1. NHS Formularies Fiona Graham Formulary Pharmacist NHS Lanarkshire

2. Aim/background Why have a Joint Formulary? -evidence based medicines -limited range of drugs -help reduce medication errors -promotes seamless prescribing -effective and economic prescribing

3. Aim/background (cont) NHS Lanarkshire Primary Care drug budget 2012/13 = £115M. Abridged version of the BNF NHS Lothian formulary framework Different Health boards - different formularies. - different formats

4. Formulary development Lanarkshire’s Area Drug & Therapeutics Committee (Area D&T C) Formulary sub-groups Joint formulary covers Primary & Secondary Care. 1° care vs 2°care – spend 2011/2012?

5. 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 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.

6. 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

7. Formulary compliance-primary care Prescribing Action Plan 2012/13 GP targets:- –ACE inhibitors% items >98% –Angiotensin 2 antagonists% items >98% –Proton pump inhibitors% items >95% –NSAIDS% items >88% –1 st line antibiotics% items >91% –1 st line antidepressants% items >78% –Wound Management Formulary % items >80% –Triptans (new indication)% items >70%

8. Formulary compliance (cont) PRISMS= Prescribing Information System for Scotland Quarterly prescribing data for GPs Can measure formulary compliance

9. Formulary compliance – 2 nd care Prescribing Action Plan 4 (2012/13) No % formulary compliance targets (yet) Hospital JAC data provides some data 40% of hospital Rxing influences GP Rxing

10. 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.

11. 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.

12. Future for Lanarkshire’s Joint Formulary Web based version and APP– always the most up-to-date. iPad mini; iPhone 6; android updates. Central servers for GPs prescribing systems Paper copy? No. APP- was launched in NHS Lanarkshire. May 2012. Other Health Boards?

13. Main challenges for the future National formulary? EMIS &Vision GP prescribing systems Further development of the NHS APP? Other Health Boards will develop a formulary App. % formulary compliance in 2° care? THE END