Minutes
Title
Details
Meeting:
Cambridgeshire and Peterborough Joint Prescribing Group (CPJPG)
Date of meeting:
6th October 2022
Time:
14:00
Venue:
Microsoft Teams
All recommendations of the CPJPG are subject to ratification by the Integrated Care Board or
delegated committee before considered approved.
Present:
GP Prescribing Lead, NHS Cambridgeshire and
Peterborough
GP Prescribing Lead, NHS Cambridgeshire and
Peterborough
Medical Director, Cambridgeshire Local Medical
Committee
Consultant and Chair of Drug and Therapeutics
Committee, Cambridge University Hospitals NHS
Foundation Trust (CUHFT)
Public Health Registrar, Public Health Team, NHS
Cambridgeshire and Peterborough (Observer)
Executive Development Officer, Cambridgeshire and
Peterborough Local Pharmaceutical Committee
Deputy Chief Pharmacist, Cambridgeshire and
Peterborough NHS Foundation Trust (CPFT)
Formulary Pharmacist, Medicines Optimisation Team,
NHS Cambridgeshire and Peterborough
Safety and Governance Pharmacist, Medicines
Optimisation Team, NHS Cambridgeshire and
Peterborough
Medicines Optimisation Pharmacist & Medication
Safety Officer, Royal Papworth Hospital NHS
Foundation Trust
High-Cost Drugs Lead Pharmacist, Cambridge University
Hospitals NHS Foundation Trust (CUHFT)
In Attendance:
Note-taker, Project Management Office Analyst –
System Project Management Office, NHS
Cambridgeshire and Peterborough
Date: 6th October 2022
Minutes – CPJPG
1
Apologies:
Chair of the Cambridgeshire and Peterborough Local
Pharmaceutical Committee
Chief Pharmacist, Cambridgeshire Community Services
NHS Trust (CCS)
Chief Pharmacist, Cambridgeshire and Peterborough
NHS Foundation Trust (CPFT)
Chief Executive, Cambs Local Medical Committee
Associate Medical Director, Cambridgeshire and
Peterborough NHS Foundation Trust (CPFT)
GP Prescribing Lead, NHS Cambridgeshire and
Peterborough
Deputy Medical Director, North West Anglia NHS
Foundation Trust (NWAngliaFT)
Formulary Pharmacist, Cambridge University Hospitals
NHS Foundation Trust (CUHFT)
Business Support Manager – System Project
Managment Office,
NHS Cambridgeshire and Peterborough
Deputy Chief Pharmacist, Medicines Optimisation
Team, NHS Cambridgeshire and Peterborough
Lay Member, Healthwatch Cambridgeshire and
Peterborough
Chief Pharmacist, Medicines Optimisation Team, NHS
Cambridgeshire and Peterborough
Chief Pharmacist, North West Anglia NHS Foundation
Trust (NWAngliaFT)
Deputy Chief Pharmacist, Cambridge University
Hospitals NHS Foundation Trust (CUHFT)
1.0
WELCOME AND INTRODUCTIONS
As above
2.0
APOLOGIES FOR ABSENCE
As above
3.0
DECLARATION(S) OF INTEREST
New forms have been sent out, please return to Note-taker, Project Management Office
Analyst – System Project Management Office, NHS Cambridgeshire and Peterborough
4.0
NOTIFICATION OF ANY OTHER BUSINESS
- Heart failure pathway (North West Anglia NHS Foundation Trust)
5.0 PREVIOUS MEETING MINUTES
5.1 Minutes of the C&P JPG meeting held on 7th July 2022 – Approved as an accurate record
5.2
Action Log updates
Date: 6th October 2022
Minutes – CPJPG
2
1. Antipsychotic prescribing guidance – distressed behaviour toolkit. On agenda – to be
removed from action log (CLOSED).
2. Acne vulgaris pathway. On agenda – to be removed from action log (CLOSED).
3. Shortage of alteplase. On agenda – to be removed from action log (CLOSED).
4. Palforzia. On agenda – to be removed from action log (CLOSED)
5. System frameworks – relevant papers have been shared with Cambridgeshire and
Peterborough Joint Prescribing Group members and due to the national period of mourning
this meeting has been postponed and rescheduled to November. To be deferred and
update provided at the December meeting (UPDATE – IN PROGRESS).
6. Multivitamin and mineral supplementation for eating disorders – further discussion
required with system providers. To be deferred and update provided at the November
meeting (UPDATE – IN PROGRESS).
7. Insulin Biosimilars recording of batch numbers. To be deferred and update provided at
the November meeting (UPDATE – IN PROGRESS).
8. Wet age-related macular degeneration pathway. This meeting has been postponed due
to the national mourning period and rescheduled to October. To be deferred and update
provided at the December meeting (UPDATE – IN PROGRESS).
9. Hydroxychloroquine prescribing support document. Further time is required in particular,
regarding the ophthalmology review and commissioning of this. To be deferred and update
provided at the November meeting (UPDATE – IN PROGRESS).
5.3
Palforzia Update
This was approved at CUHFT JDTC, and update provided to Consultant and Chair of CUHFT
Drug and Therapeutics Committee, Cambridge University Hospitals NHS Foundation Trust
(CUHFT) by Cambridge University Hospitals NHS Foundation Trust (CUHFT) Medical Director.
Patient numbers are low currently due to operational chal enges (1 adult and 2 paediatric
patients identified). North West Anglia NHS Foundation Trust (NWAngliaFT) have a
pathway in place.
6.0
PRESCRIBING GUIDANCE
6.1
Recurrent Urinary Tract Infections – new pathway guidance fol owing broad spectrum audits
carried out in primary care identifying patients with long durations of antibiotic use for
recurrent urinary tract infections. The new pathway includes a self-care element including the
use of methenamine hippurate. There has been a working group setup who developed the
guidance with the support of Regional Antimicrobial Stewardship Lead, with urologists in the
system and supported by the Systemwide Antimicrobial Stewardship Network.
Members noted that the pathway supports daily prophylaxis over self-start antibiotics and
questioned as to whether self-start antibiotics should be included earlier in the pathway and
whether this could be clarified with the working group and urologists in the system.
Members agreed that the pathway should be brought back to the November meeting once
this has been confirmed with the system working group and urologists.
ACTION: Safety and Governance Pharmacist, Medicines Optimisation Team, NHS
Cambridgeshire and Peterborough to clarify position of self-start antibiotics with system
working group and urologists and bring back guidance to the November meeting.
Date: 6th October 2022
Minutes – CPJPG
3
6.2
Acne vulgaris – guidance has been brought to a previous meeting and updates include
updates to tests to be carried out in primary care prior to referral and emphasis on self-care
for this condition. Guidance is supported by local dermatologists from provider trusts.
Members approved the changes to the pathway which reflect National Institute of Clinical
Excellence guidance. Members supported that the acne vulgaris guidance can be published.
6.3
Cow’s milk protein allergy (Presented by Lead Dietician for Primary Care) – guidance
updated to reflect product availability fol owing global supply issues with cow’s milk protein
al ergy formula milks and also to emphasise that patients can be switched to plant based
alternative products (available within supermarkets) at the appropriate age and development
point. Healthy Start vouchers are available to support families with low incomes. Guidance is
supported by local dietetic teams in the system.
Members supported the updated guidance and agreed to adopt local y.
6.4
Antipsychotic prescribing guidance – distressed behaviour toolkit (presented by Care Homes
Medicines Optimisation Pharmacist) – the guidance was reviewed by Cambridgeshire and
Peterborough Joint Prescribing Group last year and has been updated by a regional working
group. The document is planned to be utilised within trusts, care of the elderly wards and its
primary aim is for utilising in primary care, as trusts tend to deal with delirium patients rather
than patients with distressed behaviour.
Members supported the guidance and agreed to adopt. The group requested that Optimise
Rx is utilised to support implementing the guidance and that anti-psychotics should not be
initiated. The group requested whether a launch event locally for primary care prescribers
and system colleagues could be held.
6.5
End of life community chart – the chart has been updated, mainly for administrative purposes
but also to include important safety updated for the brand name of hyoscine butylbromide as
Buscopan to avoid potential errors in prescribing and administration.
Members supported the updated end of life community chart and agreed to adopt local y.
6.6
Tecovirimat as a treatment for patients hospitalised with monkeypox – brought to
members for awareness and wil be for treatment of hospitalised patients through the
infectious diseases services only regional y Cambridge University Hospitals NHS Foundation
Trust (CUHFT).
Members noted the guidance and treatment wil be updated on system formulary.
6.7
Community access to COVID-19 treatments – current service delivery model wil be
continued however, commissioning framework available and plans are being developed for
a more sustainable model from April 2023 within primary care services. A working group is
reviewing and exploring potential models for future service delivery.
Members noted the update, and this will be brought back to a future meeting in due
course.
6.8
COVID-19 vaccinations and medicines updates for September 2022 – the group noted that
bivalent vaccines have been approved as a booster vaccination for COVID-19. The vaccines
wil be updated on the system-wide formulary.
Date: 6th October 2022
Minutes – CPJPG
4
Members noted the updates.
7.0
FORMULARY
7.1
Methenamine hippurate formulary review – discussed alongside item 6.1 recurrent urinary
tract infections. This product is available to be purchased as part of self-care and evidence
suggest that it may be appropriate and beneficial for women with a history of recurrent
episodes of urinary tract infections as a non-antibiotic prophylaxis. During the current cost of
living crisis, this would be difficult for patients to self-care due to cost.
Members agreed that further advice is needed from urology to determine place in therapy
and whether this may be suitable for prescribing following the advice of a urologist.
ACTION: Safety and Governance Pharmacist, Medicines Optimisation Team, NHS
Cambridgeshire and Peterborough to clarify with urologists the place in therapy of
methenamine hippurate and bring back formulary review to the November meeting.
7.2
Evusheld – the expert panel who advise the government has made clear that there is
insufficient evidence available at this time to support procurement and deployment of
Evusheld through emergency procedures. When Medicines and Healthcare products
Regulatory Agency gave conditional market authorisation to Evusheld in March 2022,
fol owing trials conducted during the Delta wave, it noted a lack of data regarding dose and
efficacy against Omnicron. Update to be brought back to a future meeting when available.
7.3
Multivitamin and mineral supplementation in eating disorders – the patient cohort is
extremely vulnerable with the ingestion of medication having a huge psychological impact. To
review if the Sanatogen A-Z complete product (available on FP10) can be utilised across the
system for this patient cohort to avoid a change of product upon discharge from the provider
trusts.
ACTION: Safety and Governance Pharmacist, Medicines Optimisation Team, NHS
Cambridgeshire and Peterborough to discuss with providers including Formulary Pharmacist,
Cambridge University Hospitals NHS Foundation Trust (CUHFT) regarding system alignment for
this patient cohort and report back with progress at the November meeting.
8.0
SAFETY MATTERS
8.1
Differences between metolazone formulations and safety considerations – current guidance
has been issued to primary care including community pharmacies to not switch patients to the
new licensed product due to the two-fold difference in bioavailability between the new
product (Xaqua) compared to the unlicensed and imported product currently utilised. System
plan to review the new product as licensed and to convert existing patients over to the
licensed product within secondary care. Patients should not be switched until the new product
is reviewed and implementation plan to switch patients is developed.
Members noted the new formulation and differences in bioavailability, and this is to be
brought back to a future meeting.
8.2
Medicines and Healthcare products Regulatory Agency (MHRA) Drug Safety Updates
September 2022
Members noted the MHRA Drug Safety Updates for September 2022.
Date: 6th October 2022
Minutes – CPJPG
5
8.3
Medicines and Healthcare products Regulatory Agency (MHRA) Drug Safety Updates August
2022
Members noted the MHRA Drug Safety Updates for August 2022.
8.4
Shortage of alteplase – the group noted that the Specialist Pharmacy Service and Department
of Health and Social Care (DHSC) has produced national guidance regarding this shortage.
Members requested to be kept updated of developments and changes relating to this
shortage noting the critical indication for use.
9.0
SHARED CARE GUIDANCE
9.1
Stiripentol review of prescribing classification – request has been made by Consultant
Neurologist, Subspecialty Lead for Epilepsy, for Cambridge University Hospitals NHS
Foundation Trust (CUHFT) and North West Anglia NHS Foundation Trust (NWAngliaFT)
and paediatric epilepsy neurology team to remove the paediatric shared care guidance for
stiripentol and to align with the adult cohort prescribing classification of specialist initiation
without shared care guidance as there are no drug monitoring requirements for this
treatment.
Members supported that for the prescribing classification for stiripentol should be aligned
for paediatric and adult cohorts as specialist initiation without shared care guidance and
that the shared care guidance will be withdrawn.
9.2
National shared care protocols – shared care working group formed and the meeting date has
been arranged for November.
Members requested an update from the group be provided in due course, once available.
10.0 NATIONAL INSTITUTE OF CLINICAL EXCELLENCE (NICE) TECHNOLOGY APPRAISALS – for
noting and assigning a formulary classification
10.1 National Institute of Clinical Excellence (NICE) Technology Appraisal publications July –
September 2022
Members noted the National Institute of Clinical Excellence (NICE) Technology Appraisal
publications published between July to end of September 2022.
Members supported that icosapent ethyl a novel option for reducing the risk of
cardiovascular events in adults should be assigned the prescribing classification SPECIALIST
ADVICE. Consultants within the system noted that patients should be reviewed for their
eligibility for injectable therapies including inclisiran and PCSK9-inhibitors as their impact on
cardiovascular risk is greater than Icosapent ethyl. For those not eligible, for injectables
there may be a case for consideration of icosapent ethyl.
10.2 Tralokinumab for treating moderate to severe atopic dermatitis group prior approval.
Members supported the group prior approval and prescribing classification of HOSPITAL
only.
10.3 Upadacitinib for treating moderate to severe atopic dermatitis group prior approval.
Members supported the group prior approval and prescribing classification of HOSPITAL
only.
11.0 CHAIRMAN’S ACTION
11.1 Abrocitinib for treating moderate to severe atopic dermatitis Group Prior Approval – NICE
TA814
Date: 6th October 2022
Minutes – CPJPG
6
Members noted chairman’s action approval.
11.2 Brolucizumab for treating diabetic macular oedema Group Prior Approval – NICE TA820
Members noted chairman’s action approval.
11.3 Dapagliflozin for chronic kidney disease
Members noted chairman’s action approval.
11.4 Sodium zirconium for persistent hyperkalaemia in adults with chronic kidney disease or
heart failure Shared Care Guidance
Members noted chairman’s action approval.
11.5 Patiromer calcium for persistent hyperkalaemia in adults with chronic kidney disease or
heart failure Shared Care Guidance
Members noted chairman’s action approval.
12.0 ANY OTHER BUSINESS
12.1 Heart failure pathway - raised at North West Anglia NHS Foundation Trust (NWAngliaFT)
drugs and therapeutics committee that there is a difference between European and National
Institute of Clinical Excel ence (NICE) pathway guidance.
Members noted that a task and finish group will take forward a system heart failure
pathway.
ACTION: Safety and Governance Pharmacist, Medicines Optimisation Team, NHS
Cambridgeshire and Peterborough to setup working group to review heart failure pathway
and ensure representation from system colleagues at a heart failure workshop being hosted
at Royal Papworth NHS Hospital during October.
Author
Safety and Governance Pharmacist, Medicines Optimisation Team, NHS
Cambridgeshire and Peterborough
Date: 6th October 2022
Minutes – CPJPG
7