DacCom PBC Prescribing Sub Committee Meeting

20th June 2007 – Fernville Surgery- 

Present  Richard Gallow, Zunia Hirst, Richard Jones, Colin Friedland (LPC Rep)- 

Apologies – Sapana Sheth

This was the inaugural meeting of this committee and was without an agenda. 
Issues were discussed about the role of this group and its future remit. Notes were taken and summarised as follows

PBC Prescribing Sub committee
•	It is a strategic group that should be discussing issues and guidance from the PCT, E o E Strategic HA and NICE etc. and translating these into how to implement them.
•	To enable this, the sub committee should comprise the Prescribing Lead, MM Lead, PCT lead, LPC rep., PBC rep. and Nurse Rep. (?RJ to invite)
•	Work such as PGDs would be best done outside of this meeting within the Medicines Management Group.
•	Terms of Reference should be drawn up. A slightly shortened version of the WelHat ones would be valuable BUT in addition, they must include clauses relating to performance management and also to cost effectiveness. (RJ)
•	The meetings should be held quarterly- dates to be arranged approximately one month before the GP Leads meeting. Their agenda would be set and suitable papers be identified for circulation to enable debate and implementation at that meeting (RJ to arrange dates with consultation with Mary to avoid clashes)
•	No need to produce a Newsletter as there is now a Hertfordshire PCT one.

GP Prescribing Leads meeting
•	It was felt that the PBC rep. should chair the Leads meeting to enable the Prescribing Lead to be more engaged in the discussions. OK until the culture changes. (RG)
•	Continue the meetings quarterly, possibly at different GP surgeries, and to include lunch, MD or 12.30 to 2pm. To be held approx one month after sub committee meeting (RJ to arrange dates +/- venues with RG)
•	Attendance must be 75% of PBC GPs and other professionals to help
o	GP to attend 75% of meetings or sanctions (RG to discuss with PBC to decide what is allowable)
o	A Pharmacy Rep.’s presence was invaluable although the LPC rep. is now spread too thinly. Please invite a Community Pharmacist- (Ask LPC advice on whom and payment etc.)
o	Clinical Governance input is essential to ensure that NICE and NSFs and other aspects of National and core standards are adhered to.
o	Terms of Reference should include an appropriate reduce d version of  that of the sub committee with tense and person being adapted (RJ)
•	Minutes to be written up and agreed and innovations and cost effective performance issues should be included.

Projects
There was much discussion about the E o E standards and the sip feed project.
Was this money well spent? 
Was the patient’s needs being ignored?
Ongoing costs for pharmacists and extra work costs for receptionists were being ignored and must come into the equation.

I feel that the problem with the subject appealing to GPs is one of ownership. Professionals do not like being told what to do, especially if the evidence is lacking or not presented.
This can be overcome to some extent by 
•	Engaging the GPs at the Leads meeting and saying that we need to examine a project and produce the evidence of need and draw up a charter of how to do this. It will not be reinventing the wheel if other area’s methods are considered
•	The sip feeding needs written guidance to be offered to GPs of when not to give sips and also to offer an alternative. How to say no to nursing homes and palliative care if inappropriate use of resources etc. 
•	A dietician to educate the local providers is not welcomed as they only offer a limited service anyway and seem to push sip feeds themselves. (Revisit)
•	28 day prescribing will be unpopular unless explanations are given of its value. A proper discussion needs to take place.

Targeting Overspends

The PBC currently works on the most cost effective switches at present. Most gain for least work. Can we undertake the whole wish list in one go by each practice having a lead prescribing administrator? Further discussions needed.

Richard Gallow
Prescribing Lead for DacCom