NHS Formularies

Fiona GrahamFormulary/Clinical Effectiveness

PharmacistNHS Lanarkshire

WHY HAVE A FORMULARY

-supports consistent evidence based prescribing.

-supports consistent cost effective prescribing.

-limited range of drugs.

-promotes local ownership by GPs and hospital doctors.

-promotes seamless prescribing between 1° and 2°

care.

-supports budget planning.

WHY HAVE A FORMULARY (cont)

• NHS Lanarkshire Primary Care drug budget 2013/14 = £119 577 000.

• Abridged version of the BNF• NHS Lothian formulary framework• Different Health boards

- different formularies.

- different formats

Formulary development

• Lanarkshire’s Area Drug & Therapeutics Committee (ADTC)

• Formulary sub-groups• Joint formulary covers Primary & Secondary

Care.• 1°care 80% drugs costs VS 2°care 20%

Formulary formats• Last NHS Lanarkshire paper copy- Nov 2007

• Other Health Boards still printing paper editions.

• Formulary in NHS web sites…different routes/different HBs.

• NHS Lanarkshire APP- iDevices/android phones• (NHS GG&C Formulary pharmacist has a QVR code)

• GP Rxing systems:NHS Lanarkshire-100 practices;360 GPs, locums & Rxing nurses:-– Vision eformulary- diagnosis based & A to Z– EMIS eformulary- synonym based and A to Z.

Formulary- additional information

• Primary Care- first line antibiotic policy• Acute Division – first line antibiotic policy• Antibiotic IV to oral switch therapy• Gentamicin and vancomycin protocols• Antidepressants- Swapping & Stopping.• Wound Management & Simple Dressings

Formulary• Gluten Free formulary

Formulary compliance-primary care

• Prescribing Action Plan 10 2013/14 GP targets:-

– Proton pump inhibitors % items >95%– NSAIDS % items >88%– 1st line antibiotics % items >91%– 1st line antidepressants % items >78%– Wound Management Formulary % items >80%

Formulary compliance (cont)

PRISMS=

PRescribing Information SysteM for Scotland

• Quarterly prescribing data for GPs

• Can measure formulary compliance

Formulary amendments

• Want to change any drugs in the formulary?• Formulary amendment request form with the

new cost effective/evidence.• Submit to Area D & T via formulary

pharmacist for discussion or referral to formulary sub-groups.

• May be asked to appeal in person.

Formulary application

• How to add a new drug to the formulary?• Fill in a formulary amendment request form…

requires a consensus agreement from Lead Clinician where possible.

• Submit to the formulary pharmacist• Table request at next ADTC meeting• Discussed at ADTC• Add to the formulary…need to select a

formulary entry to come off formulary.

Scottish Medicines Consortium (SMC)• Advises Area D&T committees on new drugs, 2 weeks in

advance of public announcement.• Area D & T Committee Prescribing Bulletin colour codes

formulary decisions in NHS Lanarkshire. Green = accepted for general use in Lanarkshire and added

to the Joint Formulary Orange = accepted for restricted use in Lanarkshire and added to the Joint Formulary only for the restricted use advised by the SMC Light orange = Not added to the formulary due to the specialist nature of the treatment OR pending specialist advice on formulary status. Non formulary use is acceptable if the drug is used according to SMC recommendations and local protocols. Red = not accepted for use in Lanarkshire and not added to the Joint Formulary.

Scottish Medicines Consortium

• Category of submission:-Full submission-Re-submission-Abbreviated submission-Non submission• Category of decisions:-accepted for use in Scotland-accepted for restricted use in Scotland-not accepted for use in Scotland

Future for Joint Formulary

• Web based version and APP– always the most up-to-date.

• iPad mini; iPhone 6; android updates.• Creation of BNF links embedded in the

eformulary; website/APP/Vision/EMIS• Central servers for GPs prescribing systems• Paper copy? No.• APP- was launched in NHS Lanarkshire. May

2012. APP development in other Health Boards.

Main challenges for the future

• National formulary?

• Health Improvement Scotland (HIS) audits

• EMIS &Vision GP prescribing systems

• Further development of the NHS APP?

• % formulary compliance in 2° care?

THE END