Teratogenic Medicines Advisory Group minutes: June 2024

Attendees and apologies

• Alison Strath, Chief Pharmaceutical Officer (CPO), Scottish Government, Chair
• Marion Bennie, Chief Pharmacist, Public Health Scotland
• Laura Stobo, Senior Pharmacist, Public Health Scotland
• Lynne Jarvis, Senior Information Analyst, Public Health Scotland (item 4)
• Stuart McTaggart , Senior Pharmacist, Public Health Scotland (item 4)
• Scott Hill, National Clinical Lead, Healthcare Improvement Scotland
• Laura Byrne, Director of Pharmacy, NHS Forth Valley (from 2pm)
• Craig Heath, Consultant Neurologist and Honorary Senior Clinical Lecturer, NHS Greater Glasgow and Clyde
• Daniel Morales , GP, University of Dundee (until 2.30pm)
• Stuart Law, Effective Prescribing and Therapeutics, Scottish Government (covering for Iain Wilson)
• Dionne Mackison, Head of Medicines Policy, Scottish Government
• Annie Gonelli, Medicines Policy Manager, Scottish Government (from 2pm)
• Frauke Hunter, Medicines Policy Team leader, Scottish Government (covering for Gemma McCormack). Secretariat

Apologies

• Rory Chapman, Health & Social Care Alliance Scotland 
• Justine Craig, Chief Midwifery Officer, Scottish Government
• Richard Davenport, Consultant Neurologist, NHS Lothian
• Alpana Mair, Head of Effective Prescribing and Therapeutics, Scottish Government
• Irene Oldfather, Health & Social Care Alliance Scotland
• Andrew Walke, Lead Clinical Pharmacist Adult Mental Health, NHS Greater Glasgow and Clyde
• Iain Wilson, Clinical Lead (GP), Effective Prescribing and Therapeutics, Scottish Government
• Gemma McCormack, Senior Medicines Policy Manager, Scottish Government
• Roch Cantwell, Professional Advisor, Perinatal and Early Years Mental Health, Scottish Government
• Daniel Smith, Professor of Psychiatry, University of Glasgow
• Alistair Cook, Principal Medical Officer, Scottish Government
• Alexa Foster, Professional Advisor, Midwifery and Perinatal Care, Scottish Government)
• Corinne Love, Senior Medical Officer, Maternity and Womens Health, Scottish Government

Items and actions

Welcome and introduction

The Chair welcomed everyone to the Scottish Government (SG) Teratogenic Medicines Advisory Group (TMAG) meeting and invited members to introduce themselves. The Chair noted apologies, as above.

Minutes and actions from meeting of 27 February 2024

The minutes of the last TMAG meeting were agreed as accurate.

Actions are either completed or covered on the agenda, and the following updates were provided:

The SG Effective Prescribing and Therapeutics team noted the actions for timelines for the therapeutic indicators, feedback on their considerations about medicines safety guidance were ongoing and the CPO suggested to meet offline to discuss on how to progress.

• action 1: SG meeting between the teams with the Chief Pharmacutical Officer (CPO) and report back to TMAG

Public Health Scotland (PHS) noted that discussions on BadgerNet with internal colleagues who lead on work around the maternity and neonatal data hub were ongoing and would be incorporated into wider MiP work. It was agreed to remove this as an action.

The action for SG medicines policy to liaise with health digital on indication data was outstanding and feedback on discussions would be provided at the next meeting.

• action 2: SG medicines policy to liaise with health digital colleagues about indication data and report outcome of discussion

SG medicines policy team would draft an SG position on specialist services and invite feedback from TMAG members and Valproate Scotland, this was work in progress and will be progressed between TMAG meetings.

• action 3: SG medicines policy to finalise and share draft position statement on specialist services

 

TMAG work plan

The TMAG work plan discussion paper was circulated with the agenda which proposed priorities and next steps in relation to valproate and other medicines with teratogenic potential.

The Chair opened the item for discussion. PHS commented that the document, in particular the actions, were helpful as a reference, but the contents was now out of date. The Chair agreed and suggested that it would be best to pick up with relevant s individuals/groups to provide a refreshed action list. 

• action 4: SG medicines policy to refresh work plan with input from members

 

Update from Public Health Scotland on the Medicines in Pregnancy surveillance asset

The Chair invited PHS to speak to this item: PHS summarised purpose, progress update and plans including outputs, as detailed in the presentation. Itwas noted that PHS hoped the interactive dashboard would be ready for the next report, alternatively there would be Excel tables, due in early October 2024. It would include data up to June 2024 and more detailed data for other anti-seizure medicines.

The short term subgroup which had its last meeting discussed future outputs including child outcomes and Sudden Unexpected Death in Epilepsy (SUDEPs), the possibility of looking at health board level (more likely to be management information), paternal data and the development of a dashboard.

In response to the question about audience of this asset, members commented these should be both specialists and GPs, to be able to look at prescribing behaviour.

It was noted that that prevalence of epilepsy was higher in deprived areas and PHS confirmed that the asset could adjust for that to ensure valid comparisons between health boards.

In response to aquestion about patient level data, a member commented that would need to be carefully considered, particularly its purpose and ensuring the protection of sensitive personal data. It was suggested any patient level data could be made available at request only, rather than routinely released. It was noted there would be interest in GP practice level data. PHS cautioned that with low numbers, it might not be possible to provide such data while upholding patient confidentiality.

The Chair suggested to explore with GPs ‘what would this mean in my practice’.

• action 5: SG medicines policy / CPO to speak to GPs about Medicines in pregnancy

 

Update on medicine policy work

English Patient Safety Commissioners Hughes Report
SG continued to engage with UK Government counterparts on the development of their response to the report. This engagement was paused until after the general election. 

Specialist services recommendation (Independent Medicines and Medical Devices Safety Review)
As mentioned earlier, medicines policy is progressing a SG response to the specialist centres recommendation from the Baroness Cumberlege report. TMAG members and Valproate Scotland would be invited to comment.

Social Security Awareness session
Medicines policy were working with social security colleagues to hold a valproate awareness ‘in conversation session’ for social security decision makers and the organisation in general. This would include a short presentation by a health professional with knowledge of the condition, and a segment on lived experience, with time for Questions and Answers. Medicines policy were looking for a volunteer, from this group, and from Valproate Scotland and the Independent Fetal Anti Convulsant Trust (INFACT) for the lived experience segment.

Regarding recommendations for a clinical presenter, it was suggested a psychiatrist might be most appropriate and it was agreed to follow up directly with clinicians.

• action 6: CPO / medicines policy to identify clinician to present at social security session

 

Update from the Anti–Seizure Medicines Task and Finish Group

It was noted the work undertaken to develop the topiramate checklist and a supporting toolkit, liaising with learning disabilities colleagues.

The Chair opened up for questions and discussion. A plea was made for prioritisation for the implementation and taking a proportionate approach, to be mindful of workloads.

It was noted the Task and Finish group’s forthcoming meeting to discuss whether to potentially prioritise migraine prohylaxis patients and whether face-to-face consultations would be needed in all instances.

 

Update from the valproate learning network

The Chair invited Healthcare Improvemnet Scotland (HIS) to speak to this item. It was noted there had been no meeting since the last TMAG meeting as the network met twice a year, the next meeting is in August. For that, members would consider a national approach on to how to get the lived experience into boards’ experience.

The Chair opened up for questions and discussion and HIS confirmed that they would look to widen the remit from valproate to other medicines with teratogenic potential.

 

Any Other Business

The Chair thanked everyone for their contributions to the meeting. There was no other business.

The medicines policy team will arrange the next meeting of the TMAG for autumn 2024. 

• action 7: medicine policy team to arrange the next TMAG meeting