were informed that the dosing of Fostair® was a lower dose than the Seretide®,
however new evidence in COPD was showing that a lower dose of steroid at 1000 BDP was
preferred instead of traditional 2000 BDP. This is particularly beneficial for patients who are at
risk of pneumonia.
Currently this device is only available in one strength; however the company are planning on
submitting a licensing request for the higher dose.
The applicant also informed the group that on the new COPD and asthma guidelines there
would be a link on how the devices will be used.
A JPG member stated that he believed that all the companies that have made a new
formulation are likely to also produce a new device. The JPG discussed the implications of
having a large number of devices on the market. In addition the JPG recognised that patients
feedback was needed to determine whether drugs added to the formulary where improving
patients inhaler compliance. It was stated that a patient focus group for all the new inhalers
was needed.
The JPG agreed to approve the use Beclomethasone/formoterol 100/6 inhaler (Fostair®) onto
the formulary. Healthwatch Hackney to be contacted to determine if they have any respiratory
patient focus groups or if one could be developed across the sector.
2.5 11/15
Beclomethasone/formoterol 100/6 (Fostair Nexthaler®) Fast track drug application
Fostair NEXThaler® is a new dry powder formulation inhaler licensed for the regular treatment
of asthma in adults aged 18 years and over where use of a combination product (ICS and LABA)
is appropriate. This device would enable patients to be stepped up and down on the same
device.
Decision Responsibility for Prescribing
Approved Green Joint
Formulary Choice
Primary and Secondary care.
JPG Minutes Page 8 of 12 17/07/2017
‘Kanniess et al 2014: A randomised double blind 8 week trial: Extrafine
beclomethasone/formoterol combination via a dry powder inhaler (NEXThaler®) or pMDI and
beclomethasone monotherapy for maintenance of asthma control in adult patients: suggests
that in adults with stable asthma, Fostair Nexthaler® is non-inferior to the pressurised metered
dose inhaler (Fostair®), and superior to non-extrafine beclometasone dry powder inhaler in
terms of change from baseline in mean pre-dose morning peak expiratory flow with no
difference in adverse events.
The JPG agreed to approve the use Beclomethasone/formoterol 100/6 (Fostair Nexthaler®)
onto the formulary.
ACTION: Beclomethasone/formoterol 100/6 (Fostair Nexthaler®) to be added the formulary
and notify the applicants of the decision. Applicants to develop a patient focus group and
report back to JPG in a year.
2.6 11/15
Tiotropium 5 mcg (Spiriva Respimat®) Fast track drug application
Tiotropium (Spiriva Respimat®) has been used for COPD. It has recently been licenced for use in
adults with poorly controlled asthma who are currently treated with ICS (at least 800
micrograms of budesonide per day or equivalent) and LABA. This would place it at Step 4 of the
British guideline (SIGN guideline) on the management of asthma adult treatment pathway.
Applicant Presented
and
written
By
Decision Responsibility for Prescribing
Approved Green Joint
Formulary Choice
Primary and Secondary care.
Kerstjens et al 2012: Tiotropium in asthma poorly controlled with standard combination
therapy (n= 912) was a two replicate randomised controlled trials of identical design. This
showed tiotropium improved peak and trough forced expired volume in 1 second (FEV1) and
lengthened the time to first severe exacerbation compared with placebo. A NICE new evidence
summary of this trial stated that ‘Differences between add-on therapy with tiotropium and
placebo in patient-assessed asthma control and quality of life were small and did not meet the
threshold for the minimal clinically important difference. There are no RCTs comparing
tiotropium with other active treatments or in people with asthma without persistent airflow
obstruction’.
Discussion
The group were informed that this is an add on therapy therefore will incur an additional
JPG Minutes Page 9 of 12 17/07/2017
charge; however the next stage of treatment is biologics, which are more expensive (this can
cost up to £30,000 pa). The group were informed that in practice, clinicians have been using
tiotropium for asthmatics at Stage 4 prior to its licensing.
The applicant addressed the issue of cardiac related side effects and tiotropium. The group
were informed that the TIOSPIR trial published in March 2015 showed that there was no
significant difference in mortality of tiotropium delivered via Respimat® compared with
Handihaler®.
A JPG member informed the JPG that some patients were using tiotropium more than the
recommended daily dosing as they had found that it had a fast dose response, which had
resulted in patients being subject to more side effects. The applicant emphasised that the main
way to improve patients understanding was through education and training. The applicant also
informed the group that that prescription requests could also be monitored, as this would help
healthcare professionals to determine if patients were using appropriate amounts.
A JPG member stated that in his clinical practice, he had found that although patients seemed
to like the inhaler they reported that it was difficult to engage the canister into the device
when it is first used. A JPG member agreed that community pharmacist could prime the
devices for patients to alleviate this problem.
The group were informed that placebos for the inhalers approved would be sent to the
practices with a flow chart.
The JPG agreed to approve the use Tiotropium 5 mcg (Spiriva Respimat®) onto the formulary.
To be started in patients at step 4 of the BTS guideline. Patients should have had respiratory
technique and compliance addressed before initiating this therapy.
2.7 11/15
Fluticasone furoate/ vilanterol trifenatate 92/22 (Relvar®) Fast track drug application
Fluticasone furoate/vilanterol (Relvar Ellipta®) is a once-daily ICS and LABA combination
inhaler, licensed for the symptomatic treatment of adults with chronic obstructive pulmonary
disease (COPD).
Decision Responsibility for Prescribing
Approved Green Joint
Formulary Choice
Primary and Secondary care.
A head to head study of Relvar Vs a currently available ICS/LABA combination (Agusti et al): was
a randomised, multicentre, double blind, double dummy, parallel group comparative
efficacy/safety study comparing once daily Relvar® 92/22mcg (fluticasone furoate/vilanterol) in
the morning, Vs twice daily Seretide Accuhaler® 500/50mcg (fluticasone
propionate/salmeterol) in patients with moderate to very severe COPD. This showed Relvar® to
JPG Minutes Page 10 of 12 17/07/2017
be non-inferior.
The group were informed that Relvar® is one of the cheapest combination inhalers. The
applicant emphasised that this device includes a new drug molecule, so GPs should be
encouraged to use the yellow card reporting system and to also encourage patients to report
any side effects.
The JPG discussed the cost saving potential of using Relvar®.
The JPG agreed to approve the use fluticasone furoate/ vilanterol trifenatate 92/22 (Relvar®)
onto the formulary.
2.8 11/2015
Dressing Report Update
The business analyst for Accelerate presented the dressings report update to the JPG. The JPG
were informed the JPG that this scheme has been running since July. All practices have had
representatives trained on the scheme. The Accelerate team have noticed that for some
practices only the original dressings order has been placed and nothing since, therefore work is
currently being done to make sure practices understand the system and are re-ordering
appropriately.
The applicant informed the JPG that they would be doing a comparative analysis about
prescribing across the surgeries. The applicant also told the JPG that Accelerate have utilised
Scriptswitch so that a message now appears on the EMIS systems when a prescriber tries to
prescribe one of the dressings on the dressing optimisation scheme.
The Accelerate team will now be sending information regarding what primary care clinicians
should and shouldn’t be prescribing to all GP practices again. They will inform them that all
woundcare should be going through this DOS; however there are exceptions to this. i.e.
dressings for a non-wound indication. The applicant talso informed the JPG that the Accelerate
team are working with the medicines management team to ensure all dressing are prescribed
appropriately e.g.to ensure there is no excessive use of foam dressings.
The applicant informed the group that on a case by case basis, on occasion the formulary has to
be changed for individual patients with specific needs. The group asked for clarification on how
these case by case decisions were made. The applicant informed the JPG that this is often when
patients have complex requirements as they might be seen by multiple members of different
professional teams. The individual specific requirements are then reviewed by HUHFT tissue
viability team. There is also a non-formulary request procedure. This is used very rarely. The
applicant emphasised that any clinical decision is made via the tissue viability team.
Currently the Accelerate team review the formulary with the tissue viability team. The
applicant asked the JPG members whether all changes to the Accelerate formulary should be
brought to the JPG for formal review or if minor changes could be amended by the Accelerate
team. The applicant gave the example of switching from Steropaste® to Viscopaste® as this is
no longer manufactured. The JPG requested that all changes should be submitted to the group.
The applicant was informed that as the Homerton Hospital are in the process of appointing a
JPG Minutes Page 11 of 12 17/07/2017
new tissue viability nurse lead; all updates should be made in consultation with the new post
holder. Once consultation with TV team is completed the recommended formulary updates
should then be submitted to the JPG for review. The applicant was asked to submit the new
formulary to the JPG in January.
The applicant informed the JPG that all home delivery of dressings, for patients who required
this service was now in place. The applicant explained that bulky order packages allows larger
items to be delivered directly to patients homes, however Accelerate have strict criteria for use
of this service. The applicant informed the JPG that the Accelerate team have had a request
from the lymphedema team for the addition of Viscopaste® onto the bulky orders package.
The JPG agreed that Viscopaste® would be classed as a bulky order and approved for it to be
added to the bulky orders list.
2.9 10/2015
Draft Business Case NELMMN
NELMMN has been running for several years, however throughout this time there have been
vast changes in the structure of the NHS. This group aims to reduce duplication within the
network and streamline pathways, in order to enable consistency across the 7 CCGs and 3
acute trusts. The benefits of NELMMN were explained to the group. The JPG were informed
that this group would continue to review high cost drugs, specialist commissioned drugs and
PbR excluded drugs and hospital only high risk drugs. Funding had previously been agreed for
HUHFT and C&H CCG to support the network about 2-3 years ago but had not been utilised.
During previous meetings it was agreed that the group in its current format was not
sustainable.
Another JPG member reiterated that the NELMMN group would help with streamline work-
streams around management of PbR excluded drugs, which affected all providers and CCGs in
the sector. It was suggested that Homerton colleagues write to their medical director. A JPG
member explained that this is not new money being requested, but finalising a previously
agreed arrangement. A JPG member suggested that a business case could be written by
Homerton highlighting savings provided by acquiring NELMMN services compared to the time
resource required to complete and review all high cost drug requests, supporting tools such as
Tick Box Forms and pathways as a stand-alone trust. Clarification was sought on how this would
fit into the use of Tickbox and Blueteq forms. A JPG member clarified that having someone
dedicated to organising these aspects would make the whole process a lot smoother.
A JPG member sought clarification regarding the remit of the Network and the JPG. The group
were informed that the Network remained an advisory body. It would make recommendations
(not decisions) to member organisations. Recommendations would then be brought to
individual JPGs for ratification.
3.0 Standing Items
JPG Minutes Page 12 of 12 17/07/2017
10/2015 3.1 10/2015
MHRA Drug Safety Update For information only
September 2015
The JPG were informed that all practice support pharmacists have been asked to support
general practices in implementation of the mirabegron alert
3.2 14/2015
Update on Electronic Formulary/ Review
4.0 Any Other Business Not on the Agenda
4.1 Nil
5.0 14/2015
Information Only Items – For noting
5.1 10/15
Epilepsy letters
6.1
Next Meeting
Monday 14th December Trust Office Meeting Room