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NHS Formularies. Fiona Graham Formulary/Clinical Effectiveness Pharmacist NHS Lanarkshire. WHY HAVE A FORMULARY. -supports consistent evidence based prescribing. -supports consistent cost effective prescribing. -limited range of drugs.

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nhs formularies

NHS Formularies

Fiona Graham

Formulary/Clinical Effectiveness Pharmacist

NHS 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°


-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
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
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
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
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
Formulary compliance (cont)


PRescribing Information SysteM for Scotland

  • Quarterly prescribing data for GPs
  • Can measure formulary compliance
formulary amendments
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
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
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
Scottish Medicines Consortium
  • Category of submission:

-Full 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
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
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?