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

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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.

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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

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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.

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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

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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

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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.

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‘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

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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

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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

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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

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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