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Regional Medicines Optimisation Committee (London)

Antimicrobial Resistance / Stewardship Subgroup

20thSeptember 2019 (11:00 to 1pm) Room: 5B3, Skipton House, 80 London Road, London, SE1 6LH

Accepted Minutes

1. Welcome, apologies and introductions

RG welcomed the group

Apologies were acknowledged.

2. Notes and actions on draft Minutes from July 2019 meeting

The minutes were accepted as an accurate reflection of the meeting.

Attendees

Richard Goodman [RG] NHS England & NHS Improvement (London), Regional Pharmacist [Chair]

Aparna Babu [AB] Southwark CCG, General Practitioner,

Silvia Ceci [SC] Specialist Pharmacy Service. Clinical Fellow, Chief Pharmaceutical Officer Clinical Fellow Scheme 2019/20 [Observer]

Stephen Hughes [SH] Chelsea & Westminster Hospital, Antimicrobial Pharmacist

John Minshull [JM] NHS Specialist Pharmacy Services, Deputy Director Medicines Information

Tania Misra [TM] PHE (London), Consultant in Health Protection

Preet Panesar [PP] University College London Hospitals (UCLH) NHS Foundation Trust, Lead Pharmacist – Microbiology.

Tushar Shah [TS] NHS England & NHS Improvement (London), Pharmacy Advisor,

Vivek Soni [VS] Specialised Commissioning NHSE & NHSI, Deputy Regional Pharmacy Lead London (Antifungal Stewardship Lead)

Jane Sproat [JS] Healthy London Partnership (HLP), Enhanced Health in Care Homes Improvement Manager

Anna Stec [AS] NHS England & NHS Improvement (London), Healthcare Science Fellow

Sheena Vithlani [SV] NHS Specialist Pharmacy Services, Regional MI Manager [minutes]

David Webb [DW] Guys & St Thomas NHS Foundation Trust, Clinical Director and Chief Pharmacist

Apologies

Sue Alexander [SA] Royal Marsden NHS Foundation Trust, Principal Biomedical Scientist,

Mandeep Butt [MB] Health Innovation Network AHSN, Co-Convener - Medicines Optimisation Community of Practice. North Central London STP, Co-Director, Medicines Efficiencies Programme.

Fiona Coogan [FC] London North West University Healthcare NHS Trust, Director of Infection Prevention and Control

Sally Kingsland [SK] NHS England & NHS Improvement (London), Clinical Quality Manager

Ruth Thomsen [RT] NHS England & NHS Improvement, Scientific Director

Peter Wilson [PW] University College London Hospital, Consultant Medical Microbiologist

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Review of Action Log (open action items not on agenda)

Several actions were closed: 17, 48 and 49 (relating to Point of Care Testing), 37, 59 and 60 (relating to Engaging STPs with AMR/ IPC agenda), 40-42, 62 and 63 (relating to "PGDs for antimicrobial use in urgent care centres) 65-68 and 70 (relating to the AMR data pack) and 43, 57, 64, 71-76.

Actions 27 and 61 (Identify and engage relevant STP pharmacist leads in each area of London and prepare a letter for medical directors in each STP about engagement with the AMR agenda and with this group) remain open as the details of STP AMR leads are not yet finalised.

Actions 39, 61 and 69 (relating to on utilisation of work in NEL STP to drive establishment of AMS/ AMR networks in other areas of London) remain open as this work is not yet published.

Actions Who

Update actions log SV

3. Point Of Care Testing (POCT) pilot scheme

The group were presented with a draft paper outlining a pilot scheme which introduces POCT as a diagnostic tool in primary care and in doing so, aims to reduce antibiotic prescribing. The pilot aims to evaluate the outcomes of and barriers to using POCT devices as diagnostic tools and it will assess what support is needed to facilitate implementation of POCT. The pilot focuses on POCT by community pharmacists who will use this to make decisions about antibiotic use (or offer support for self-care) for a specific presentation, such as suspected UTI, RTI or sore throat infection.

The group heard that the draft paper was well received by the pharmacy integration oversight group although more detail was sought in the final version by Rob Proctor, Pharmacy Integration Lead (South Regions & London) and James Raymond, Chief of Staff, Primary Care Strategy & NHS Contracts. The RMOC London AMR/AMS Subgroup were very supportive of the paper. AS and TS explained that there is currently some incongruence between different stakeholders as to which group of patients should be eligible. Suggested groups include those mentioned above and patients with COPD. The group felt that the size of the eligible patient population is important. The paper explains that NHS 111 will direct eligible people to a designated local community pharmacy to have a POCT for a suspected infection. There was discussion around the future scope of POCT such as access via GP referral and in urgent care centres (UCCs) or care homes. The route of supply of antibiotics if patients test positive is yet to be decided upon. It was suggested that national PGDs could have a role, which this group could support. Following feedback from NHSE & NHSI, the paper will be updated to provide further detail on the patient pathway (including specific detail on which community pharmacy providers, GPs and PCNs would be involved), the specific presentation and POCT to focus on and SMART objectives to measure outcomes. The next iteration of the paper will also include information around the governance of the pilot scheme such as roles, responsibilities and training requirements for those involved. It was confirmed that the pilot would take place in London and the national team would look at scaling it up and spreading POCT. Following these changes, the paper will go to the NHSE & NHSI development group who will provide clinical governance oversight before it is taken to the NHSE & NHSI decision making group. AS and TS reported that they were currently meeting with stakeholders (which includes members of this group; RT, TS, MB and PW)

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to decide which priority area of patient presentation to focus on. AS and TS asked for the groups comments on the pilot scheme, particularly around which patient group to focus on initially. AS and TS accepted AB’s offer to provide GP input into the project. Actions Who

Send comments to AS and TS on first and subsequent iterations of draft pilot project on POCT in community pharmacies, particularly around which patient group to focus on initially.

ALL

Share subsequent iterations of POCT project papers with group. AS/ TS

Liaise with AB regarding involvement in POCT pilot project AS/ TS/

4. Update of short-life working group to develop PGDs for antibiotic use in Urgent Care Centres

(UCCs) A short life working group has been established based on membership suggested by the SPS PGD team and the RMOC “Do Once” Governance framework to develop PGDs for antibiotic use in UCCs. The group will begin their work by delivering a PGD for management of sore throat which SH is writing the first draft of. JS suggested that Eileen Sutton (head of integrated urgent care London) be invited to this meeting and this was agreed as an action.

Actions Who

Share paper(s) for the meeting of the short-life working group to develop PGDs for antibiotics in UCCs with this group.

JM

Invite Eileen Sutton (head of integrated urgent care London) to the meeting of the short-life working group to develop PGDs for antibiotics in UCCs.

JM

5. STP update including updates from North Central London and South East London

This group has committed to act as a focal point for knowledge and co-ordination of the AMR agenda in London and has agreed to work with STPs to support this. The group discussed the letter sent in July 2019 by Ruth May (Chief Nursing Officer) and Professor Stephen Powis (NHS Medical Director) to all STP and ICS leads requesting them to identify an individual to be the Senior Responsible Officer (SRO) for the AMR strategy in their region. To support SROs, NHSE & NHSI are hosting a series of events for system leaders during the autumn. A number of members from this group are attending and will feedback to the group at the next meeting. RG reported that he is waiting for a list of SROs in London and will update the group on this at the next meeting. TS agreed to circulate the link for this meeting to group members.

Post Meeting Note: An email was forwarded to the group by SK which stated that the AMR event for London is scheduled for 26.11.2019 and each STP SRO will be invited to bring a small team from their patch to the event. The event will include speakers from outside of the region describing where they have got to with system wide learning and there will opportunity for each STP to look at their data and consider their priorities for improvement. The SROs in London are:

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London area SRO Role

North Central Jennie Williams Director of Nursing and Quality, Haringey and Islington CCG

South West Gwen Kennedy Interim Director of Quality SWL Alliance

South East David Webb Chief Pharmacist, Clinical Director, Guy’s and St Thomas’ NHS Foundation Trust

North West Diane Jones Chief Nurse (North West Collaboration of CCGs)

North East Moira Coughlan Joint Head of Medicines Management (NHS NEL CSU)

Update from North Central London (NCL):

The Chair welcomed Preet Panesar (PP) to talk to the group about the work being done by the North Central London Antimicrobial Working Group (NCLAWG) which she leads. The NCLAWG reports activities to the North Central London Medicines Optimisation Committee every two months. The NCLAWG was initially formed of pharmacists working in secondary care and has expanded to include pharmacists working in primary care. The NCL AWG aims to evolve to become a multidisciplinary AMR strategy group. PW has previously agreed to join the group. TM, who has worked with NEL AMRSG, also indicated her interest in joining the group and her offer was accepted.

A paper was presented which outlines the NCLAWG’s progress and ambitions which align with the UK’s 5 year national action plan. To date, the group has:

Developed a joint NCL primary care guideline (now superseded by NICE guidelines). There

was a discussion about whether local antibiotic sensitivities influenced recommendations

in local prescribing guidelines. PP said that antibiotic sensitivities to UTI causing bacteria

were perceived to be different and there was resultant variance in each constituent CCG’s

guidelines. However, subsequently, it was found that resistance rates were similar

between CCGs and so implementing NICE guidance across the STP was considered

reasonable.

Undertaken some benchmarking activity looking at antimicrobial resistance CQUIN data

from Fingertips in 2018/19. The group found these data helpful and asked whether they

are available in the format presented in the public domain – PP said that this part of the

paper is presented using data from the public domain but the presentation is bespoke.

The data demonstrated some improvements in total antibiotic usage although many

Trusts in the NCL STP found it difficult to reduce total carbapenem usage. IT difficulties in

benchmarking different types of Trusts were acknowledged but these data have

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promoted useful discussions and shared learning on interventions that work and those

that don’t.

Undertaken a comparison of primary care antibiotic prescribing in different areas of NCL

Reviewed UTI resistance and prescribing.

Worked on addressing the issue of penicillin allergy being documented correctly and

appropriately. This work was done with an immunologist at ULCH and there is a paper

being developed on this.

Going forward, the group plans to work on:

GP prescribing of broad spectrum antibiotics

Healthcare associated gram-negative blood stream infections

Reducing UTI infections

Work on improving antifungal stewardship

Education and training of patients, public and healthcare workers.

Scoping activities across NCL – including issues emerging from out-of-hours services, walk-

in centres, community pharmacies and care homes.

Replicating the work done by the NEL AMRSG with the NCLAWG and they are considering how to replicate this. PP said that the NCLAWG are keen to learn from the NEL AMRSG and have arranged a meeting with them to discuss ‘what good looks like’ from the STP level perspective.

Engaging with care homes because, within NCL, Medicines Optimisation in Care Homes scheme (MOCH) pharmacists look to AMR pharmacists for guidance on how to drive change in this area but until recently, the NCLAWG was secondary care focussed. As the group expands and broadens, they should be able to provide more direction to colleagues in primary care.

The group heard that Jennie Williams has been appointed the interim SRO for the NCL STP. She will work with the NCLAWG and provide system leadership for delivery of the national AMR strategy in NCL. PP reported that a meeting is being planned with Jennie Williams and the NCLAWG on the next steps, which will including making the group a multidisciplinary group and developing a co-ordinated long term action plan PP asked for the RMOC London AMR/AMS Subgroups views on resource to support this network, since the remit of the group would be expanding. The group felt that this was something to be addressed locally with the input of the SRO. It was suggested that there may be funding available in association with the NHS Aging Well programme. This involves improving local support to community settings as part of local priorities and NCLAWG’s remit may fit with this. JS agreed to send a paper to PP regarding this. PP asked how the RMOC London AMR/AMS Subgroup envisaged they would interact with the NCLAWG in the future. RG stated that the ambition of the RMOC London AMR/AMS Subgroup is to see each STP in London develop AMR teams to drive improvements across each footprint. Some work can be developed and delivered or supported across London (e.g. such as work in care homes) but some work needs to be done locally and replicated in areas where it is relevant

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and appropriate to do so (such as the penicillin allergy work stream mentioned by PP earlier).The RMOC London AMR/AMS Subgroup view is that direction from multidisciplinary teams at regional with implementation at STP level can together drive improvement and meet intention of the NHS 5-year plan. There was consensus that close links between teams working at regional and STPs level facilities good communication and co-ordination to improve communications and therefore practices– and this should make attainment of goals more achievable. It was agreed that the NCLAWG will maintain close links with this group through MB, TM and PP and that a paper describing the work done by NEL AMRSG (from a previous meeting of this group) would be sent to PP.

Update from South East London (SEL):

In SEL, the interim SRO is David Webb (DW). DW said that he found it useful to hear about the work done by NEL AMRSG and NCLAWG. He reported that there is currently no equivalent group in South London although a lot of is being done at CCG level. Examples include addressing prescribing of broad spectrum antibiotics, work on achieving the national Quality Premium to reduce Gram Negative Bloodstream Infections (GNBSIs) and tackling inappropriate antibiotic prescribing in at risk groups. The group agreed, upon DW’s suggestion, that a reasonable step would be to create a similar group in the South London STP and suggested that Paul Wade (Consultant Pharmacist for Infectious Diseases at Guy's and St. Thomas' NHS Foundation Trust) is in an ideal position to convene an initial meeting. It was suggested that the group should be multidisciplinary since many aspects of AMS and IPC are not medicines related. This would enable the group to have broad scope with local leadership to account for local issues and variances such as local antimicrobial sensitivities patterns.

Actions Who

Circulate the link for the SROs for AMR event hosted by NHSE & NHSI to group members.

TS

Feedback from SRO event hosted by NHSE & NHSI at next meeting RG/ TS

Email PW and TM details of next meeting of NCLAWG PP

Email paper to PP on the NHS Aging Well programme to support PP in assessing whether the NCLAWG’s work could fit within the remit of this programme.

JS

Email paper presented at a previous meeting by Oge Chesa on behalf of the NEL AMRSG to PP and DW.

SV/ JM

Email the article published in Journal of Antimicrobial Chemistry by Oge Chesa on behalf of the NEL AMRSG to PP and DW.

SV/ JM

Provide update to Midlands RMOC about AMR/ AMS/ IPC activities in London

JM

Make contact with SROs in London and invite to this meeting. SK/ RG

6. RMOC London AMR/AMS Subgroup strategy document

At the last meeting, it was agreed that the group should develop a document to set the strategic direction of the group through to March 2021. A paper was presented outlining the draft strategy largely based on that proposed by the Midlands RMOC and on the activities of the group thus far. The proposed overarching aim of the group is to optimise the use of antimicrobials, and it seeks to do this by:

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Working closely with the Midlands RMOC • Reducing inappropriate prescribing and unwarranted variation

Developing appropriate metrics to support antimicrobial stewardship

Improving knowledge and promoting awareness of appropriate antimicrobial use

The group will achieve this through a range of activities including co-ordination of a work plan to be delivered through the London region, focussing on supporting aspects of the current system in ways that add value. For example, by identifying examples of best practice and adapting them for regional use or by disseminating practice tools and support materials. These will help to reduce duplication of effort and improving consistency in approach to implementation of the 5-year plan. The group will work collaboratively with relevant stakeholders in London and nationally and will report to the London RMOC. The draft paper was well received and it was acknowledged that some progress is already being made towards the goals set out in the document. Group members were invited to comment on the draft by the 14th October 2019, particularly around how the group wants STP AMR groups to link in with this group and to populate the table of work areas on the work plan. Group members were asked to put themselves forward as volunteers to lead work areas where they have interest and/or relevant experience (e.g. AS for POCT, SH for PGD development and JM for data metrics work). The group were asked to prioritise each work area, so that resource is focussed on high priority areas. They were asked what completed outputs should look like, how they should be presented and when the group should aim to have completed each work area by. JM agreed to circulate the latest version of the document to the group for comment. RG agreed to finalise the document following comments from the group and include this as an item for the London RMOC meeting in November. Actions Who

Circulate the latest version of the RMOC London AMR/AMS Subgroup strategy document to the group for comment.

JM

Comment on the draft by the 14th of October, particularly around:

o How the group wants STP AMR groups to link in with this group o To populate the table of work areas on the work plan. o What priority each area of work should be given o What deadline each area of work should be given o How completed outputs of the group should be presented

ALL

Volunteer to lead area(s)of the work plan ALL

Finalise the paper following comments and present at the London RMOC.

JM/ RG

Share paper on the RMOC London AMR/AMS Subgroup strategy with the Midlands RMOC

JM

7. AMR / IPC in care homes

The Chair welcomed Jane Sproat (JS) from Healthy London Partnership, who provided the group with information about her role for the HLP, the work that the HLP are doing and how this could link in with the work and aims of this group. JS suggested that the HLP is a useful vehicle for driving improvements in AMR, AMS and IPC forward in London and together with the HIN, the HLP can provide support with the adoption and spread of good practice in care homes across

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the city. The group considered how to link the AMR / AMS and IPC agenda with the HLP’s work across whole system in London. There was discussion around whether work on AMR, hydration and IPC should be implemented nationally or regionally. It was concluded that there is no national work plan incorporating these and implementation of good practices around AMR, IPC and hydration is considered to be non-uniform in care homes across London. Therefore, this was seen as a good opportunity to influence, adopt and spread good practices, starting with the London region and utilising existing systems and networks.

Opportunities to influence AMR in care homes at regional level was discussed and the group recalled the successful work done by the NEL AMRSG which reduced incidences of UTIs in care homes and the number of antibiotic items prescribed in practices. Several ideas, initiatives and ways of working were discussed:

a. The group discussed how the CarePulse portal (a quality measurement system which also hosts resources for care home teams) could be useful to improve AMS and IPC in care homes. CarePulse was seen as a useful tool which could host resources that could help bolster IPC and hydration in care homes. JS advised the group that there may be a development cost to add resources to CarePulse and it was noted that there may be a small budget within the HLP which could potentially be used to support this.

b. JS told the group how the HLP are working to support care home staff in being able to accessing information digitally by setting them up with secure NHS email addresses. Improved communication with care home teams was seen as useful by this group as it will help facilitate the flow of information to and from care homes.

c. JS enquired whether the group were aware of any training that care home staff could do to improve IPC in particular since training programmes provided by the private sector organisations are expensive. The group agreed to signpost JS to SK and FC who may be aware of some training. TM said that the PHE training she provides to care homes includes some aspects of IPC although capacity to provide detailed training on this is limited.

d. It was acknowledged that there is also work to be done around catheter management which can be shared across the region (e.g. developing standards for catheter care including who should be replacing them and when). Possible ways to begin to address this were suggested, i.e. by involving urology specialist nurses and other members of the team and creating a once for London catheter management passport.

e. It was suggested that Dr Wasim Baqir (National Pharmacy Lead for Care Homes, NHSE & NHSI) should be approached as he will be able to provide/signpost to some relevant resources on this (e.g. on how pharmacists working as part of the Medicines Optimisation in Care Homes scheme are supporting and adding value around the AMR/IPC agenda). He will also be able to support adoption and spread of good practices nationally using the NHS England Pharmacy Integration Programme message boards.

f. JS informed the group that the enhanced health in care homes framework (2016) is being updated and there is an opportunity to influence the clinical elements which would have impact at national level. Currently one of the elements is hydration but there are no elements on AMR or IPS. Work done by the NEL AMRSG and comments from the group would be helpful to help define the priorities and recommendations for improvements within the national refresh of the framework.

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g. Other suggestions were to create a region wide network of care home champions and also to provide proactive flu updates through NHS safeguarding teams

For actions; SH agreed to form a paper highlighting good practice examples around AMR, IPC and good hydration in London (including work done in NEL) and defining 'what good looks like' with input from the AHSN and from JS. The paper will recommend priorities around AMR, IPC and hydration for the updated enhanced health in care homes framework and guide STP leads of what to include in AMR action plans.

The group heard that the HLP are keen to work with this group and others to drive changes in this area. The group agreed to put JS in touch with SK, FC and the Alka Maru in PHE London who leads on the care homes IPC work to further discuss and develop these ideas and consider them for inclusion in this groups strategy and work plan.

Actions Who

Send the group a link to the enhanced health in care homes framework (2016)

JS

Write paper highlighting good practice examples and recommendations around AMR, IPC and good hydration for the updated enhanced health in care homes framework and STP leads in London – seek input from JS and from the AHSN.

SH

Liaise with JS for other examples of good practices around AMR/ IPC and good hydration in London as part of above paper.

SH/ MB/

Liaise with Dr Wasim Baqir regarding above paper and to discuss spreading of good practice examples around the country using the NHS England Pharmacy Integration Programme message boards.

SH/ MB

Circulate link to group to sign up to the NHS England Pharmacy Integration Programme message boards.

SV

Provide details of care homes pharmacists in North Central London to PP for invitation to join the AMR group in that region.

JS

Liaise with the Midlands RMOC (Lead for AMR nationally) to make them aware of these actions relating to identifying and spreading of good practice around AMR/ IPC and hydration as well as the opportunity to influence the enhanced health in care homes framework (2016)

JM

Put JM in touch with SK and FC to further discuss suggestions around how this group and the HLP could work together.

JM/ SV

TM to email JS regarding details of the PHE care homes group so that JM can begin to work with them to develop ideas on how to work together.

TM

8. Antibiotic prescribing and AMR data pack review of comments and next steps

The group have been working on preparation of a data pack to be used across London as a basis for reflection and to drive improvements in AMR/AMS. This group saw this as a useful way to enabling STP leads to view antimicrobial prescribing data from several sources in a single document. It was re-iterated that the role of good AMS is to be able to identify outliers and

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either take account of the reason for variation or to address any unusual prescribing. The purpose of developing the pack is so that this group and STP AMR leads can use it to assess how to focus resource and activity to drive improvements. Comments concerned with the issues of comparing Trusts in the pack were felt as being not wholly reasonable when considered in this context. To ensure the document was viewed as unbiased, it was agreed that adding any commentary would be avoided. In terms of costs, a pragmatic approach was agreed to update the data quarterly utilising data readily available in the public domain and to present it without manipulation. It was agreed that the frequency of update for the pack could change depending on user feedback and that that this would be cost effective for the intended purpose. It was concluded that overall, there is value in using this data pack as a tool by this group and STP AMR leads. STP AMR leads could use it to reflect on their own prescribing and goals and interpret the data at each STP level. The pack will be finalised and updated quarterly, with narrative added at the start to explain the intention, purpose and any caveats. All commentary regarding specific Trusts will be removed. The colours used in the pack (i.e. purple as opposed to red/amber/green) will be retained. The pack, it was agreed, will then be finalised and suitable for sharing. The group will re-visit the pack in 12 months’ time and consider how it is being used across the city with a view to withdrawing it if uptake is poor. JS put forward that the NHS End Of Life Care Networks have created STP level data packs which are also intended to prompt discussion. These are in a different format to this data pack and have landed well –so it was suggested that a similar approach might work well in this scenario. JS agreed to share the end of life care networks STP level data pack with the group and asked that any questions about these should be directed to Lucy Nelson (lucy.nelson18@nhs.net). Actions Who

Share End of Life Care STP level packs with group (in case their presentation can inform any changes in the AMR data pack for London).

JS

Add narrative at the start of the data pack to state the intention, purpose of it and any caveats associated with its use. Remove all commentary regarding specific Trusts.

JM

Finalise pack and share with STP AMR leads RG/ JM

9. Feedback from MOPP on Bezlotuximab / Fidaxomicin RMOC topic

At the previous meeting, the group agreed to submit a topic to the RMOC to discuss whether an evidence review was needed to establish the appropriate place in therapy of these high cost drugs commissioned by CCGs. RG reported that the MOPP had considered this and had decided against adding this to the RMOC’s agenda. The rationale for this decision is that NICE is expected to update their guidance on management of CDI within the next 6-12 months. As a subgroup of the RMOC, it would be inappropriate for us to pursue development of a commissioning agreement in London and it was agreed to review this decision in 6 months’ time. Post Meeting Note: The group received a response after the meeting on 20.09.2019 from the RMOC co-ordinating hub. NICE have now confirmed that the CDI guideline in development will update the relevant section of the joint PHE/NICE summary of antimicrobial prescribing

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guidance – managing common infections table and will cover management of adults and children with C. Diff infections. They have confirmed that bezlotuximab is included as an intervention in the review protocol and that they will consider the evidence for its use in managing CDI. The guideline is expected to go out for public consultation between March and April 2010 via the NICE website with final publication anticipated 30/09/2020. Actions Who

Consider issue for addition to agenda in March / May 2010 SV

10. AOB

At the previous meeting, the group considered whether data from the NUMSAS scheme showed concern around a higher rate of issues of antibiotics in London than expected. It was accepted that the NUMSAS data are being studied at national level. Actions relating to the NUMSAS scheme were closed by this group.

11. Dates of next meeting

Friday 15 November 2019 – 9am to 11am – LG17 Wellington House booked

Friday 10 January 2019 – 9am to 11am – venue TBA Actions Who

Circulate poll for meeting in March and May 2020 SV

ACTION LOG: See attached spreadsheet

STP AMR ACTIVITY

STP SRO Notes Update Date

NWL Diane Jones

Doesn’t have anything centralised. Four of the NWL CCGs are working together through the Medicines Management Team. There have been no MDT discussions, and there is nothing labelled as AMR at the STP level

27.09.18

NCL Jennie Williams

Jennie Williams will work with the NCLAWG and provide system leadership for delivery of the national AMR strategy in NCL. The NCLAWG have undertaken some benchmarking activity looking at antimicrobial resistance CQUIN data in 2018/19. They have also done a comparison of primary care antibiotic prescribing in different areas of NCL, reviewed UTI resistance and prescribing and worked on addressing the issue of penicillin allergy being documented correctly and appropriately. The group plans to work on GP prescribing of broad spectrum antibiotics, healthcare associated gram-negative blood stream infections and reducing UTI infections, improving antifungal stewardship and they will focus on the education and training of patients, public and healthcare workers. They also plan to carry out scoping activities across

20.09.19

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NCL – including issues emerging from out-of-hours services, walk-in centres, community pharmacies and care homes.

NEL Moira Coughlan

AMR activities undertaken in NEL submitted for publication and to be disseminated to other areas of London.

28.05.19

SEL David Webb

The interim SRO for AMR is David Webb. There are imminent plans to develop a multidisciplinary group.

20.09.19

SWL Gwen Kennedy

No reported activity. 15.03.19

Agenda Items for future meetings:

November 2019 STP updates including how to adopt and spread work of the NEL AMRSG

Update on SROs for each area of London.

Update on AMR / AMS and IPC in care homes

Discussion on data pack, its uptake and where to focus attention in London

Feedback from SROs event on 26th Nov?

Update on short-life working group for PGDs and service specs for UCCs.

POCT update (if any)

Dental AMR Prescribing update – inc. Rx data

January 2020

March 2020 Re-visit issue of POCT with a view to recommending what commissioning of some POCT will look like.

Discussion on whether London-wide commissioning statement for fidaxomicin and bezlotoxumab place in therapy is warranted

May 2020 STP leads to attend meeting of this group to report back on their work.

July 2020 Re-visit issue of commissioning POCT

Glossary of commonly used abbreviated terms:

AMR: Antimicrobial Resistance AMS: Antimicrobial Stewardship IPC: Infection Prevention & Control NEL AMRSG: North East London Antimicrobial Resistance Stewardship Group NCL AWG: North Central London Antimicrobial Working Group HLP: Healthy London Partnership CDI: Clostridium dificile infection RMOC: Regional Medicines Optimisation Committee