Teratogenic Medicines Advisory Group minutes: November 2022

Attendees and apologies

• Alison Strath (Chair), Chief Pharmaceutical Officer (CPO), Scottish Government
• Marion Bennie, Chief Pharmacist, Public Health Scotland
• Juliet Brock, Medical Officer, Mental Welfare Commission 
• Laura Byrne, Director of Pharmacy, NHS Forth Valley
• Roch Cantwell, Consultant Perinatal Psychiatrist, Perinatal Mental Health Network Scotland
• Alastair Cook, Principal Medical Officer, Scottish Government
• Craig Heath, Consultant Neurologist and Honorary Senior Clinical Lecturer, NHS Greater Glasgow and Clyde
• Scott Hill, National Clinical Lead, Healthcare Improvement Scotland
• John Paul Leach, Consultant Neurologist, University of Glasgow
• Corrine Love, Senior Medical Officer – Maternity and Women’s Health, Scottish Government
• Laura McIver, Chief Pharmacist, Healthcare Improvement Scotland
• Alpana Mair, Head of Effective Prescribing and Therapeutics, Scottish Government
• Euan Reid, Lead Pharmacist, NHS Fife 
• Daniel Smith,    Professor of Psychiatry, University of Glasgow
• Iain Wilson , Clinical Lead (GP), Effective Prescribing and Therapeutics, Scottish Government
• Alexandra Foster, on behalf of Justine Craig (Chief Midwifery Officer), Scottish Government
• Jennifer Stewart, on behalf of Irene Oldfather, Health & Social Care Alliance Scotland
• Dionne Mackison, Head of Medicines Policy, Scottish Government
• Frauke Hunter, Policy Team Leader, Scottish Government
• Gemma McCormack, Senior Policy Manager, Scottish Government
• Grace Jamieson, Secretariat, Scottish Government

Apologies

• Richard Davenport, Consultant Neurologist, NHS Lothian
• Andrew Walker, Lead Clinical Pharmacist Adult Mental Health, NHS Greater Glasgow and Clyde

Items and actions

Welcome and introduction

The Chair welcomed everyone to the SG Teratogenic Medicines Advisory Group (TMAG) meeting (formerly known as the Sodium Valproate Advisory Group (SVAG)).

A welcome was extended to nursing representatives and to representatives from the Alliance for third sector. 

Minutes and actions from meeting of 2 March 2022

The minutes of the last SVAG meeting were agreed and it was noted that all actions were in hand or have been completed.

The Chair gave thanks for the input into the work plan and the revised Terms of Reference (ToR) which will be updated at regular intervals as the group evolves. 

Scottish Government update

It was noted, that following permissions from TMAG members to share membership details, that a TMAG webpage has been published on the SG website and will host the TMAG work plan and future meeting minutes.

Action 1:  members to share any views regarding the publication of future TMAG meeting minutes on the SG website by email.

It was noted that the SG issued an update letter on the progress of the First Do No Harm recommendations to Baroness Cumberlege and the Health Committee in October 2022.

The medicine policy team gave an update on Recommendation 5 from the First Do No Harm report regarding specialist centres, noting that the CPO met with the Head of Planning and Information at NHS Ayrshire and Arran, in September, who is taking forward the gap analysis work on specialist services. Members were informed that the gap analysis work will aim to provide an understanding of what neurodevelopmental services are currently available across Health Boards in Scotland. The work will also involve the development of an implementation plan, which will include proposals and timescales for moving forward. Members were advised that this work is still at an early stage and that pressures in the system have affected the speed of this work but that it is still progressing.

Refreshed terms of reference for the TMAG

It was noted that in light of the rebranding from the SVAG to TMAG that the medicine policy team has undertaken a refresh of the ToR for the group. 

Given the widened remit of the TMAG, it was suggested that going forward, task and finish groups (that would operate as sub-groups of the TMAG) would be established to focus on specific medicine groups. It was recognised that sodium valproate and other anti-epileptic medicines would be the first teratogenic medicines to be considered by the TMAG. It was proposed that the task and finish groups would meet as required in between the overarching TMAG meetings and include the relevant expert membership from out with the group to progress agreed actions.

Members provided their thoughts on the proposal to establish a task and finish group. There was a positive response to this approach and the refreshed ToR. The group suggested minor amendments to the ToR.

Action 2: The SG Senior Medical Officer agreed to identify wider expertise on obstetrics and midwifery care to feed into the group(s). 

In further discussion around the ToR, members agreed that there is a need for:

• early identification of pre-pregnancy stage risks in the population
• how observations could be undertaken
• how to develop pre-pregnancy stage messaging to capture people in places such as waiting rooms

Action 3: The SG Effective Prescribing and Therapeutics team agreed to share their animation and provide a paragraph based on the work their team has done on a system of interrogation polypharmacy information, which is used in health boards.

Action 4: The medicines policy team agreed to set up a meeting with marketing colleagues to discuss reaching and engaging the pre-pregnancy population.
Concerning the establishment of task and finish groups, discussions focused on future considerations related to the establishment of these groups. This included:

•  raising awareness with partners
• extending membership to include patient involvement
•  considering industry involvement (e.g. with a focus on product labelling)
• exploring nationwide mass marketing campaigns to cover teratogenic medicines 

Members acknowledged that the industry partners would be keen to be involved. Colleagues from Healthcare Improvement Scotland (HIS) agreed to discuss with the Association of the British Pharmaceutical Industry (ABPI) at their regular meetings and consider how to engage with the MHRA to inform them of our guidance and workflow plans to include in SIGN guidance.  

Action 5: HIS to discuss engagement with the MHRA with ABPI

Presentation from Public Health Scotland (PHS):  PHS Medicines in Pregnancy: National Surveillance

PHS provided an overview of building a medicines surveillance capability in pregnancy in response to the First Do No Harm Report. 

In building the surveillance capacity, PHS collaborated with pharmaceutical companies who now provide data monthly. 
Members then discussed the feasibility of linking data assets and how best this information could be used to encourage positive action in teratogenic medicine prescribing practices. 

It was agreed that the medicine policy team will meet with SG digital colleagues to discuss how best future digital policy can be influenced to best support medicines surveillance practices.

Action 6: PHS and the SG Effective Prescribing and Therapeutics team to consider timescale and resources for the next meeting.  

Action 7:  Medicine policy team to arrange a meeting with digital colleagues. 

It was recognised work is needed on guidance for Scotland with indicators for a whole system approach that enables prescribing appropriateness to address medicine safety. PHS and the Effective Prescribing and Therapeutics team to consider and bring back for discussion at the next meeting.

Action 8:  PHS and the Effective Prescribing and Therapeutics team to consider medicine safety guidance for the next meeting.

Update on the Scottish Epilepsy Register 

The consultant neurologist at NHS Greater Glasgow and Clyde who is leading on this work gave an update on progress and plans to extend the Epilepsy Register across Scotland. The focus is on how to improve care in epilepsy as clinicians are not aware when there is an adverse event e.g. pregnancy, death etc.

Next stage: The platform will go live in December and be available for use in NHS Lanarkshire and Tayside over the next six months.

Members reported that the system was encouraging and good to get the resulting information from this platform. 

Any other business   

The Chair thanked everyone for their contribution to the meeting and for identifying the gaps in work that need to be taken forward.

The medicine policy team will arrange the next meeting of the TMAG and will communicate a plan for forming a task and finish group to look at anti-epileptic medicines.

Action 9: medicine policy team to arrange the next TMAG meeting.

Action 10: medicine policy team to communicate a plan for forming a task and finish group to look at anti-epileptic medicines.