Medicines Management

I would like to enquire as to whether you have a switching policy in place within your PCT? And if so, what are the conditions for this?

Please provide any written policies you have.

1. The names of all individuals on you trust Drugs and Therapeutics Committee or equivalent.

2. Names of individuals involved in Medicines Management in your Trust

3. Details of your Medicines Management Policy

4. Names of individuals involved in Medicines Reviews

5. Organograms or equivalent hierarchy structure of the Medicines Management Team

6. The last twelve months Drug and Therapeutics Committee meeting minutes

7. A copy of your trust approved drugs list or formulary

8. A copy of the trust policy document on working with pharmaceutical industry

9. Number of new medicines approved and rejected by your Drug and Therapeutics committee in the last year

10. Number of requests by pharmaceutical company representatives to discuss drugs with health care professionals both granted and declined in 2009-2010 period

11. Send me the details of the drug reviews that are sent to and distributed to the Drugs and Therapeutics Committee members before the Committee meets for the last year

12. Send me the minutes of the meetings and member names and roles of any allied Area Prescribing Committees or Joint Formulary members

13. Provide full details on all current and future prescribing incentive schemes

14. Provide full details of all current and future prescribing audit strategies

15. Copies of all documents related to a drug formulary submission that a healthcare professional would have to complete to apply for a drug

I am interested to know if glucosamine prescribing forms any part of the PCT’s efficiency savings as defined within your PCT QIPP plan. If glucosamine forms part of your local QIPP plan we would be grateful for an electronic copy.

I am also interested to know what the PCT’s policy is on the prescribing of unlicensed products i.e. those that do not carry the POM (Prescription Only Medicine) classification.

A.     Non managerial staff:

A1.   GP with Special interests: names, contact information, specialties

A2.   GPs with Declared Interests: names, contact information, declared interest

A3.   Nurses with Special Interest, Nurse Prescribers, District Nurses employed by the organization

A4.   Clinical Leads/ Public health/ Disease leads and the domain of their specialty

B.     Medicines Management Staff and Committees:

B5.   Medicines Management/ Formulary/ Area Drugs and Therapeutics/ Prescribing Committees

B6.   Members of such committees

C.     All the PCTs sole and joint formularies 

Information regarding the measures the PCT will be taking in the next financial year (2011/12) to make savings to GP drug prescribing budgets, in accordance with instructions issued by the Department of Health as part of the medicines management work stream of its Quality, Innovation, Productivity and Prevention (QIPP) agenda.

1. Have you been working with any pathfinder GP consortia, or private companies, to develop prescribing guidelines for GPs?

2. Have you made any estimates of how much the PCT would like to save from the prescribing budget in 2011/12?

3. Will you be placing restrictions on the prescribing of specific drugs, or classes of drugs, by GPs in 2011/12? If so please give details.

4. Will you launch any new primary care initiatives to help GPs reduce their spend on prescribed drugs in 2011/12? If so please give details.

1. Have the medicines management, pharmacy, commissioning or public health teams had any discussions with the local pharmaceutical committee or internally since September 2010 on halting (or not extending, where a contract has come to an end) any community pharmacy enhanced services. 

2. Where such a discussion has been held, could you confirm:
• The date of the meeting
• Which service was discussed
• Whether a decision has been made on discontinuing the service
• The (brief) reasons for that decision and when the service will be stopped.

3. If any minutes or notes are available from these meetings, please could I see a copy of these.

a) How many Exceptional Case requests have been accepted and rejected using funds from the Interim Cancer Drugs Fund since 27 July 2010

b) Which Cancer treatments were funded and not funded following exceptional case requests using funds from the Interim Cancer Drugs Fund since 27 July 2010?

c) What is the estimated total cost of cancer treatments funded and not funded following exceptional case requests since 27 July 2010?

1. I would like to know who your prescribing lead/advisor is?

2. If you don't have a prescribing lead/advisor, I would like to know who deals with prescribing guidelines in the PCT and what their job title/role is?

3. Is there anyone who deals specifically with antidepressant guidelines?  Who is this?

1. The annual cost for ScriptSwitch or equivalent Prescribing Software System or the E prescribing system that you have purchased.

2. The initial cost for purchase of ScriptSwitch or equivalent Prescribing Software Sytem or the e prescribing system that you have purchased.

3. A copy of all the electronic based documents that exist on your Head of medicines Management or Chief Pharmacist or Specialist in Pharmaceutical Public Health or Equivalent Computer System as at the date of this letter.

4. The latest copy of your "dashboard" or “toolkit” or "audit tool" or "tracker" used in medicines management.

5. The names of all black listed or not recommended or brown category drugs.

6. The evidence base that you used to justify the blacklisted or brown or not recommend drugs.

7. The latest copy of your drug formulary or preferred prescribing list or equivalent document.

8. The minutes of your APC, DTC, Joint Medicines Committee, JAPC, HENIG, NMAG, NPAG or whatever name you call your forum for reviewing medicines that exists locally since January 2011.

9. The names of all GP Consortia that have been set up locally

10. The names of all the commissioning leads locally

Please could you supply the following information:

• Patient Care Pathways relating to Stroke Prevention and/or Atrial Fibrillation (SPAF);

• Treatment Protocols relating to Stroke Prevention and/or Atrial Fibrillation (SPAF);

• Clinical Guidelines relating to Stroke Prevention and/or Atrial Fibrillation (SPAF)

1. Please confirm or deny whether the PCT has issued guidance advising GPs to limit prescriptions to 28 days' supply at a time. (If the reply to this is 'deny', please ignore all part of question 2.)

2. Please confirm or deny whether the PCT has assessed the effect of its guidance on 28-day prescribing on:
i) the PCT's prescribing budget
ii) the number of prescriptions issued by doctors and collected by patients
iii) the cost and inconvenience to patients and patient care
iv) the administrative costs for GP practices and community pharmacies

On behalf of the Primary Care Cardiovascular Society, Atrial Fibrillation Association and Chris Ruane MP, please find attached a request that we wish to make under the Freedom of Information Act 2000.

The requested information concerns the diagnosis, management and treatment of Atrial Fibrillation patients by your Primary Care Trust.

I am researching diabetes services and would like to request a copy of the most up to date diabetes care pathway, which I haven’t been able to find online. I have a copy of ‘Derbyshire Diabetes Network Diabetes Model of Care 2008’, but presumably this is out of date now?

Also, in light of the recent organisational changes, with PCTs clustering and the formation of GP Commissioning Consortia, please could you tell me how medicines management teams in the area are restructuring?

Please send me the following information relating to Unlicensed Medicines Practice:

1.     Number of patients prescribed Firdapse in 2011

2.     Number of patients prescribed 3,4-Diaminopyridine in 2010 and 2011

3.     Number of Patients prescribed amifampridine

4.     The number of patients with LEMS treated by your trust.

5.     Copy of all emails containing the word Firdapse

6.     Copy of all emails containing the word 3,4-Diaminopyridine

7.     Copy of all emails containing the word 3,4-Dap

8.     Copy of all emails containing the word amifampridine

9.     Copy of all documents containing the word Firdapse

10.   Copy of all documents containing the word 3,4-Diaminopyridine

11.   Copy of all documents containing the word 3,4-Dap

12.   Copy of all documents containing the word amifampridine

1. How many prescription items were dispensed by pharmacists in your PCT in each of the last 3 financial years (2008/09, 2009/10, 2010/11)? Also, please provide annual figures on (a) how many were paid for, (b) how many were exempt from payment with evidence provided and (c) how many were exempt from payment with the ‘evidence not seen’ box marked.

2. How many of these prescription forms were sent to NHS Protect in each of the last 3 financial years (2008/09, 2009/10, 2010/11) to check the exemptions? For each year please provide a breakdown by whether the “evidence not seen” box was marked or whether evidence was provided.

3. How many did NHS Protect report to be incorrect (i.e. where exemption status could not be confirmed)? Please provide an annual breakdown.

4. For how many of these prescription forms where the exemption status could not be confirmed, did the PCT undertake further local verification of circumstances? Please provide an annual breakdown.

5. Of these cases of further verification, how many were subsequently found to be fraudulent? Please provide an annual breakdown.

6. How many penalty charges were imposed in each of the last 3 financial years (2008/09, 2009/10, 2010/11) as a result of these checks by the PCT?

7. Please also provide annual totals for the value of these penalty charges imposed, and the total monies received.

8. Please provide any other details on subsequent action taken by the PCT for the cases in relation to question 5.

Thanks for your response. I am surprised that you say the number of forms sent off to NHS Protect for checking is zero for each of the last 3 financial years.

I have spoken to the NHS Business Services Authority and they have assured me that the information requested in q2-8 is held at PCT level.

I suspect the information is held with your Counter Fraud or Finance teams rather than the Prescription teams – if you haven’t already checked with them could you please do so? As I understand it, every PCT sends off a certain number of forms to NHS Protect (formerly NHS Counter Fraud Service) who carry out some checks for them, and report back for the PCT to verify the details.

Do you have more than one formulary in the PCT (eg separate formularies generated by Clinical Commissioning Groups)? If yes, please answer the following questions in relation to each formulary

What are the contact details, including job title, of the individual responsible for managing the formulary day-to-day?

In the last six months, have there been any changes to the details of the individual responsible for managing the formulary day-to-day? If yes, please give details

Is there a group overseeing the formulary? If yes, please give numbers and job titles of members of the committee or other group

In the last six months, have there been any changes to the details of the group overseeing the formulary? If yes, please give details

Is there a formal application process for considering inclusions, substitutions, removals, or other amendments to the formulary? If yes, please give details (including when applications can be made, to whom if not the individual responsible for managing the formulary day-to-day, and when applications are considered). Please send us a copy of any application form(s) and/or relevant documentation (in hard copy or electronically). If no, please describe the process by which products are considered for inclusions, substitutions, removals etc.

In the last six months, have there been any substantive changes to the application process for considering inclusions, substitutions, removals, or other amendments to the formulary? If yes, please give details

Is a copy of the formulary available? If yes, please send a hard or electronic copy, or direct us to a URL from which it can be Obtained

What changes do you anticipate as a result of the Department of Health’s PCT Cluster Shared Operating Model, the NHS Operating Framework for 2011/12, or any other local or national guidance relevant to the creation of PCT Clusters or the development of Clinical Commissioning Groups? Please give details of new arrangements and timings, if known. If not yet known, please give details of the process, including timings, that you consider are (or are likely to be) relevant to

Please give details of the person who completed the response to this enquiry.

1. Please send me a link to (or a copy of) the PCT's most recent prescribing formulary, or any equivalent document containing details of which drugs the PCT classifies as:
(i) not recommended for prescribing by either secondary or primary care;
(ii) not recommended for prescribing by primary care
(iii) recommended for initial prescribing in secondary or tertiary care, with prescribing continued in primary care.

2. Please explain what action the PCT takes if any prescribing falls outside the recommendations of the prescribing formulary.

3. Please state how many times in 2009-10 and 2010-11 the PCT has needed to take action in response to prescribing decisions by GPs that have fallen outside the recommendations of the PCT's prescribing formulary. Please provide details of how such disputes were resolved.

Many thanks for your response but please could I have a little more detail on your response to QP1 as shown below.

“Our response: QP1
Three areas have been agreed with each practice depending on their own practice performance position. The areas have been selected from the 7 national indicators for which data is available (insulin detemir and glargine as % of long-acting and intermediate acting insulins (excluding biphasic insulins); ACE inhibitor as % drugs affecting renin-angiotensin system (exluding aliskiren); metformin and sulphonylureas as a % of oral antidiabetic drugs; ibuprofen and naproxen as % NSAIDs; low cost statins as % all statins and ezetimibe; low cost PPI as % all PPIs; cephalosporins and quinolones as % all antibacterials). Practices were asked to return their choices by 30th June 2011. It is 7 selected from the national BCBV indicators which provide information on national 75th quartile.”

Which three areas have been selected by each practice?

Please would you provide answers to the following:

1.  Do you record adherence to formulary at practice/ BNF Chapter level?
2.  Do you incentivise your GPs to promote adherence to formulary?
3.  At what time intervals?
4.  What scale do you use to quantify lack of adherence?

Within the limits of your system we need to know the percentage adherence of each of your practices, identified by NHS Code, in the following chapters

1. Overall
2. Gastro-intestinal system
11. Skin

Request 1 / Reference 68: Please confirm the process for reviewing a new drug and the associated process for formulary inclusion within your healthcare economy

Request 2 / Reference 69: Please disclose the names of any committees and the members included involved in the review of a new drug and its addition to your formulary

Background
Community Pharmacies UK Ltd have recently made two separate applications to open pharmacies within medical centres.

Both applications are under regulation 13(1)(b) of the NHS Pharmaceutical Services regulations 2005, to open a pharmacy for 100 hours. These are at Appletree Medical Centre, Duffield and Littlewick Medical Centre, Ilkeston.

Following our Freedom of Information Request of February 2010 the cost or notional rent funded by Derbyshire County PCT is:

Appletree Duffield £95.000
Littlewick £97,000 (relates to premises before re-development – I understand the new figure is in excess of £200,000)

Rent Reimbursable Information as at 30.1.12:
• Appletree Medical Centre £95,500.00
• Littlewick Medical Centre £371,000.00 + VAT

Further Request for Information

The PCT funds the entire demise of these premises either under a notional rent scheme where the property is owned by the practice, or a cost rent scheme where it is owned by a developer and leased.

Question 1
What assessment has been made of the space within the demise that will be allocated to the pharmacy?

Question 2
What steps have been taken to value that space, either on a pro-rata basis on the rent payable or on a commercial basis looking at similar rent within other medical/pharmacy complexes within the PCT area?

Question 3
What assessment has been made of the value of the lease i.e. lease premium, again on the basis of similar lease premiums paid within other medical/pharmacy complexes with the PCT area?

Question 4
Has the PCT had discussions with the Valuation Office to benchmark these figures?

Question 5
What steps has the PCT made to offset the value of the lease and rental income against the cost or notional rent paid by the PCT?

If the area within the demise is now considered not to be required and can be let commercially:

Question 1
What steps have been taken to recoup monies paid in previous years for space funded clearly in excess of the practices requirements?

Question2
On-going will the PCT be making an assessment of its cost/notional rent funding as all practices to ensure that only space needed by the practices for the operation of medical services are reimbursed?

I’ve been trying to find the latest meeting minutes of your:

1.     Medicine Management Committee
2.     Formulary Committee
3.     Joint Area Prescribing Committee
4.     and any other committee involved in Medicines Management, Prescribing and Formulary Management
 
To ensure that I have found a complete set, could you please send me the minutes directly, in electronic format, or give me a weblink/URL to the source?

1. Does your PCT Cluster have a commissioning policy for the overall management of Hereditary Angioedema?  If so please supply a copy of your policy.  If policies vary within your cluster, please state which PCTs do/do not have a policy for the management of Hereditary Angioedema, and attach each individual policy.

2. Does your PCT Cluster have an overall commissioning policy for any of the following drugs: C1 Esteraise Inhibitor, Icatibant?  If policies vary within your cluster, please state which PCTs do/do not have a policy, and attach each individual policy.

3. Does your PCT Cluster have an overall policy for home use of the above named drugs?  If so, please supply a copy of your policy.  If policies vary within your cluster, please state which PCTs do/do not have a policy for this, and please attach individual policies.

4. How many requests for funding of the above named drugs for Hereditary Angioedema or Acquired Angioedema has your PCT Cluster received over the past two years.  Please provide details of the indication and the drug concerned, together with the particular PCT receiving the request.

5. How many requests for each drug were approved and how many were refused.  Please indicate the particular PCT involved in each instance.

1) Is the PCT using any of the following schemes as a way of saving money / improving access to specific pharmaceutical products?
- PCT (or primary care) Rebate Scheme
- Patient Access Scheme Rebate
- Locally Agreed Procurement arrangements

2) If Yes to any of the above, then which drugs / therapeutic areas are involved?

3) If Yes to any of the above, then is this a current scheme (2011/12) or scheme planned for 2012/13?

Q1      How many pharmacies are on the PCT’s pharmaceutical list?

Q2      How many of these pharmacies are located within the same premises as a GP practice?

Q3      In how many of the pharmacies currently on the PCT’s pharmaceutical list is the PCT aware of there being a GP with a financial interest? (e.g. by holding a financial stake in the pharmacy or being a director of the owning company).

Q4    Please provide the following data in relation to applications received by the PCT, between 1st April 2010 and 31st March 2011, to join the pharmaceutical list.
[table redacted]

Q5 Please provide the following data in relation to applications received by the PCT, between 1st April 2011 and 31s March 2012, to join the pharmaceutical list.
[table redacted]

1) Please can you provide details on any current Local Enhanced Service specifically pertaining to the administration of GLP-1 pharmaceuticals (exenatide and liraglutide). Please could you provide a copy of any Local Enhanced Service specific to GLP-1s

2) Is there a specific service developed purely for the administration and management of GLP-1s? If so, please provide specification.

3) What is the cost per initiation for a GLP-1 where there is a LES or specific service in place for each PCT?

4) What training is required for the medical professional to initiate a GLP-1 and receive an LES payment?

5) What spend has been made on Exenatide and liraglutide by brand annually for past 3 years by each PCT?

Q1 Did the medicines management, pharmacy, commissioning or public health teams have any discussions with the local pharmaceutical committee or internally during the 2011-12 financial year (ie April 1 2011 to March 31 2012) on either:

• halting (or not extending, where a contract has come to an end) any community pharmacy enhanced services
• concerns about the quality of any community pharmacy enhanced service (this should cover general concerns raised about more than one contractor, not specific contractual issues or complaints raised about any individual contractor, and could include things like contractors not delivering services in sufficient quantities; collections of patient or other complaints about a particular service; PCT concerns about general service standards) 

(Please note, enhanced pharmacy services may include smoking cessation, minor ailments, weight management, EHC, vascular risk checks, Chlamydia screening, vaccinations etc)

Q2 Where such a discussion has been held, could you confirm:

The date of the meeting
Which service was discussed
For meetings on quality: what the concerns raised were (briefly) and what the outcome of the meeting was (eg service discontinued; certain contractors decommissioned; more training provided etc)
For meetings on decommissioning services: whether a decision has been made on discontinuing the service and the (brief) reasons for that decision and when the service will be stopped

Q3 If any minutes or notes are available from these meetings, please could I see a copy of these.

Click for response

Click for note - May 11

Click for note - Aug 11

Click for note - Nov 11

Click for note - Feb 12

Please could you provide me with the following information under the Freedom of Information Act?

1. The Medicines Formulary and date of review

2. The Skin Formulary and date of review

3. The  Woundcare formulary and date of review

4. Detail of ScriptSwitch including;
• Do you use it?
• How many practices currently have it?
• Details of the lead GP for Scriptswitch

1: Minutes of all commissioning meetings relating to Sativex

2: All supporting documentation that was presented to the commissioning board for their deliberation

3: If they do prescribe Sativex, what is the criteria for approving funding?

4: What are the patient criteria?

5: If they don't prescribe sativex, why was that decision taken?

6: According to the evidence presented to them, what is the estimated number of people who would benefit from being prescribed Sativex.

7: How many patients have applied for Sativex

8: How many patients have been given Sativex

This document can be found on the Derbyshire Medicines Management website. Please follow this link

Please provide the following information regarding all joint Working and sponsorship projects between the following organisations where applicable:

Pharmaceutical companies involved
Project name
Project type e.g. Joint working/sponsorship
SHA/PCT/CCG involved
Therapy area/s
Project objectives
Financial outcomes
Patient outcomes
Level of industry involvement
Was this a positive/negative experience?
Any other relevant information?

1.         Do you operate any prescribing rebate or prescribing risk sharing schemes?

2.         If yes, please provide details of the products included in this scheme

3.         Are your practices incentivised to follow the scheme?

4.         If yes, please provide details

5.         Please give details of how often you are reimbursed by the pharmaceutical companies?

I would be grateful if you could let me know the formulary status in your PCT for the following drugs used by the chronic pain team.
Drug    Status (e.g. GP first line, Consultant initiated, Consultant only etc.)
Amitriptyline
Gabapentin
Pregabalin
Duloxetine
Lidocaine 5% patch
Quetenza
Ziconotide
Ketamine nasal spray
Targinact
Oxycodone
Fentanyl patch
Buprenorphine patch
Tapentadol

I would also like to know when the formulary section on chronic or neuropathic pain was last updated.

In pursuance of the 2006 controlled drug regulations (SI 3148):

On what date was the most recent CD declaration of GPs started?

Was this declaration at individual practitioner level?

What proportion of practitioners on your practitioner/performer list completed a declaration?

On what date was the most recent CD declaration of Dentists started?

Was the declaration at individual dentist level?

What proportion of dentists completed a declaration?

What proportion of community pharmacies undertake enhances services that involve controlled drugs (for example supervised consumption or palliative care supply)?

On what date was the most recent CD declaration of community pharmacies providing enhanced services undertaken?

What proportion of these community pharmacies have completed a declaration?

We would like to understand how NHS Derbyshire Cluster deals with the treatment of HIV and therefore we would like to request any documents that are used to cover this treatment area. In particular, if possible, we would like:

• Treatment protocols
• Patient Care-pathways
• Disease Strategies
• Prescribing Guidelines

I can confirm that treatment of HIV is commissioned on behalf of NHS Derbyshire Cluster by East Midlands Specialised Commissioning Group (EMSCG). We would recommend that you contact EMSCG for more information at the following location:

East Midlands Specialised Commissioning Group
Fosse House
6 Smith Way
Grove Park
Enderby
Leicester
LE19 1SX
info@emscg.nhs.uk
http://www.emscg.nhs.uk/

1.How many drugs are prescribed by health care professionals within your PCT which are designated ‘orphan drugs’ – by this we mean drugs which fall under Regulation(EC) No 141/2000 of the EU, in which pharmaceuticals developed to treat rare diseases are referred to as ‘orphan medicinal products’. Please give details of the names of the drugs.

2.Since January 2007, please can you give a list of the drugs which your PCT has decided no longer to prescribe?

3.How many of these drugs listed (in 2)  are designated ‘orphan drugs’ under the European legislation?

4.How many drugs are prescribed by health care professionals within your PCT which are either a. off label or b. unlicensed drugs. Please name them.

1. Is there any reason why funding may not be allocated to providers of treatment for stand alone prescribed tranquiliser addiction not in association with illicit use as part of your CCG's Public Health responsibilities for Drug and Alcohol services?

2. Will providers of treatment for stand alone prescribed tranquiliser addiction be unable to tender under the new funding arrangements unless they also provide treatments for illicit use including opiate addiction treatment under the new arrangements regarding integrated drug and alcohol services?

3. Is there a directive from the Department of Health or the NTA stipulating that funding will only be allocated for provision for integrated services including illicit, licit and prescribed medication and that funding will not be available for providers of treatment for stand alone prescribed tranquiliser addiction not in association with illicit use?

4. Would you please provide me with copies of any such directives from the DH or NTA with links to them and quoting the relevant paragraphs or sections?

5. Tranquilliser withdrawal after long-term use can be a serious undertaking and may take up to a year or more and can be more difficult  than withdrawal from opiates or other drugs. The expertise often comes from ex-addicts. This service is currently provided by a handful of charities and a few PCTs; some of these charities have 20 plus years experience in successful prescribed tranquilliser withdrawal. What system is in place to ensure that potential service providers will have the expertise, experience and training to provide this service under the new commissioning arrangements?

6. What will the withdrawal protocols be and how will your CCG ensure national uniformity of treatment?

I require the following information for the practices, identified by practice code, residing within the organisations:

From the list below please indicate by practice which three areas have been prioritised [table redacted - see response]

We are trying to build a national picture of gluten free prescription status across the UK and we would appreciate it if you could send to us by reply to this email the current gluten free prescription guidelines for your PCT and also the formulary list for gluten free foods available on prescription in your PCT. This will also help us greatly with compiling our sampling campaigns for next year as we don’t want to send any of your patient’s products they’re not able to receive.

It would also be very helpful to us if you could provide us with an email address and contact name for the person who is responsible for the formulary list in your PCT in order for us to be able to inform you of any product or price changes swiftly and effectively.  

463-473

Derbyshire County and Derby City

I would like to request some information regarding pharmacy methadone service in your PCT under the freedom of information act. Please can you tell me how much you spent on supervised methadone consumption in:

a) The financial year 2009/10
b) The financial year 2010/11
c) The financial year 2011/12

Please could you also attach copies of any communication sent to healthcare providers either internal or in the past financial year regarding the switch from supervised consumption of methadone to unsupervised or vice versa (ie from unsupervised to supervised)?