The professional voice of general practice in Kensington, Chelsea and Westminster Londonwide LMCs is the brand name of Londonwide Local Medical Committees Limited Registered and office address: Tavistock House North, Tavistock Square, London WC1H 9HX. T. 020 7387 2034/7418 F. 020 7383 7442 E. [email protected]www.lmc.org.uk Registered in England No. 6391298. Londonwide Local Medical Committees Limited is registered as a Company Limited by Guarantee Chief Executive: Dr Michelle Drage Kensington and Chelsea, Westminster and Hammersmith and Fulham LOCAL MEDICAL COMMITTEES MEETING To be held at 1.00 pm on Tuesday 10 April 2012 at The Lighthouse West London, Ladbroke Grove PART 1 LMC Members only 1.00 – 2.30 AGENDA 1.0 Apologies 2.0 2.1 Declarations of interest Members to declare any conflicts of interest in connection with any items on the agenda or in the light of subsequent debate 3.0 Minutes and matters arising not listed elsewhere on the agenda: 3.1 3.2 3.3 3.4 Minutes of LMC meeting Part One on 14 February 2012 (pages 3-5) Minutes of LMC Meeting Part Two on 14 February 2012 (to follow) Actions of the NWL Cluster Meeting 16 February 2012 (page 6) Meeting notes from the NWL Operational Meeting 27 March 2012 (pages 7-9) 4.0 Items for discussion: 4.1 GP Clinical Commissioning Groups – to receive an update of the developments in Kensington and Chelsea, Westminster and Hammersmith and Fulham 4.3 ICP 4.4 Enhanced Services 4.5 NWL formulary- latest version (guidance and factsheet attached, pages 10-17) 4.6 Forthcoming bi-annual LMC elections -To note that it is election year in 2012 (Nomination packs will be issued in early May to all GPs) - To note from the attached LMC Terms of Office those whose term finishes this August and who will need to stand for election if they wish to continue to serve on the LMC (page 18-20) 4.7 Sessional GP issues – to raise any issues 5.0 Part 2 agenda To discuss the Part 2 agenda 6.0 6.1 Items to receive: GPC News ( pages 21-35) 6.2 LEAD:-to receive a list of forthcoming lead events (pages 36) 1
Transcript
The professional voice of general practice in Kensington, Chelsea and Westminster Londonwide LMCs is the brand name of Londonwide Local Medical Committees Limited Registered and office address: Tavistock House North, Tavistock Square, London WC1H 9HX. T. 020 7387 2034/7418 F. 020 7383 7442 E. [email protected] www.lmc.org.uk Registered in England No. 6391298. Londonwide Local Medical Committees Limited is registered as a Company Limited by Guarantee Chief Executive: Dr Michelle Drage
Kensington and Chelsea, Westminster and Hammersmith and Fulham LOCAL MEDICAL COMMITTEES MEETING
To be held at 1.00 pm on Tuesday 10 April 2012 at The Lighthouse West London, Ladbroke Grove
PART 1 LMC Members only
1.00 – 2.30
AGENDA
1.0 Apologies
2.0 2.1
Declarations of interest Members to declare any conflicts of interest in connection with any items on the agenda or in the light of subsequent debate
3.0 Minutes and matters arising not listed elsewhere on the agenda: 3.1 3.2 3.3 3.4
Minutes of LMC meeting Part One on 14 February 2012 (pages 3-5) Minutes of LMC Meeting Part Two on 14 February 2012 (to follow) Actions of the NWL Cluster Meeting 16 February 2012 (page 6) Meeting notes from the NWL Operational Meeting 27 March 2012 (pages 7-9)
4.0 Items for discussion: 4.1 GP Clinical Commissioning Groups – to receive an update of the developments in
Kensington and Chelsea, Westminster and Hammersmith and Fulham 4.3 ICP 4.4 Enhanced Services 4.5 NWL formulary- latest version (guidance and factsheet attached, pages 10-17) 4.6 Forthcoming bi-annual LMC elections
-To note that it is election year in 2012 (Nomination packs will be issued in early May to all GPs)
- To note from the attached LMC Terms of Office those whose term finishes this August and who will need to stand for election if they wish to continue to serve on the LMC (page 18-20)
4.7
Sessional GP issues – to raise any issues
5.0 Part 2 agenda To discuss the Part 2 agenda
6.0 6.1
Items to receive: GPC News (pages 21-35)
6.2
LEAD:-to receive a list of forthcoming lead events (pages 36)
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7.0 LMC newsletter To identify items for the next newsletter
8.0 Date of next meeting: 12 June 2012
9.0 Any other business
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Draft and unconfirmed minutes of the Kensington and Chelsea, Westminster, Hammersmith and Fulham LMC Meeting held on 14 February 2012
In attendance
LMC Members
Dr P O'Reilly
Dr M O'Rawe
Dr D Abadi
Dr K Rollinson
Dr G Moses
Dr S Taslaq
Dr A Joshi
Ms A Barnes
Ms A Dalal
Dr M Edwards
Dr M Ali
Dr R Dandapat
Londonwide LMCs
Dr T Grewal
Ms A Michaels
Ms S Beech
1.0 Apologies
2.0 Declarations of interest
There were no new declarations of interest raised by LMC Members.
3.0 Minutes and matters arising not listed elsewhere on the agenda:
3.1 Minutes of LMC meeting Part One on 13 December 2011
The minutes were agreed.
3.2 Minutes of the Londonwide LMCs and NHS North West London Primary Care Contracting
team interim meeting
Practice vacancies and procurement (item 9.0 refers)
K&C Practice Closure
Dr Grewal reminded practices they needed to let the PCT know what their capacity was. Ms
Dalal explain it had been very busy at her practice, they had registered 80 patients in 2 days.
ICP (item 5.4 refers)
Dr Abadi raised concerns about the ICP, in particular the cumbersome IT and the lack of
evaluation. Dr O'Reilly agreed there was a lot of dissatisfaction in many places, the practices that
are opted in are not achieving the targets. It appears that the I.T tool is not fit for purpose and
they will be re-tendering the service. Dr O'Reilly pointed out that the ICP savings are being
written into next year's QIPP plans. Ms Barnes added that the process was time consuming,
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especially if patients have opted out of the spine. It is repetitious, practices are required to input
the data twice and the referral cannot be done on the ICP. It was agreed that the LMCs concerns
would be raised with Daniel Elkeles
3.3 Minutes of the NWL Cluster Meeting 8 December 2011
Acute Commissioning Vehicle
Dr Abadi reported the ACV was being reviewed again, it has been reviewed before. The CSO is
going to review the ACV but the CSO has not been set up yet. Dr Grewal commented if CCGs
feel they are out there on their own, they will end up having to respond top down rather than
bottom up.
4.0 Items for discussion:
4.1 GP Clinical Commissioning Groups – to receive an update of the developments in
Kensington and Chelsea, Westminster and Hammersmith and Fulham
Dr Grewal reported that Authorisation is at different stages in different areas. The requirements
for authorisation change on a daily basis. Dr O'Reilly added that this round of authorisation is
dependent on QIPP savings and ICP seems to give greater control to the centre and away from
grass roots. There is a move to create a single CCG to comprise all of North West London but
this was deemed to not give enough local input so it has been decided there will be an outer and
inner- outer will consist Ealing, Brent, Harrow and Hillingdon, and inner will be West London,
Central London, Hammersmith and Fulham and Hounslow. The forced merger of VCC and CLH
was the first stage of authorisation. Dr Dandapat reported there was a lot of confusion in
Hammersmith and Fulham, the practice have phoned to get clarification but this has not helped.
Ms Dalal reported that although she was a CLH Board member, they still do not feel like they
have a choice. For example, with the Out Of Hospital strategy, GPs have been told that hospitals
are going to close and GPs will have to stand up defend the decision. A huge amount of work is
going into primary care but with limited resources. Dr Grewal pointed out that CCGs are sub-
committees of the PCT. Extra work can come through enhanced services which will be run by the
LMC. Practices are able to refuse if they feel they are bring pushed into more work they can
refuse.
4.3 North West London Reconfiguration Programme
Dr Edwards stated she would be attending the meeting at Lords. Dr Abadi pointed out that the
paper showed CCGs were being given responsibility without power. Dr Grewal added the
membership of the Board was a concern; there was not one person with a patient representative
hat on.
4.4 Enhanced Services
Dr Abadi questioned why the enhanced services were being reviewed. Ms Dalal responded that
the plan was to leave the review to the Once for London principles.
4.5 Once for London Principles
Dr O'Reilly commented he was impressed by Once for London and the opportunity to mitigate
potential harm.
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list maintenance: Dr O'Reilly questioned whether the commissioner will speak to practices before
sending out letters. Dr Grewal responded that all the different letters have been looked at in
terms of how well they were responded to. The only thing is required a declaration from the
practice that the patient is still receiving medical services. Ms Dalal added the difference is that
the practice generates the list.
Enhanced services: Dr Abadi commented from a PCT point of view, its all aimed at reducing
cost. Ms Dalal commented she was pleased to see we will be paid for inputs and as well as
outputs.
4.6 PMS issues
No issues were raised.
4.7 Sessional GP issues – to raise any issues
No issues were raised
4.8 Communication- Imperial College Bulletin
Dr Moses commented that there is no process for it to be sent to sessional GPs, he had tried to
pursue this with Michelle Elston. THere is no communication with sessional GPs. Dr Grewal
agreed this could be included in the LMC newsletter, the vast majority of sessional GPs have not
updated their contact details.
4.9 Motions to Conference –members to raise items that can be formulated into motions to
conference
No issues were raised
5.0 Part 2 agenda
To discuss the Part 2 agenda
6.0 Items to receive:
6.1 The GPC News 5, December 2011 was received.
6.2 The LEAD events were received.
7.0 LMC newsletter
Links to Imperial/UCL/Chelsea and Westminster bulletins
8.0 Date of next meeting:
The date of the next meeting was noted.
9.0 Any other business:
There were no items raised as Any Other Business.
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Actions arising from the North West London Cluster Meeting held on Thursday 16 February 2012 at NHS NWL
4.0 Minutes and Matters Arising 4.2
matters arising from the meeting on 8 December 2011 111 DSU agreed to share the Brent/Harrow/Ealing business case with the LMC. The DSU also agreed to share the NHS London-wide specification with the LMC. The DSU agreed to share the details of the procurement lead for 111.
DSU DSU
5.0 Commissioning Support Organisation It was agreed that the tabled paper would be sent to the LMC electronically.
Reconfiguration and Out Of Hospital Strategy It was agreed the DSU would share the OOH strategy with the LMC. North West London Formulary Project- DSU to present It was agreed the DSU would send an electronic copy of the latest version of the NWL Formulary Project Planned Procedures with a Threshold (PPWT) It was agreed that the DSU would send an electronic version of the tabled paper. The DSU agreed to clarify whether a report was produced regarding compliance of the NWL process in line with the recent guidance published nationally regarding value based surgical care Integrated Care Pilot (ICP) It was agreed that the LMC would send the Cluster examples of where the ICP was causing concerns with GPs on the ground.
Received 20/2/12 Draft received 22/2/12 DSU LMC
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Londonwide LMCs and NHS North West London Primary Care Contracting team interim meeting
Action notes from Tuesday 27 March 2012
1.0 In attendance: Rachel Donovan (RD) Andy Michaels (AM) Julie Sands (JS) Ariadne Siotis (AS) Kathryn Charles (KCh) Alison Dalal (AD) Gill Rogers (GR) Karen Clinton (KC) Sue Hardy (SH)
2.0 Apologies: No apologies were received.
3.0
Additional Items not listed on the agenda Matters arising from meeting 28 February Minor Surgery DES – it was agreed that no further action would be taken regarding the Minor Surgery LES in Hounslow. The Cluster confirmed that the specific issue raised regarding offering a LES specification only was not relevant to any of the other DESs except Minor Surgery. The Cluster also confirmed that if a practice chose not to provide the LES then the service would be commissioned for their patients from other providers. Extended Hours DES claims – the group confirmed that the revised wording sent by RD was acceptable. QoF End of Year Processes - KCh noted that the Cluster needed to send out an email clarifying the deadlines and that they should copy in the Borough PCTs so that everyone was on the same page. RD undertook to do this (RD) List Maintenance – KC noted that if the Cluster agreed to reimburse practices for patients who were wrongfully removed following the FP69 process then they would also want to look into clawing back money for patients who were not removed soon enough. It was agreed that an audit should be undertaken to get an idea of the losses and gains before making a final decision on this matter. (KC)
4.0
QoF Process 2012/13 – RD reported that the 5% PPV visits would take place as normal in 2012/13 but that the Cluster were not intending to undertake any pre-payment visits unless there was a movement of plus or minus 10% in which case they would investigate. PE7 & PE8 appeals process – RD agreed to write to let those practices who appealed know that they could contact the PCT if they wanted more information on how the decision regarding their appeal had been reached. (RD)
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5.0
Premises Update – KC outlined that starting from June, FHS would be taking on the administration of rent schemes for GP premises and that the minimum standards visits would be done as part of the contract compliance process. KC undertook to liaise with SH in the interim period about training and other transition needs for the FHS team to take on the work. Improvement Grants – SH explained the improvement grant process which the PCT had followed. She noted that the PCT had put in a bid to NHSL for Capital Funding before Christmas for Ealing, Hounslow and Hillingdon however Brent, Harrow and the Inner Boroughs did not put in bids. NHSL initially said that any money granted would have to be spent by the end of March 2012 and the PCT invited practices to enter EOIs on that basis. These were then forwarded to NHSL and then nothing was heard back until the end of February at which point NHSL awarded the money and said that it could be spent any time in 2012/13. Ealing and Hounslow were given £400,000 each and Hillingdon £200,000. All the successful practices had now been informed. It was agreed that in the future there should be a more equitable approach across the Cluster with regards to this kind of funding and KC suggested that in the future such bids might be managed by the Cluster team (KC). In the meantime, the LMC office undertook to write to the Borough PCT Directors of the areas that did not put in bids to ask them why and to encourage them to do so for next year (AS) KC also reported that two infection control nurses had been TUPEd over to the Primary Care Contracting team from CLHC and they would be working across NW London using a light touch approach.
6.0 Enhanced Services 2012/13 DES Specifications 2012/13 – AS undertook to collate any comments on the DESs and to feed them back to the Cluster. (AS)
7.0 Contracts Annual Contract Reviews – The Cluster reported that one third of practices would be visited and that visits would start in June. RD agreed to send the list of practices to the LMC for the office to randomise and then select the third. (RD/AS) Transfer of Contracts to the NCB – KC reported that the Cluster was currently in the “stabilisation phase” and that although they were missing some contracts there weren’t any major concerns. It was agreed that anything going out to practices on this issue should be sent to the LMC office first in order to avoid causing undue anxiety to practices (Cluster/LMC team)
8.0 Olympic Planning – KC updated the group on the Cluster’s planning for the Olympics. A self-assessment survey was being devised by use across London for practices to complete. AD noted that she had a list of things which were raised at the PM’s forum and which ought to be included and she agreed to send the list to KC. (AD) KC also reported that the Cluster would be hosting a number of workshops with TFL and that details of these would be shared once available.
9.0
Practice Boundaries – KC reported that the Cluster would be writing to practices to ask them to begin thinking about what their outer boundaries might be in the future but that no further action was being taken at this time.
10.0 Practice Vacancies and Procurement – There was nothing new for the Cluster to report but a suggestion was made that perhaps some joint working could be arranged between the Cluster and Londonwide LMCs around succession planning as it seemed that a lot of contracts were
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being lost to dispersal. (Cluster/LMC team)
11.0 FHS Services – There were no particular updates to report however the Cluster agreed to ensure that a communication went out to practices as soon as possible to let them know who they should contact in the FHS team. The LMC office would also include this information in the newsletter once it was available. (Cluster/LMC team)
12.0 A.O.B
AD reported that practices were receiving empty Lloyd George envelopes and also raised the issue of deduction notes being available on disc rather than in hard copy due to the size of them. KC undertook to raise this with FHS. (KC) AS highlighted a concern raised by an LMC member regarding the 1 April deadline for responding to the Cluster about 084 numbers. RD suggested that the concerned member contact her directly to discuss the issue. (RD)
13.0
Date of Next Meeting – Tuesday 24 April 1:30 – 3:00pm, BMA House
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Integrated Formulary factsheet
You may be aware that an Integrated Formulary is being developed for North West London. A first round of engagement took place during January and February this year, in which you may have participated. Hundreds of suggested amendments were received as part of this engagement exercise.
A key piece of feedback that emerged was the need for basic information about the project: this factsheet is the result. There is still time to input into the content of the Formulary. Please see below for more detail on how this can be done.
What is the Integrated Formulary?
The Integrated Formulary is a tool to support prescribing decisions in primary care, and at the interface between primary and secondary care.
The scope of the formulary includes prescriptions / recommendations for outpatients and patients discharged into the care of general practice, but does not cover in-patient prescribing. The formulary is also recommended for use in the community.
The formulary contains 660 medicines, covers all 15 chapters of the British National Formulary (BNF), and should be used in conjunction with the BNF.
Medicines will be prioritised into 1st, 2nd and 3rd line order to guide prescribers toward the most effective, best value choices. A series of workshops will be scheduled throughout April and May to achieve this for all therapeutic areas.
Secondary care clinicians can recommend off-formulary medicines, as long as they provide a clear clinical justification for doing so.
A version of the formulary, focused on adults, will go-live on 1st April 2012. A paediatric formulary will be follow later in 2012.
Why is the Integrated Formulary being developed?
The aim of the formulary is to improve the consistency and reduce the cost of prescribing in the cluster by introducing a tool to support decision-making by prescribers.
The need for an NW London Integrated Formulary was agreed as a key planning initiative at the joint QIPP planning event in September 2011 involving both primary and secondary care providers.
What are the benefits of the Integrated Formulary?
Benefit Description Improved quality of primary care prescribing
Primary care clinicians will benefit from increased familiarity with a narrower range of medicines, improving decision-making.
Better alignment between primary and secondary care
A GP s decision to change a prescription
written by a secondary care clinician can often be source of anxiety for patients, even when this decision is entirely appropriate. The
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formulary will reduce the extent to which this occurs by harmonising primary and secondary care prescribing practices.
Better alignment with patient guidance materials
Incorrect use of medication is a common problem in some specialties (e.g. the London Respiratory Team suggests that 90% of both patients and clinicians use inhalers incorrectly). Useful guidance materials for patients are more difficult to produce if they have to cover a wide variety of medicines. The formulary will limit the extent of this problem by reducing prescribing variation.
Enabler for future prescribing interventions The wide geographical and clinical scope of the Integrated Formulary means that it will be an excellent vehicle for sharing and embedding best practice.
Potential financial benefits The formulary has the potential to generate savings by guiding prescribers towards better value, equivalent medicines.
How has the Integrated Formulary been created? The project team is led by Dr Mark Spencer (NWL medical director), and consists of:
Primary Care Trust (PCT) chief pharmacists;
Clinical Commissioning Group (CCG) prescribing leads;
A senior hospital chief pharmacist (Chair of the North West London Medicines Management Pharmacy Network); and
The NHS NW London Delivery Support Unit.
The Integrated Formulary development process is still under way and can be summarised as follows:
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In excess of 400 comments on how the Formulary could be improved have been received to date. All comments have been considered carefully by the project pharmacy team and the vast majority have been accepted.
Not all proposed amendments have made their way into the latest draft of the Formulary. Some common reasons for this are as follows:
Proposed medicine for hospital use only / GPs unlikely to be asked to prescribe;
Proposed medicine unlicensed;
Proposal relates to paediatrics out of scope for this version of the Formulary;
Proposal relates to line order further clinical workshops will be required to agree line
order for each therapeutic area, where there are issues;
Proposal relates to a specific indication currently, the Formulary follows the BNF
structure and therefore follows BNF-listed indications.
How can you get involved?
The proposed go-live date for the adult-focused version of the Integrated Formulary is 1st April 2012. It is clear that the Formulary will require further revision during its first few months of operation. The project team will continue to accept feedback from clinicians and pharmacists throughout this period. Feedback can be submitted in the following ways:
1. A draft version of the formulary will be available for review by the end of March. Feedback on how the draft could be improved is welcomed, and should be sent to [email protected]. Once the new draft is released, further information will be circulated setting out the feedback process in more detail.
2. Proposed amendments can be raised via your Trust New Drugs Panel in the usual way for hospital clinicians and via your Medicines Management team in primary care;
3. Please contact your Trust chief pharmacist for further information on how you can become involved.
How will the Integrated Formulary be made available?
The Integrated Formulary will be made available on a variety of provider-appropriate platforms. For example, in primary care, the formulary will be compatible with Scriptswitch, Vision, EMIS and SystmOne.
A similar approach will be taken in secondary care, with electronic platforms (such as eBNF, NELM) favoured where they are available. A smartphone app is being explored. Platform choices will be guided by Trust preferences. MS Office and hardcopy versions of the formulary will also be made available but the online electronic version is preferred, to ensure that the most up to date copy is always being used.
The Formulary will be accompanied by a detailed guidance document designed to:
Set out scope and structure;
Define terms;
Articulate how the Formulary should be used in practice;
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- bing in the rare instances where this will be required.
How will new medicines be added to the Integrated Formulary?
An Integrated Formulary New Drugs Panel (NDP) will be established to consider proposed amendments. All NWL Trusts and CCGs will be represented on the panel. Proposals for new medicines initiated in secondary care will continue via existing Trust NDPs in the usual way.
.
How will use of the Integrated Formulary be encouraged?
In secondary care, formulary use will be incentivised via a CQUIN written into all acute and mental health Trust contracts. CQUIN negotiations are being led by the NHS NWL Acute Commissioning Vehicle team, and will be agreed locally.
In primary care, it is anticipated that the Integrated Formulary will be incorporated into existing local peer review arrangements. The mechanism used will be locally agreed and Clinical Commissioning Group-led. It is the responsibility of CCGs to decide upon the most appropriate approach for their borough.
Will it be possible to localise the Formulary?
Trusts and CCGs can agree to place further restrictions on the use of specific medicines in the Formulary cross-border patient issues to be resolved on a case-by-case basis;
Non-formulary medicines that have been approved by Trust New Drugs Panels (NDPs) can continue to be used in hospital however, they should not be made available for use in primary care;
Drugs on the Formulary should be used in line with local protocols e.g. Antibiotics.
For further information
Please contact your Trust or PCT chief pharmacist in the first instance. Alternatively, please contact Sam Benghiat ([email protected]) in the NHS NW London Delivery Support Unit.
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Integrated Formulary Guidance
Format of the Formulary
The Formulary is arranged in BNF order. It consists of a list of drugs recommended in each
section. Each drug is categorised to facilitate prescribing choice.
The prescriber should always ensure they have the expertise to prescribe an agent before
making the selection. In its guidelines on responsibility for prescribing between hospitals and
general practitioners, the Department of Health has advised that legal responsibility for
prescribing lies with the doctor who signs the prescription.
Definition of terms
• First line drugs - These drugs are recommended as first line agents;
• Second line drugs - These drugs are included as alternatives (often in specific
conditions);
• Third line drugs – These drugs may be required by a small minority of patients (due to
intolerances or other clinical factors), but should only be prescribed in exceptional
cases;
• Specialist initiation drugs - These are drugs that can only be initiated by a specialist.
A specialist is not exclusively a consultant, rather someone with recognised skills (eg.
GP with a Specialist Interest, Community Psychiatric Nurse). Once initiated by a
specialist and stabilised, the GP can be asked if they are willing to take over clinical
responsibility for on-going prescribing.
Scope of the Formulary
• The scope of the formulary specifically covers prescribing in Primary Care and prescribing at the interface between Primary and Secondary Care. It therefore includes prescriptions/ recommendations for outpatients and patients due to be discharged into the care of general practice, but does not cover in-patient prescribing;
• The Formulary covers all 15 chapters of the British National Formulary (BNF), but is designed to be used in conjunction with the BNF. Prescribers should refer to the BNF for additional guidelines and warnings;
• The Formulary does not include unlicensed preparations, except where it is deemed clinically appropriate to do so.
• The Formulary does not include ‘red-listed’ medicines as these are for hospital use only. Prescribers should refer to the most recent North West London Sector Prescribing Policy for the list.
• Initially, the Formulary covers prescriptions for adults only. The Formulary will be expanded to cover paediatrics later in 2012;
The Formulary is not a comprehensive guide to all medicines available. For those medicines that are included, reference to the British National Formulary and Summary of Product
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Characteristics may still be required to prescribe safely. Any national safety alerts circulated supersede Formulary recommendations.
The Formulary is specific to the North West London cluster, and should be adhered to by the following hospital Trusts and PCTs/CCGs:
Acute and Mental Health Trusts PCTs / CCGs Imperial College Healthcare NHS Trust Brent Clinical Commissioning Group
(CCG) Royal Brompton and Harefield NHS Foundation Trust
Harrow CCG
Hillingdon Hospitals NHS Foundation Trust
Ealing CCG
Ealing Hospital NHS Trust Hillingdon CCG North West London Hospitals NHS Trust
Great West Commissioning Consortium
Central and North West London NHS Foundation Trust
Hammersmith and Fulham CCG
West London Mental Health NHS Trust West London Commissioning Consortium
Chelsea and Westminster Hospital NHS Foundation Trust
Central London Healthcare
West Middlesex University Hospital NHS Trust
Localising the Formulary
The Formulary is intended to facilitate a degree of local flexibility. For example:
• Local Trusts and Clinical Commissioning Groups (CCGs) may develop protocols to further restrict the use of certain medicines in their area. For example, by restricting the initiation of specific drugs to consultants in certain specialties rather than specialists more generally;
• The Formulary should be used in conjunction with locally developed therapeutic guidelines. For example, prescribing decisions concerning the appropriate use of anti-biotics should reference local guidelines and protocols;
• Medicines approved by local Trust New Drugs Panels (NDPs) or Drug and Therapeutics Commeettes (DTCs) but rejected by the Integrated Formulary NDP may still be prescribed locally in hospital. However, these medicines may not be transferred for prescribing in Primary Care.
Prescribing non-Formulary medicines
In some instances it may be clinically appropriate for a patient to be prescribed with a medicine that does not feature on the Formulary. Clinicians can recommend non-formulary medicines as long as they record a clear clinical justification for doing so. This clinical justification should be communicated and agreed with the patient’s GP.
Non-formulary prescriptions and recommendations are subject to challenge from general practice. A GP may challenge a non-formulary prescription or recommendation by appealing to their local CCG pharmacy team, or directly to the relevant Trust pharmacy team.
Please see Appendix A for draft inappropriate prescribing pro-forma based on a template developed by Ealing PCT.
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It is important to note that the Formulary applies to newly initiated treatments only. For example, if a patient who is currently taking non-Formulary medication is admitted to hospital, secondary care clinicians will not be expected to switch their prescription in order to comply with the Formulary, unless it is clinically appropriate to do so.
Prescribing unlicensed medicines
The Formulary does not include unlicensed medicines except under exceptional circumstances. Before deciding to prescribe an unlicensed preparation, clinicians should bear in mind the following information.
The term ‘unlicensed medicine' is normally applied to those medicines which do not have a UK Marketing Authorization (MA). Formerly a Product License (PL), granted by the Medicines and Healthcare Products Regulatory Authority (MHRA) or European Medicines Agency (EMA). Such products are not subject to the strict licensing controls of the MHRA/EMA and neither the prescriber nor pharmacist can make the same assumptions of safety, quality and efficacy that they would with licensed items.
Bearing this in mind the use of unlicensed medicines is therefore the sole responsibility of the prescriber.
Prescribing and supply of unlicensed medicines (or medicines to be used outside their licensed indications) presents a risk to individual patients, prescribers, nurses and pharmacists.
Prescribers are therefore reminded:
• Unlicensed products are not intended for routine, ongoing use;
• Where suitable licensed alternatives to unlicensed products exist these should always be used in preference to unlicensed medicines;
• Wherever an unlicensed medicine is prescribed, the prescriber is professionally accountable for his judgement in so doing and may be called upon to justify his actions;
• A pharmacist who manufactures, prepares or procures an unlicensed medicine in response to a prescription is professionally accountable for any harm caused by a defect in the medicine which is attributable to his own actions or omissions;
• A General Practitioner is not obliged to prescribe an unlicensed medicine.
When not to prescribe generically
Generic prescribing is universally regarded as good practice, however, a small selection of drugs should not be prescribed generically. Where it is appropriate to prescribe by brand, to the particular brand name for this drug should be used avoid confusion.
Proposing new medicines for inclusion
The process for adding new medicines to the Formulary will differ between Primary and Secondary Care, as follows:
Secondary Care process
Proposals for new medicines will be submitted to existing Trust New Drugs Panels (NDPs) and Drug and Therapeutic Committees (DTCs) in the usual way. Where a proposed medicine is in-scope for the Integrated Formulary, the proposal will be passed to the Integrated Formulary NDP and will be on the agenda of the next available panel meeting.
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There will be no requirement to re-work the proposals for the benefit of the Integrated Formulary NDP. All supporting documentation submitted as part of the original application to the Trust NDP will continue to be valid and will be used to support Integrated Formulary NDP decision making.
In most instances, the original applicant will be expected to attend the Integrated Formulary NDP meeting to make the case for inclusion in person.
Primary Care process
Proposals originating from Primary Care will be submitted directly to the Integrated Formulary NDP.
For a proposal to be considered by the Integrated Formulary NDP, the applicant will be expected to demonstrate the following minimum level of support:
• Endorsement by at least two GPs;
• Endorsement by at least one PCT/CCG pharmacist;
• Endorsement by at least one hospital consultant in the relevant specialty;
• Endorsement by at least one hospital Chief Pharmacist;
• A minimum of three peer reviewed academic papers supporting the proposal.
As with secondary care, the applicant will be expected to attend the Integrated Formulary NDP meeting to make the case for inclusion in person.
For further information
Please contact your Trust or PCT chief pharmacist in the first instance.
Alternatively, please contact Sam Benghiat ([email protected]) in the NHS NW London Delivery Support Unit.
<insert details of Integrated Formulary pharmacist editor once appointed>
Appendix A
Inappropriate prescribing request pro-forma.
Inappropriate prescribing pro forma_v0 2.doc
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KENSINGTON, CHELSEA AND WESTMINSTER
LOCAL MEDICAL COMMITTEE
TERM OF OFFICE FROM 2010 Kensington and Chelsea Constituency
Elected LMC members Term of office 2 years until 31 August 2012 (4 places)
GP Contractual Status
Term of office 4 years until 31 August 2014 (4 places)
GP Contractual status
Dr Mohammed El-Borai GMS GP Principal Dr Mohammed Ali GMS GP Principal
Dr Jane Pettifer GMS GP Principal
PMS GP Principal
Dr Khaleeda Siraj GMS Salaried GP Dr Hilary King GMS GP Principal
Dr Annalea Wyatt GMS GP Principal Dr Anil Joshi PMS GP Principal
Westminster Constituency
Elected LMC members Term of office 2 years until 31 August 2012 (4 places)
GP Contractual Status
Term of office 4 years until 31 August 2014 (4 places)
GP Contractual status
Dr Krishan Aggarwal Freelance/GP Locum
Dr Anouska Hari (Vice-Chair)
Freelance GP/Locum
Dr Maria Lazari PMS GP Salaried Dr Dennis Abadi GMS GP Principal
Dr Neveen Rady Freelance/GP Locum
(Chair) PMS GP Principal
Dr Robert Quilliam PMS GP Principal Dr Oluwatoyin Odunuga Freelance GP/Locum
Co-opted members until 31 August 2012 (A practitioner representing a particular class of experience not otherwise represented on the committee) The number of co-opted members should not exceed a quarter of total number of elected members. (Maximum of 4 co-opted members)
Name Reason for Co-option Dr Kim Rollinson Dr Samer Taslaq Sessional GP
Observers until 31 August 2012 (No voting rights on the committee, can include Practice Managers and Practice Nurses) Anne Barnes- Practice Manager Representative Kensington & Chelsea Alison Dalal - Practice Manager Representative Westminster
Last updated: 13 December 2011 Version 1.7
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EALING, HAMMERSMITH AND HOUNSLOW
LOCAL MEDICAL COMMITTEE
TERM OF OFFICE FROM 2010
Ealing - Elected LMC members (Acton, Ealing and Southall constituencies)
Term of office 2 years until 31 August 2012
GP Contractual status
Term of office 4 years until 31 August 2014
GP Contractual status
Acton (1 place) Dr Kajal Shah
GMS GP Principal
Acton (1 place) Dr Soe Yin
GMS GP Principal
Ealing (3 places) Dr Ramesh Bhatt
GMS GP Principal
Ealing (3 places) Dr Dennis Heavey (Vice-Chair+ Locality Chair)
GMS GP Principal
Dr Neil Crowley GMS GP Principal Dr Adam Jenkins (Chair) GMS GP Principal
Dr Suk Shergill
GMS GP Principal Dr Ric Naish GMS GP Principal
Southall (1 place) Dr Param-Jeet Singh Sandhu
GMS GP Principal
Southall (2 places) Dr Mohammed Alzarrad
GMS GP Principal
Dr Shri Gautam GMS GP Principal
Hammersmith and Fulham Elected LMC members (Hammersmith North and Hammersmith South constituencies)
Term of office 2 years until 31 August 2012
GP Contractual status
Term of office 4 years until 31 August 2014
GP Contractual Status
Hammersmith North (2 places)
Hammersmith North (2 places)
Dr Marini Edwards Freelance GP/Locum Dr Raja Dandapat GMS GP Principal
Dr Joanna Huddy GMS GP Principal Dr George Moses (Treasurer)
Freelance GP/Locum
Hammersmith South (3 places) Hammersmith South (3 places)
Vacancy Dr Dave Gill GP Registrar
Vacancy Vacancy
Vacancy Vacancy
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Hounslow Elected LMC members (Brentford & Chiswick, Feltham, and Heston & Isleworth constituencies)
Dr Alick Munro GMS GP Principal Dr Bashir Qureshi Freelance GP/Locum
Dr Rashmi Singh GMS GP Principal Dr Paul Shenton PMS GP Principal
Co-opted member until 31 August 2012 (A practitioner representing a particular class of experience not otherwise represented on the committee) The number of co-opted members should not exceed a quarter of total number of elected members (Maximum of 8 co-opted members)
Name Reason for Co-option Dr Mark Spencer Special Experience Commissioning Dr Victoria Weeks Salaried GP Representative Dr Rosalind Adam GP Registrar
Observers until 31 August 2012 (No voting rights on the committee, can include Practice Managers and Practice Nurses)
Name Kathryn Charles Practice Manager Representative Jill Gamblin LPC Representative
Last updated: 14 March 2012 Version 1.7
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Events Calendar
April 2012
Thursday 19 Increase Your Patient Consultation Effectiveness Workshop
