GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST. Formulary Working Group 2.00pm 20 th September 2018 The ALIS Room, The Academy, GWH

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1 Formulary Working Group 2.00pm 20 th September 2018 The ALIS Room, The Academy, GWH The 3T s Formulary Swindon CCG & Wiltshire CCG Great Western Hospitals NHS Foundation Trust (In collaboration with Avon and Wiltshire Mental Health Partnership and Oxford Health NHS Foundation Trust Attendees: Dr Francis Campbell (FC) (Chair) Dr Rachel Hobson (RH) Kathryn Buchanan (KB) (mins) Harpreet Rajput (HR) Dr Anne Woods (AW) Dr Philip Mayes (PM) Lisa King () GP representative, Swindon CCG Formulary Pharmacist, Wiltshire CCG Deputy Head of Medicines Optimisation, Swindon CCG Deputy Director of Pharmacy and Medicines Optimisation, GWHNHSFT GP representative, Wiltshire CCG GP representative, Swindon CCG Formulary Pharmacist, GWHNHSFT Apologies Paul Clarke (PC) Associate Director of Medicines Optimisation, Swindon CCG In attendance: Dan Jackson (DJ), GWH endocrine nurse specialist for SCA updates Dr Simon Manchip (SM), Consultant, AWP for dementia update Agenda Item 1 APOLOGIES Description Action by whom 2 3 MINUTES OF LAST MEETING Minutes of the last meeting were agreed as accurate. to upload pdf version to formulary website and forward to TPC for information. MATTERS ARISING Please see action tracker for progress on actions from last meeting and plan to expedite matters arising. Of particular note: Dan Jackson in attendance - SCA for testosterone & alfacalcidol Awaiting comments from endocrine consultants on both draft SCAs. Bring back to November meeting. RH to re-share original SCAs Dr Manchip in attendance review TLS of dementia drugs Simon summarised the implications of the 2018 NICE guideline; Melatonin / z drugs not endorsed, trazodone is recommended sedative Antisychotics in dementia; review at 6 weeks and continue ONLY if benefit Antidepressants not recommended generally for dementia patients Moderate dementia add in memantine to donepezil routinely Proposal were agreed for: Wiltshire change all dementia treatments to green but change memantine to amber. It was recognised that such traffic light changes for Wiltshire would need to be tied in with changes to their dementia LES, and ALL RH Page 1 of 5

2 hence no change would be possible until the LES was changed. It is anticipated that the updated LES would start from 1 st April Swindon change all dementia treatments to red so all prescribing goes through memory clinic. GPs in attendance and Dr Manchip were very supportive of this approach, citing GP pressure as the main reason. The current mixed picture, of some GPs prescribing in line with amber TLS and SCA, does cause much confusion and potential for errors in patients receiving / taking no dementia treatments or duplicate supply. The memory clinic are happy to take referrals from GWH consultants and will take over prescribing for patients in the interim period until they can be seen. Dr Manchip agreed to update other dementia-related documents for 3Ts Formulary. to forward current versions for revision. GWH extranet will not be supported in the longer term. This is the most useful version of the 3Ts formulary as it has search functionality. A further 6-12 months is possible therefore the planned work programme for establishing STP area prescribing committee needs to move forward. This work has already been flagged as a priority for the Medicines teams across the STP patch and we await October STP meeting to further galvanise progress Vitamin B12 pathway guidance from Bath agreed for formulary inclusion, in principle, depending on comments from GWH Haematology. RH to resend document. to re-circulate to GWH Haematology and chase comments. Pain guidance agreed. To be uploaded. Positioning of the lidocaine patch was discussed; GWH s use of Lidocaine plasters is higher compared to RUH and SFT where it is non formulary and red. Invite pain team representative to FWG to discuss. Antiplatelet guidance minor change to triple therapy length of treatment, now states 1-6 months rather than short term. To be uploaded. SM ALL RH / ITP pathway with Joy Craine (BaNES CCG) for finalising OAB to liaise with divisional pharmacists with view to engaging with GWH Urology & GWH Gynae and setting up a review of OAB guidance, including conversation about patches. Neither department appear to be prescribing in line with current agreed guidance. / KB Freestyle Libre prescribing has recently started within GWH for adults and paediatrics CHAPTER/SECTION UPDATES Emollients Prescribing Guideline. New inclusions for Excetera cream, Epimax ointment and Hydromol (ointment only). Subject to minor formatting changes this was approved for uploading to the website. For sharing with dermatology and other teams also. Chronic Migraine Pathway for Adults. This pathway developed by RUH reflects NICE and BASH guidelines. Approved subject to a check with Dr Lennox RH / Page 2 of 5

3 Sacubitril Valsartan guidance. KB to clarify wording around dose optimisation for ACE-I Dry Eye Syndrome. Comments for SFT are awaited on this updated guidance. Discussion around potential difficulties of supplying 1 st /2 nd line options due to hospital contract arrangements, which may have a cost impact for secondary care. to explore further and get detailed costings as ideally need to avoid transferring to different products in primary care. Useful to also include any recommendation about omega 3 oils supplementation being OTC rather than prescription. Dupilumab pathway. Available now within GWH and on bluteq. Potential problem with threshold of moderate eczema which is in line with NICE TA. Need to monitor patient numbers. KB RH / 5 NEW DRUG Update UKMI New Drugs Online Newsletters for July 2018 & August 2018 were noted New Drug Requests Intravitreal Bevacizumab. Commissioning Policy already in place approving the use of bevacizumab, KB to share Swindon statement, to share with Mr Shah. Add to formulary as red [Post meeting update high court appeal lost and therefore use of unlicensed bevacizumab for wet AMD within the NHS is now supported] NICE NICE TAs TA 217 Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease TA531 Pembrolizumab for untreated PD-L1-positive metastatic nonsmall-cell lung cancer TA 532 Cenegermin for treating neurotrophic keratitis Not commissioned TA533 Ocrelizumab for treating relapsing remitting multiple sclerosis Commissioned by NHSE. Add as red drug. TA534 Dupilumab for treating moderate to severe atopic dermatitis CCG commissioned. Already in pathway and added to formulary as red drug outside of last meeting due to rapid 30 day implementation date TA535 Lenvatinib and sorafenib for treating differentiated thyroid cancer after radioactive iodine TA536 Alectinib for untreated A-positive advanced non-small-cell KB / Page 3 of 5

4 lung cancer TA537 Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs CCG commissioned. Add as red drug. TA538 Dinutuximab beta for treating neuroblastoma TA539 Lutetium (177Lu) oxodotreotide for treating unresectable or metastatic neuroendocrine tumours TA540 Pembrolizumab for treating relapsed or refractory classical Hodgkin lymphoma 8 RMOC 3 RMOC briefings noted; adalimumab, London update July 18, North update June 18 Advice on Free of Charge medicines also noted and recommendation that this advice is adopted by GWH, Wiltshire and Swindon CCGs. For sharing with AWP also. / RH / KB Noted was the national conference and the current survey monkey on RMOC processes 9 MHRA Drug Safety Alerts July and August Drug Safety alerts were reviewed. Of particular note; add the link for eltrombopag review TLS for Esyma. It was felt appropriate for Esyma to be a red drug but funding position needs clarification RH/KB/ AOB Octreotide TLS It is noted that octreotide is red or amber depending on indication. it was agreed to put more information on formulary Tresiba A request to amend the wording on formulary to better reflect the approved indications for use. There are differences between GWH, SFT and RUH in agreed formulary 2 nd line insulins and so potentially it is an area of confusion. KB and Dr Vaks are in process of reviewing Swindon Insulin guidelines and will attempt to align. Seretide price reduction Changes to inhaler prices including a new cost effective MDI equivalent to Seretide / sirdupla is now available; Combisal which needs due consideration. Henryk (Wiltshire CCG) and Bridget (Swindon CCG) to bring proposal to 3Ts KB / VV HK / BF Page 4 of 5

5 Lidocaine plasters see matters arising Nalmefene information for GPs Information has been updated to reflect there is no longer in place a company resource to support patients. Upload to 3Ts Antibiotic doses in paediatrics LMC information has gone out to all GPs, not just Surrey GPs to alert them to changes in their paediatric antibiotic guidelines. Elizabeth Beech has intimated they are not endorsing wholesale changes to the existing PHE guidelines that the local Swindon & Wiltshire guidelines were based on. We will adhere to current agreed guidelines locally. Ibandronic acid for early breast cancer Proposal to try oral ibandronic acid in preference to zolendronate infusion. Awaiting response from Tiffany, Oncology pharmacist Interferon beta 1-b (Betaferon) Brand needs to be stipulated on formulary and all prescriptions as NICE are not recommending all brands Nadine Fox, Wiltshire CCG is currently off on long term sick leave Date, time & venue of next FWG Meeting: 2.00pm 15 th November Seminar Room 4, The Academy, GWH Future Meetings: Date Start Finish Room Time Time pm 4.30pm Cherwell Education Room, Brunel Treatment Centre pm 4.30pm ALIS Room, The Academy, GWH pm 4.30pm ICU Seminar Room, 1 st Floor, GWH pm 4.30pm Cherwell Education Room, Brunel Treatment Centre pm 4.30pm ICU Seminar Room, 1 st Floor, GWH pm 4.30pm ICU Seminar Room, 1 st Floor, GWH. Agreed as an Accurate Record: Chair: Page 5 of 5