Supporting Realistic Medicine through the delivery of a Single National Formulary

Welcome

Today’s session In this interactive session, delegates will take part in group discussions to consider how to implement the new approach throughout Scotland by considering current practice and what will help facilitate the roll- out of the national formulary and how it can be embedded.

Realistic Medicine and the development of the Scottish Formulary

What is Realistic Medicine?

Aims of Realistic Medicine

Benefits of the Scottish Formulary Support the reduction of unwarranted variation in prescribing practice, reducing medicine harm and continuing to improve patient outcomes. Help to achieve more equitable, greater value-based care so that the potential population benefit from medicines can be maximised. Supports the principle that services and functions of the health service which can be delivered more efficiently at national level will be done on a ‘Once for Scotland’ basis

Current position 11

Defining the Scottish Formulary How do the existing formularies describe themselves? “list of medicines approved for local use” “promoting high quality, safe and cost-effective prescribing” “evidence-based formulary ” “drug prescribing guidance” “provide appropriate treatment for the vast majority of patients” “a tool to assist” “based on local expert opinion and practice” “primary and secondary care”

Business As Usual Arrangements Development approach Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Business As Usual Arrangements Development Process Chapter Groups Evidence & Guidance Analysis Data Platform IT Comms & Engagement SMC Decisions Appeals Process

Development process 1. Preparation 2. Development 3. Peer Review 4. Completion

A consultant’s perspective on the Scottish Formulary

Scottish Formulary and the Scottish Diabetes Group perspective Brian Kennon Consultant Diabetologist, QEUH, Glasgow National Lead for Diabetes

SIGN 154: Diabetes SIGN update on the pharmacological management of T2DM Evolving evidence base New class of agents Several studies assessing CV outcomes

SNF within the wider context Aims of Quality Prescribing

Ensuring spending is effective…. 8% of medicines spend on DM

Guidelines & Clinical Practice Analogue Insulin use as basal insulin in T2DM

Potential Benefits of a SNF Reduce variation across health board areas Improve safety as complex area challenging for specialists & non-specialists Dynamic process beneficial with rapidly evolving evidence base Avoid unnecessary duplication of effort 14 health boards often reviewing the same information Potential to link in with procurement maximise cost effectiveness

Scottish Formulary Diabetes and Endocrine John Chalmers Clinical Lead for NHS Fife Diabetes MCN

Management of Type 2 Diabetes: Fife 1988 Newly diagnosed Type 2 Diabetes Normal BMI Obese Metformin Sulphonylurea Combination of Metformin+Sulphonylurea Insulin Professor IW Campbell Personal Communication 1988

SIGN 154 Scottish Intercollegiate Guidelines Network (SIGN). Pharmacological management of glycaemic control in people with type 2 diabetes. Edinburgh: SIGN; 2017. (SIGN publication no. 154). [November 2017]. Available from URL: http://www.sign.ac.uk

Gliptins Vildagliptin Gemigliptin Sitagliptin Anagliptin Saxagliptin Tenegliptin Linagliptin Trelagliptin Alogliptin Omarigliptin Evogliptin Gosogliptin Dutogliptin https://en.wikipedia.org/wiki/Dipeptidyl_peptidase-4_inhibitor (Accessed 12/6/18)

Choice of Agent Published Evidence Meta analysis CV Outcome Studies Evidence of efficacy SMC Guidance Licensed Indication Prescriber experience Patient preference Cost

Scottish Formulary: Diabetes and Endocrine Chapter Lead Chapter Development Group Specialists Endocrine, Diabetes, Bone, O&G GPs, Nurses, Pharmacists SMC, Industry, National Procurement Effective Prescribing and Therapeutics Team

Scottish Formulary: Benefits Patients: Consistent approach across Scotland Non specialists Medical Students Trainees “Cross-border” Effective Prescribing IT Platform

A GP’s perspective on the Scottish Formulary

Group discussions

19 20 21 18 17 14 15 16 22 23 28 29 30 27 26 24 25 12 13 4 5 2 1 End 6 3 10 7 9 11 8 Group discussions Time remaining: People Promotion Processes Patients Minutes Which roles within your Board should we be directly communicating with regarding the implementation of the Scottish Formulary? (prioritise your suggestions) Which communication methods should be utilised when engaging with Board colleagues around implementation? (prioritise your suggestions) Which existing processes within your Board should we be considering as part of the implementation plans? (consider what happens now and what processes you feel will change when the Scottish Formulary is introduced) What do you feel are the key points to be considered in communications with patients around the Scottish Formulary? (prioritise your suggestions)

Feedback from group discussions

Thank you for your contribution Keep up to date at: http://www