all wales prescribing advisory group

Enclosure No:
Agenda Item No:
9 – Minutes of AWPAG Meeting 24th September 2014
Chairman, AWPAG
Tel: 029 20716900
E-Mail: [email protected]
DRAFT Minutes of meeting held
Wednesday 24th September 2014 commencing 9.30 am
At the St Michael’s Centre, 10a Pen Y Pound,
Abergavenny, NP7 5UD
Voting members
Mrs Louise Howard-Baker (Chair)
Mrs Jane Barnard
Mr Alan Clatworthy
Mrs Sian Evans
Mr Stefan Fec
Miss Sophie Harding
Dr Peter Horvath-Howard
Mrs Sarah Isaac
Dr Susanna Jacks
Dr Sue Jeffs
Mrs Robyn Miles
Mr Jonathan Simms
Mrs Fiona Walker
Mrs Bev Woods
Pharmacist, Betsi Cadwaladr
Lay member
Pharmacist, Abertawe Bro Morgannwg
Pharmaceutical Public Health Wales
Community Pharmacist
Pharmacist, Velindre
GPC (Wales)
Pharmacist, Hywel Dda
GP, Aneurin Bevan
Consultant, Aneurin Bevan
ABPI Wales Industry Group
Pharmacist, Aneurin Bevan
Pharmacist, Cardiff and Vale
Pharmacist, Cwm Taf
In attendance (non-voting)
Mr Paul Fleming
Dr Rick Greville, Director
Mr Paul Gimson
Karen Eveleigh
Miss Christine Collier
Ms Kath Haines
Mr Jamie Hayes
Mrs Kate Jenkins
Dr Tessa Lewis
British Generics Manufacturers
ABPI Cymru Wales
Public Health Wales
Welsh Government
Key of abbreviations
Association of the British Pharmaceutical Industry
All Wales Medicines Strategy Group
AWMSGSC All Wales Medicines Strategy Group Steering Committee
All Wales Prescribing Advisory Group
All Wales Therapeutics and Toxicology Centre
Comparative Analysis System for Prescribing Audit
Clinical Effectiveness Prescribing Programme
(formerly called the Prescribing Incentive Scheme)
Community Pharmacy Wales
Department of Health and Social Services
General Practitioner
Medicines and Healthcare products Regulatory Agency
National Medicines Management Programme Board
Draft minutes AWPAG –September 2014
National Institute for Health and Care Excellence
New Medicines Group
NHS Wales Informatics Service
Prescribing Support Unit
Task and Finish Group
University Health Board
Welsh Analytical Prescribing Support Unit
Welsh Medicines Resource Centre
Welsh Government
1.0 Welcome & introduction
The Chair opened the meeting and informed the group that Dr Mark Walker had been
appointed to AWMSG and therefore would no longer be attending AWPAG and that Dr
Sean Young had resigned from the group. The Chair extended thanks to them both for
all they have done for AWPAG. The Chair also informed the group that Dr Ashok
Rayani had been unwell and Dr Peter Horvath-Howard was attending as his deputy
from GPC (Wales). A welcome was also extended to Karen Eveleigh from Welsh
Government and to Paul Gimson, Primary Care Lead from the 1000 Lives Programme.
Members introduced themselves.
2.0 Apologies
Dr Mark Walker
Mrs Karen Samuels
Dr Hamsaraj Shetty
Mr Andrew Evans
Ms Marnel Owen
GP, Betsi Cadwaladr
Consultant, Cardiff and Vale
Community Nurse, Betsi Cadwaladr
3.0 Declaration of interest.
The Chair asked for any declarations of interest. Mrs Robyn Miles declared interests
pertinent to the meeting.
4.0 Chair’s report
The Chair informed the meeting that a project proposal for a Welsh Lexicon for
labelling medicines is currently being considered, and gave a brief update on the
Trusted to Care report.
5.0 Minutes of previous meeting
The minutes of the previous meeting were checked for accuracy. Tessa Lewis asked
for it to be noted that her attendance should now be entered onto the minutes under
the non-voting section as member of AWTTC. It was agreed the minutes were an
accurate reflection of proceedings.
The Chair asked for an update of the action points:
Role of Oral Anticoagulants for the Prevention of Stroke and Systemic Embolism
Tessa Lewis informed the group that this paper had now been endorsed by AWMSG.
Dose Taper and Discontinuation of Biologics in Low Disease Activity
Kath Haines informed the group that Jayne Price is still working on the points for
clarification requested from the last meeting
BNF Chapter Analysis: Respiratory Therapeutic Area
Kath Haines informed the group that this paper is going to AWMSG on 8 October 2014
as the “GP Cluster Level Comparators” paper.
Draft minutes AWPAG –September 2014
6.0 Feedback from AWMSG meetings held 16 July and 3 Sept 2014
Polypharmacy – Guidance for Prescribing in Frail Adults
The Polypharmacy – Guidance for Prescribing in Frail Adults document was supported
by AWMSG in July 2014. Positive feedback and requests to use the document were
reported from NICE, Welsh Government and the Centre for Medicines Optimisation,
Keele University. A letter had been received from the Chair of the National Specialist
Advisory Group for Older People with positive comments about the guidance. The
group questioned how it was to be implemented and suggested the inclusion of a
summary. Sarah Isaac suggested Appendix 2 as a useful summary and agreed to
share the PowerPoint presentation she has used in Hywel Dda.
The recently established Prudent Prescribing Implementation Group can help with
implementation of AWPAG guidance, including the polypharmacy document. JH will
Action: LHB to talk to Prof John Hindle.
Action: AWTTC/LHB to continue working with interested parties to support the
implementation of the guidance.
Pharmacotherapy for Smoking Cessation
Pharmacotherapy for Smoking Cessation was endorsed by AWMSG in July 2014.
All Wales Advice on the Role of Oral Anticoagulants
The All Wales Advice on the Role of Oral Anticoagulants document was endorsed by
AWMSG in September 2014. Minor edits had been made and resources updated. It
was felt that some further alteration in relation to the NICE Clinical Guidelines for AKI
could not be made without consultation.
NPIs 2013–2014: Analysis of Prescribing Data to March 2014
NPIs 2013–2014: Analysis of Prescribing Data to March 2014 document was supported
by AWMSG in September 2014.
Paul Gimson joined the group.
7.0 Presentation – National prescribing Indicator (NPI) related outcome measures
proposal – Paul Gimson
The Chair welcomed Paul Gimson, Primary Care Manager at 1000 Lives who
presented the NPI related outcome measures proposal and highlighted the need for
NPIs to support key principles of prudent prescribing. It was suggested that NPIs
should become more outcome-focused and that 1000 Lives could support this.
Difficulties with availability of outcome data were raised. Need to clarify the purpose of
NPIs and who they are intended for, together with the context of their criteria for
The group agreed that antidepressant and respiratory prescribing could be investigated
as possible areas where NPIS could become more outcome focused. It was suggested
that WAPSU pursue respiratory data and 1000 Lives look at antidepressants, with
support from each other.
Action: Two groups to report back to December AWPAG meeting.
Action: KH and PG to co-ordinate the respiratory and antidepressant work
Action: JS and BW to support respiratory work.
Action: PF to provide feedback on the medicines optimisation document when it
is ready to a future AWPAG meeting.
Karen Eveleigh left the meeting.
Jane Barnard joined the meeting.
Jonathan Simms and Sarah Isaac left the meeting during the next item.
Draft minutes AWPAG –September 2014
8.0 Documents for discussion
National Prescribing Indicators 2015–2016
Kate Jenkins presented the proposed NPI 2015–2016 document and referred to the
notes of the AWPAG Task and Finish Sub-Group held on 21 July 2014 plus a
circulated key discussion document. Discussion then followed on the document in
general; order of the document, the setting of thresholds, decision support tools (e.g.
ScriptSwitch) and the development of key messages. The group agreed that a
summary document and PowerPoint support material would be useful and that
formalised shared learning should be developed. It was requested and agreed that
English averages were included within the graphs/data.
Each proposed NPI was then discussed in detail, as to whether it should be included
as a NPI and the appropriate measure used.
Proton pump inhibitors, lipid modifying drugs, hypnotics and anxiolytics, opioid
analgesics, NSAIDs and yellow card reporting were supported by the group with some
minor amendments to the supporting information
Inhaled corticosteroids - KJ circulated further graphs to show alternative measures to
the one proposed in the document. Following lengthy discussion it was agreed to
monitor all low dose inhaled corticosteroids. The All Wales Primary Care Pharmacists
group will be approached to check and agree the final drug baskets for this measure.
Antibiotics – the proposed revised measures were agreed for the individual antibiotics/
groups of antibiotics. It was agreed that annually monitoring data to December would
be appropriate to identify whether or not prescribing was reducing.
Drug baskets and measures for tramadol and NSAIDs were discussed following
feedback from health boards; however the group agreed with the proposals of the subgroup and the measures remained unchanged
TL proposed the inclusion of an alternative, that is, non-drug measure for a NPI around
patients on oral anticoagulants receiving a baseline bleeding risk assessment or a
record of Time in Therapeutic Range. The group discussed the proposal and although
the suggestion was supported, it was felt that it should not be included as a NPI at this
point because they aren’t readily available measures.
Action: AWTTC to explore authoring prescribing decision support message
(ScriptSwitch) to support AWTTC projects.
Action: KJ to revise the document for consultation and present final document to
December AWPAG meeting.
Action: KJ to approach Primary Care Pharmacists group to check drug baskets.
Action: BW to propose a project on morphine use in chronic pain, to reduce its
association with palliative care only.
Advice on the Role of Oral Anticoagulants – Supporting documents
Tessa Lewis presented the Advice on the Role of the Oral Anticoagulants – Supporting
documents. The group were informed that QOF had now been updated regarding use
of aspirin in AF. Discussion followed and it was agreed that in recommendation 1.1 of
the Questions for Health Boards the section on flu clinics should be removed. The
group also discussed the Summary for Patients and it was agreed that this needed
rewording. Rick Greville, Alan Clatworthy and Jane Barnard agreed to forward
rephrasing suggestions outside of the meeting.
Action: AWTTC to update documents, share with AWPAG (who will share more
widely) then PAPIG, then present to AWMSG for information.
Draft minutes AWPAG –September 2014
9.0 Verbal updates
Prescribing Dilemmas
Tessa Lewis gave a verbal update on the Prescribing Dilemmas document. Dr Rob
Bracchi is supporting this project and will contact contributors individually to clarify any
outstanding issues. It was agreed that the section on HPV should be removed.
Action: Updated document and any outstanding issues to December AWPAG
Kate Jenkins informed the group that the Bisphosphonates paper had been put out to
consultation and that debate about the content had arisen. The paper will be
discussed at the WOAG meeting in November, and will be amended as appropriate
and then presented to AWPAG in December 2014.
Action: AWTTC to amend following WOAG meeting and present at December
AWPAG meeting.
Medicines-related Admissions
Jamie Hayes updated the group on the Medicines-related Admissions work. Currently
this project is being undertaken in Wrexham and is soon to be presented to the ABPI.
A WeMeReC Bulletin regarding medicines-related admissions is due to be released in
October 2014.
Action: JH to update members on progress at December AWPAG.
Dose Taper & Discontinuation of Biologics in Low Disease Rheumatology
Work is ongoing.
Action: Jayne Price to update members on progress at December AWPAG.
Antibiotic Audit Outcomes
Tessa Lewis gave an update on the Antibiotic Audit Uptake. Outcomes are also being
collated though fewer responses had been recieved. A suggestion was made for the
audit to be given to medical students, or registrars for appraisal/revalidation support
Action: Members to send any further results to AWTTC.
Action: AWTTC to continue to collateaudit results and CEPP plans including
tramadol, and present to PCDG.
10.0 Feedback from the All Wales Chief Pharmacists Committee (AWCPC)
There were no items of note.
11.0 AOB
There was no other business and the meeting closed.
The date of next meeting – Wednesday 10th December 2014
Draft minutes AWPAG –September 2014