3rd June 09 by I14TpTUD


									              Minutes of the Meeting of the WPCT Clinical Effectiveness Group
                     held on 3rd June 2009 at 3-5pm in room 3 in WBH

Present: Nick Beavon – Chief Pharmacist, Chair
         David Finch – Joint Medical Director
         Ross Anderson, St George’s Medical School
         Dr Rachel Hazeldene – VTS SHO
         Donald Roy – Lay member
         Alisi Mekatoa – Clinical Effectiveness Facilitator – Joining Aug 09
         Crystal Stewart, Exceptional Circumstances Administrator
         Joshua Bull, Service Improvement Management WPCT
         Judith Nelson, Community DSN
         Liz Frost – SMPCT Optometric Advisor
         Linda Troy – Chair, Sutton, Merton, Wandsworth Local Optometric Committee
              Satvinder Bansal – Wandsworth Rep, Local Optometric Committee

09/01       Welcome and Apologies for Absence
            The group welcomed AM to the group in August when she comes to
            work in the department. Also welcomed LT, JN and LF who are
            attending to present item 5.
            Mick Sanders – Clinical Effectiveness Facilitator
            Dr Stephen Farrow - Public Health Consultant
            Norman Evans – Public Health Pharmacist
            Amanda Cranston - Consultant in Public Health
            Ken Abhayaratna – Non acute Commissioning Manager
            David Selwyn, Lay member
            Chris Gilleard St Georges MHT
            Fiona Hicks, Clinical Governance Manager WPCT
            Dr Josephine Ruwende- Consultant in Public Health Medicine
09/02       Minutes of the Previous Meeting and Matters arising
            The minutes of the meeting held on 5th
            February 2009 were agreed as a correct record.
            DR informed the group that he had contacted Ted Poulter concerning
            the mapping and audit of services of the Mental Health wellbeing in
            Older People.
            NB had spoken to AC concerning the Baseline Assessment being
            done by the Mental Health Trust, we have not received any feedback.
            NB to check with JR spoke to Chris Gilleard from the MHT.           NB

09/03       Revised Terms of Reference and Membership
            The group discussed the revised ToR and decided that it cannot be
            approved at this meeting. It was suggested that there is 4 medically
            qualified members required, only 1 need to attend each meeting. To
            be brought back to the next meeting for discussion when JR. ToR
            required from Trudi Kemp, St. George’s hospital; Chris Gilleard,
            Mental Health Trust Springfield Hospital and to check with JR quoracy,
            re. medically qualified person attendance at meetings.

09/04       Latest NICE Guidance
            TA170 Venous thromboembolism – rivaroxaban. NB informed the

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            group that this is a very new drug used for knee replacement
            operations, not sure whether St George’s has approved the drug yet.
            NB to check. Also to check if the sector has approved. GPs may
            be reluctant to prescribe this drug, or many may not have heard about NB
            it yet. Implications are very significant, less side effects than warfain.

            CG84 Guidance on Diarrhoea and vomiting in children under 5 – To
            check whether GPs and WIC are adhering to these guidelines.

            IPG296, IPG297, IPC298 are all guidelines for the procedures which
            are effected in secondary care.

09/05       Baseline Assessments – glaucoma Linda Troy
            LT relayed to the group that NICE has lowered the threshold for
            diagnosis of Occular Hypertension, not only will referrals increase but
            the number of patients who require ongoing management will also
            increase. These additional patients will have huge implications in
            terms of capacity within hospital eye
            departments. The proposed pilot is for a low level of intraocular
            pressure and visual fields. If IOP is above the NICE threshold for
            ocular hypertension at routine sight test, the optometrist will use the
            gold standard Goldmann tonometry, and repeat if necessary. This will
            reduce the number of false positive referrals. The use of Goldmann
            tonometry is not a requirement of a General Ophthalmic Services sight
            test, although it is a core competency of optometrists. Similarly, if a
            suspicious visual field is detected at sight test, the visual field test
            is repeated on a separate occasion.
            The Royal College of Ophthalmologists estimates that 60% of
            glaucoma referrals are discharged following investigation. With the
            lowering of the IOP threshold, this figure is likely to increase.
            It is thought likely that 35% of patients who have Goldmann tonometry
            will have IOP ≤ 21mmhg and will be discharged, and that a further
            15% will be discharged following the second IOP reading.
            For those who need repeat fields, we have assumed 60% will be
            referred to Hospital Eye Services.
            Patients, who are diagnosed by secondary care or specialist
            practitioner as having OHT which does not require treatment, will be
            referred for monitoring in the community at intervals specified by
            NICE. If there is no change in clinical status next appointment is
            booked as per NICE recommendations and if there is a change in
            clinical status patient will be referred back to specialist.

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            The only real set up cost to consider is that of the Goldmann
            tonometers, but the costs of these will be quickly recouped in the
            referral refinement pathways.
            There will be the opportunity for full diagnostic clinics in the
            community as optometrists become accredited to carry out techniques
            beyond core competencies such as gonioscopy.

09/06       Off-label Prescribing of miconazole oral gel and fluconazole -
            Nick Beavon
            NB presented this item. JR had collated the information NB presented
            previously. The group supported the guidelines for miconazole,
            however the use of fluconazole is restricted to babies over 4 months
            old, would need to look to capsticks for legal advice. The breast
            feeding Network have not produced a policy on the use of miconazole.
            DF stated that if the indemnity has been picked up by the PCT it could
            come to this group as long as the prescribing nurse has adhered to the
            policy/guidelines. Recommendations will need to be provided for
            independent prescribers as community pharmacists may refuse to
            provide Miconazole ‘off label’. Provider will be encouraged to seek
            advise from capsticks.
09/07       Shared care protocols Mitta Bathia, Nick Beavon
            Leflunomide – DR highlighted that this drug requires contraception
            drug given to both men and women, and has been placed on the SWL
            list for shared care, and the SWL Prescribing Committee agreed at the
            last Perscribing Committee that Leflunomide should go onto the
            shared care list. It has been prescribed by 25 GPs. Has been sent to
            Charlotte Levitt – practicing GP in Wandsworth and will be discussed
            at the next monthly review. The guidelines need to be altered – not to
            be given to males if considering fathering childern and not to be given
            to women if considering pregnancy within 3 months of stop taking the
            drug. Group will agree guidelines subject to these amendments.
09/08       Tonsillectomy audit Katie Hunter/Mick Sanders
             KH presented the audit completed for WPCT patients who are treated
            in St George’s hospital. Difficulties found when completing the audit
            that information was not complete for quarter 2 – quarter 3, April –
            October 2008, therefore it was difficult to read data effectively. KH
            suggested when collecting data a tick box questionnaire be set up. KH KH
            to double check what the dominator figure and run by JR.

09/09       Approved Research Projects – for information
            Not discussed
09/10       Proposed dates for 2009
                        Date                  Time            Room
                    February 5th              3-5pm             1
                       April 1                3-5pm             3
                       June 3                 3-5pm             3
                      August 5                3-5pm             1
                     October 1                3-5pm             1
                    December 2                3-5pm             3
                  February 4th 2010           3-5pm             1
09/11       Any Other Urgent Business

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              Guidelines - Draft
            30th June 2008 - 06 05 2009.doc

            JN informed the group that the guidelines are to be used for diabetic
            patients presenting in both primary and secondary care. There has
            been a rise in patients presenting with Type 2 diabetes in secondary
            care, now these patients are going to be discharge into primary care.
            JN wished to ask the group to look through the guidelines to see if
            they meet the right criteria. The guidelines are a working document
            and will need updating regularly. NB suggested that documents like
            these need to be kept in a place where they are easily accessible. The
            Wandsworth Diabetes Implementation Group (WIG) have their own
            website, the document may be better placed there as well as the PCT
            website. NB suggested to bring back to the next meeting for approval.
            JN to send draft to DF

Approved as a correct record:

Signed:      ……………………………………………..

Date:        ……………………………………………..

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