Northern Lincolnshire Area Prescribing Committee Terms of Reference

1.0         Purpose

  • To establish a collective strategic approach to prescribing & medicines optimisation issues across the Northern Lincolnshire Health Community, in relation to the safe, clinical and cost effective use of medicines.
  • To approve policy on prescribing and medicines optimisation issues at the interface between primary and secondary care and identify associated resource implications.
  • To approve prescribing policy, guidance and medicines optimisation issues at the interface between specialist care providers serving the Northern Lincolnshire region, including organisations providing mental health services.
  • To ensure robust governance arrangements are in place for the effective delivery of medicine policy within a framework of the whole patient care pathway.
  • To make commissioning decisions on prescribing issues on behalf of member organisations.
  • To monitor uptake and compliance by all APC member organisation of decisions made by the APC; to provide a forum for the raising and resolution of non-compliance of an APC member organisation with APC decisions and other commissioning/contracting issues related to prescribing or medicines optimisation.
  • To support the implementation of NICE and National Patient Safety Agency (NPSA) Guidance and other national guidance, e.g. Better Care, Better Value Indicators.
  • To ensure that all applicable medicines with current NICE Technology Appraisals (NICE TAs) are available to patients and correctly listed on the Northern Lincolnshire Formulary.
  • To collaborate with and support neighbouring organisations so that optimum efficiency is achieved.
  • To manage resources effectively so that there is limited duplication of work.

2.0         Relationships and Accountability

  • Each organisation will need to agree accountability and reporting arrangements for the Committee.
  • The committee will need to ensure clear links/accountability with Commissioning, Finance groups and Governance Groups.
  • The decisions made by the APC and the consequences of implementation are binding on member organisations unless stated otherwise at the time of meetings and recorded formally in the minutes.

3.0         Duties

  • To approve prescribing policies, formularies, shared care agreements and prescribing guidelines for implementation across primary and secondary care and establish a robust governance framework for the delivery of medicines policy.
  • To provide advice and input into the commissioning and contracting process for the introduction of new drugs and priorities for funding. Establish a consensus, based on the available evidence, regarding the place in care pathways for relevant new drugs/formulations, or for existing drugs with new indications, and ensure that such advice is disseminated to all stakeholder organisations.
  • To establish, maintain and monitor a joint formulary between the member organisations. Examine the clinical and cost effectiveness of different preparations within particular clinical areas and agree on ‘drugs of choice’ to be applied consistently across both primary and secondary care.  The APC will accept onto the formulary all drugs approved by the Specialist Commissioning Group (SCG) including cancer treatments included in Yorkshire and the Humber Cancer Commissioning Network (YHCCN) protocols.
  • To advise and assist North East Lincolnshire Clinical Commissioning Group (NEL CCG), North Lincolnshire Clinical Commissioning Group (NL CCG) and Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) in the formation, development and implementation of plans for the introduction of new treatments, local policies and national guidance with implications for prescribing.
  • To provide advice and recommendations to the commissioning process in partner organisations on the resource implications of new prescribing policy, to ensure that prescribing and medicines use issues are given due weight in wider healthcare planning and service delivery agreements locally.
  • To make recommendations to assist in the resolution of problems relating to prescribing at the interface between primary, secondary, tertiary and social care.
  • To develop effective communication channels with neighbouring APCs to enable sharing of proposed advice where this might impact significantly on another locality.
  • To respond in a timely manner to local, regional and national changes in NHS policy that will affect prescribing and medicines optimisation locally, including NICE guidance, NICE TAs and NSFs. Provide advice on the local implementation of such policy within the health community.
  • To act as a focus for developing and refining local professional opinion on prescribable products and associated pharmaceutical issues, and to convey such opinions to all relevant organisations and bodies, including those not directly represented on the committee.
  • To make recommendations on medicines optimisation governance standards and support the inclusion of these into service agreements with local providers of primary and secondary care.
  • To advise on policy and procedures for the clinically appropriate use of drugs outside their marketing authorisation.
  • To provide local advice on working with the Pharmaceutical Industry and Sponsorship and register declarations of interest for committee members.
  • To receive summary information on research and development activity across the health community and identify potential implications for prescribing.
  • To review each section of the Formulary on a biyearly basis and ensure that any new evidence, NICE Clinical Guidelines and Technology appraisals are acted upon promptly.

4.0         Responsibilities

Membership is drawn from senior positions within each organisation represented and must fulfil the following responsibilities:

  • Represent the views of their constituent organisations and professional groups
  • Ensure that decisions taken by the committee are communicated and implemented by their organisation and professional groups
  • Commit to attend meetings regularly
  • Nominate a deputy if they cannot attend
  • Contribute to agenda items
  • Commit to work outside the meeting where required
  • Come to meetings prepared with all documents and ready to contribute to the debate and vote, when required, on behalf of and with the authority of their organisations
  • Declare any outside financial or personal conflicts of interest at the start of each meeting

5.0         Membership

5.1          Core membership:

  • Three NLaG representatives including Chief Pharmacist, a consultant and a finance officer involved in contracting/commissioning
  • Three NL CCG representatives including a Prescribing Advisor (Senior Pharmacist), a GP and a finance officer involved in contracting/commissioning
  • Three NEL CCG representatives including the Prescribing Advisor (Senior Pharmacist), a GP and a finance officer involved in contracting/commissioning
  • Three public members drawn from NLaG public governors, NL CCG and NEL CCG patient and public involvement groups
  • One LMC representative
  • One LPC representative
  • One RDaSH representative
  • One NAViGO representative
  • One LPFT representative
  • One professional secretariat
  • Core membership includes voting and associate (non-voting) members. Regular attendance is expected from all Core Members. Where possible, arrangements should be made for a suitable representative to attend in the absence of a Core Member.
  • Each voting member organisation will provide an equal level of support to the management of the committee.

5.2          Co-option:

  • Up to six associate members nominated by NLaG including non-medical prescribers
  • Up to three associate members nominated by NL CCG including non-medical prescribers
  • Up to three associate members nominated by NEL CCG including non-medical prescribers
  • Additional members will be co-opted from clinical networks, specialist services/organisations, working groups as required according to agenda items under discussion.

5.3          Voting Structure

The voting members of the committee are:

  • 3 x Northern Lincolnshire & Goole Hospitals NHS Foundation
  • 3 x North Lincolnshire CCG
  • 3 x North East Lincolnshire CCG

When a voting member is unable to attend, providing the meeting is quorum, a member may vote by proxy or select a suitable representative to attend the meeting and vote on their behalf.

6.0         Procedural issues

6.1          Frequency of Meetings

Meetings will take place monthly.

6.2          Chairperson

  • The Chair will be democratically elected from within the voting membership of the committee. The committee should also elect a vice-chairman and appoint a professional secretary.
  • All elected officers will serve for a period of 3 years, with an annual review of the appointment to take account of changes within year. Officers may stand for re-election.
  • The Chair will provide a written report for the Boards of all trusts on an annual basis.

6.3          Secretary

  • The administrative and secretarial services to Committee will be provided by and funded as agreed by the voting organisations.
  • Meeting Agenda and papers will be circulated to members two weeks prior to each meeting.
  • The Secretary will manage meeting arrangements to ensure that Agenda items are prepared and presented in a suitable manner.
  • The Secretary will update the Formulary within 2 weeks of decisions being made and will disseminate the information to the Trusts involved and other relevant parties.
  • The Secretary will ensure that any NICE Technology Appraisals are acted upon within 90 days of their publication. Any material relating to the impact on patients or financial considerations will be collated, reviewed and disseminated by the Secretary.
  • The Secretary will promote effective horizon scanning and engage appropriate specialist groups from the member Boards.
  • On receipt of a New Line Request, the Secretary will engage specialist groups from within the region and invite relevant individuals as appropriate to attend APC meetings. This ensures a collaborative and professional decision is made.
  • In the occurrence of the Chair and Vice Chair being absent, the Secretary will chair the meeting.
  • The Secretary will create a systematic procedure for the receipt and review of New Line Requests and other APC duties. This information will be disseminated appropriately. Management and IT skills will be utilised to ensure that APC systems adhere to the criteria defined in NICE Good Practice Guideline 1 (GPG1).
  • The Secretary will publish the Formulary and other relevant updates in the public domain so that complete transparency is displayed.

6.4          Other Administrative Matters

  • The venue for the meeting will be chosen which is accessible for the whole health community to ensure attendance by all members of the Committee.
  • The Committee will have the ability to establish time-limited task groups as and when required, to undertake specific tasks.
  • In the event of urgent decisions being required in between scheduled meetings, e-mailed or postal communication will be used. Where this fails, an emergency meeting may be called.
  • Commissioning/contracting issues related to prescribing or medicines optimisation, including non-compliance by APC member organisation of decisions made by the APC will be the first item of business after apologies and declarations of interest. After this item committee members without a clinical role do not need to attend the remainder of the meeting.

6.5          Quorum

The meeting will be deemed quorate where there are 5 voting members (or their deputies), including the Chairman (or deputy) with at least one representative from each voting organisation present. A medic from each organisation must attend, send a deputy or vote by proxy in relation to each agenda item. Decisions will not be ratified unless a medic from each organisation is in attendance or has communicated their decision to the Committee via the Professional Secretary in advance.

6.6          Minutes of Meetings

  • Draft minutes of the meeting and summary sheet will be circulated to members within one week of each meeting, and decisions disseminated with 2 weeks of the meeting.
  • A public website will be maintained which will include the APC Terms of Reference, the joint Formulary, a record of committee decisions and a summarised monthly Newsletter.
  • The Minutes and Newsletter to be provided to each member Board.

6.7          Review

The Terms of Reference will be formally reviewed every 12 months.

7.0         Equality Act (2010)

  • In accordance with the Equality Act (2010), the Trust (NL&G) will make reasonable adjustments to the workplace so that an employee with a disability, as covered under the Act, should not be at any substantial disadvantage. The Trust will endeavour to develop an environment within which individuals feel able to disclose any disability or condition which may have a long term and substantial effect on their ability to carry out their normal day to day activities.
  • The Trust will wherever practical make adjustments as deemed reasonable in light of an employee’s specific circumstances and the Trust’s available resources paying particular attention to the Disability Discrimination requirements and the Equality Act (2010).