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MEDICINES OPTIMISATION GROUP (‘MOG’) Established by Trust Board Reports and accountable to the Information Governance Group(IGG) (Non-Statutory) TERMS OF REFERENCE Overview The Medicines Optimisation Group is a formally constituted part of the internal governance arrangements of the Trust. Summary of purpose To provide a strategic direction for the Trust on medicines optimisation related to documentation, training, practices, policies, prescribing and guidelines to IGG Objectives and Purpose To promote evidence based prescribing and monitor the introduction of new medicines, related documentation, practice policies, prescribing and use by: Commissioning Trust wide Audit on medicines optimisation where appropriate Review audit results and advise on actions to localities/speciality directorates To commission and monitor training programmes relating to medication and publishing newsletters for staff. To advise the Trust on policies to be accepted, through endorsement and recommendation to the Quality and Standards Committee. To make decisions on new drugs and explicitly consider the clinical effectiveness of treatments, safety, cost, value for money and availability of resources (following standards as criteria for decision making (NICE GPG1) To develop and maintain treatment guidelines to encourage evidence based and cost effective prescribing. To manage the introduction of new mental health medication in conjunction with the localities and specialist units. To review progress, oversee compliance and make recommendations on improving medicines optimisation to ensure readiness for Foundation Trust application. To adhere as closely as possible to the recommendations given in the NICE Medicines Practice guidelines. Plan for and manage the introduction of new medicines and new indications for existing medicines in the treatment and management of mental health conditions through the use of ‘Formulary decision guide’ (where there is a NICE TA) or ‘Product Evaluations’ as appropriate. Revised ToR agreed June 2016 V0.2 1 To ensure that medicines available for use by prescribers in AWP are evaluated by MOG are evidence based and cost effective. To review the use of unlicensed / off-label medicines and ensure risk assessments are in place for their use where needed (See Procedure ‘Med 10’). To consider applications for specific treatments for clients as one off applications (done through the ‘non-formulary request / Specialist use only request’ form on Ourspace). To have process(es) in place for applications for new drugs to the AWP formulary or as ‘one-off’ requests. To review NICE guidance and identify appropriate leads for the NICE guidance and ensure implementation within AWP where appropriate. NICE page on Ourspace here To include medicines with a positive NICE technology appraisal into the AWP formulary automatically, where clinically appropriate to the services provided by AWP. To adopt medicines with a NICE technology appraisal as ‘option for treatment’ into the AWP working formulary (where clinically appropriate) and identify its place in the relevant care pathway(s) in line with NICE recommendation. (Or otherwise ‘agree as no action as necessary, as this does not directly affect Trust services’). To have an Appeals process in place to adhere to the NICE GPG1 recommendations. To ensure implementation of medicine related safety alerts within AWP. To regularly review drug expenditure against allocated budgets. To advise on resource allocated for medicines across the Trust e.g. in year budget to support decisions on new drugs. To develop and approve shared care agreements, product evaluations (for new drugs relevant to psychiatry) and relevant policies and procedures. To monitor the use of antibiotics as part of the Antimicrobial Stewardship Implementation plan. Any Shared Care Agreement / prescribing guidance for use in Primary care must also be approved by the relevant Joint formulary Group / Drug & Therapeutics Committee for that local area or Acute Trust. Provide guidance on medicines optimisation issues that have an effect on clinical practice and the overall delivery of healthcare in the local health economy, e.g. developing and keeping the AWP working formulary up-to-date; agreement of medication related policies, patient group directions (PGDs) and self-funding by individual clients. To work closely with the Joint formulary and Drug & Therapeutic groups of the local Acute Trusts and *CCGs that commission their services from AWP to ensure access to medicines across the interface and on discharge. Ensure that its advice, once agreed, is implemented and / or endorsed by relevant organisations, e.g. by an implementation and monitoring plan. Consider the treatment options available, ensuring the choice of medication is the most appropriate for the individual service user. Patient safety must also be an integral factor when considering treatment options, as well as the way medication is used in practice. To advise on medicine related safety alerts as and when appropriate. Revised ToR agreed June 2016 V0.2 2 To advise on all matters of quality in relation to medicines optimisation that impact on safety, effectiveness or patient experience. To consider the policy and procedural issues emerging from medication incidents as reported to the ‘MOG’ by MIRG. *Clinical Commissioning Groups Scope The information the Medicines Optimisation Group will use to undertake its duties is shaped by national guidance e.g. NICE, CQC, Trust incidents, integration with Acute Trusts formulary groups and other NHS bodies. The Medicines Optimisation Group, on behalf of IGG, has oversight of the use of medicines in AWP Trust and complies with NICE and relevant national guidance. Accountability/reporting requirements This Committee is accountable to the Information Governance Group. Minutes will be prepared after each meeting of this Group and circulated to members of the Group and others as necessary. These will be reported at the next meeting of IGG following the meeting of the Group. Reports will be submitted to the Quality and Standards Committee on an exceptional basis to escalate issues, and an annual report will be provided. Minutes will be prepared after each meeting of this Group and circulated to members of the Group and others as necessary. These will be reported at the next meeting of IGG following the meeting of the Group. The Committee will draw to the attention to any other Management Group or Committee any issues which it believes requires that forum’s consideration. Membership Medical Director/ deputy (Chair) Chief Pharmacist/ deputy (Deputy Chair) Specialist Clinical Pharmacist x3 Representative from each Locality Unit Trust Lead for non-medical prescribing Chair of MIRG Deputy Director of Finance CCG/Heads of medicines management representative (BNSSG, Wiltshire) Service User Representative Revised ToR agreed June 2016 V0.2 3 Meeting requirements Quorum – The group will be considered in quorum if the Chair, and 6 other members are present, as long as at least 4 are clinical (medical, nursing or clinical pharmacy representatives).. Substitutes/Deputies – All members are asked to send a deputy if they are unable to attend so that there is appropriate representation for all relevant professions Invitees – Specific invites will be given to relevant expert clinicians for discussions on particular medications or policies or other relevant parties as required (e.g. Clinical Audit lead or Head of Quality Academy) Attendance – is required at each meeting. If a member cannot attend apologies must be received. Representatives from the Locality and Specialist Delivery units must act as a link between local quality governance and MOG and must provide feedback to the relevant management triumvirate structure. They are authorised to make decisions on behalf of Clinical Directors or Heads of Professional Practice for their LDU/SDU. They also have an expert role in advising on their area of clinical practice. Support – The work of this Group will be supported by the Medical Director (also the Chair) who will normally attend and ensure appropriate attendance from other representatives. Frequency of Meetings – The Group will meet bi-monthly, on the 3rd Thursday of the month. Administration of Group – The PA to the Medical Director shall provide appropriate administrative support to the Chair and Group members. The minutes will be published on the MOG page on Ourspace within 3 weeks of ratification. The minutes (excluding any Governance content) will also be published on the Trust internet page. Notice of Meetings – Unless otherwise agreed, notice of each meeting confirming the venue, time and date, together with an agenda of items to be discussed, shall be available to each member of the Group and other person required to attend no later than *4 working days before the date of the meeting, unless it is deemed inappropriate to wait until the next meeting (2 months later) e.g. new guidance directly relevant to meeting such as NICE TA, complex fast-track needing discussion etc. Each member will have authorised access to a designated link to the ‘Medicines Optimisation Group’ page on ourspace where the papers will be uploaded. Conflicts of Interest – Each member of the group is responsible to declare any potential conflicts of interest relevant to the group by completing a ‘Declaration of interest’ form at the start of the meeting. Declarations of interest may include any gifts or hospitality received from the pharmaceutical company, presentations, advisory panels, sponsorship of research, consultancy work, conference fees, honoria or lecture fees etc. funded by pharmaceutical company, shares held in the company, drug lunches. Please refer to the ‘Guidance on the Declaration of gifts and Hospitalities’ and ‘Standards of Business Conduct Policy P075’ on ourspace for further information. Lead contact for this Meeting PA to the Medical Directorate Revised ToR agreed June 2016 V0.2 4 Monitoring Effectiveness In order to support the continual improvement of governance standards this Group is required to complete a self-assessment of effectiveness at least annually and advise the Trust Board of any suggested amendments to these Terms of Reference which would improve governance arrangements. The process for monitoring will take the form of a report to the Senior Management Team on the work of the Group, membership and attendance. The group has an action log in relation to its responsibilities and monitor progress on the work plan on a regular basis. Review These Terms of Reference were agreed by the Medicines Optimisation Group on 30 th June 2016. The Terms of Reference of this Group must be reviewed and subsequently approved by the Trust Board at least annually. Revised ToR agreed June 2016 V0.2 5