1. Secondary and Primary Care Prescribing
Process flow for Formulary, Non Formulary and Self Care medications
Start

2. Introduction
This slide set has been requested by GPs and Clinicians in order to aid compliance with the different processes to be followed to ensure evidence based cost effective prescribing within the Lincolnshire Healthcare System
The process reinforces the need to follow the Lincolnshire Joint Formulary and explains that wherever possible and clinically appropriate self care advice should be provided rather than prescribing.

3. The Lincolnshire Joint Formulary
The formulary lists, by BNF chapter, the various medicines that are recommended by the Lincolnshire Healthcare system as being the most appropriate for patient treatment based upon current research, guidance and cost effectiveness.
The Formulary is controlled by the Lincolnshire Prescribing and Clinical Effectiveness Forum (PACEF) with representation at the forum from the various healthcare prescribing organisations and chaired by a lead GP.
The PACEF URL is:
The Lincolnshire Joint Formulary URL is:
Medicines are listed with coloured traffic light status with the following definitions:

4. Formulary Traffic Light Status Information
Amber 1
Medicines that should be initiated by a specialist and prescribed by primary care prescribers only under a shared care protocol. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred.
Amber 2
Medicines suitable to be prescribed in primary care after specialist recommendation or initiation

5. Formulary Traffic Light Status Information
Green
This will signify a product that is approved for initiation in either primary or secondary care within licensed indications. Specialist initiation and shared care guidelines are not considered necessary.
Grey
Medicines restricted for use in those patients under the care of external trusts i.e. – North West Anglia Hospitals NHS Foundation Trust or the Northern Lincolnshire and Goole NHS Foundation Trust

6. Formulary Traffic Light Status Information
Red
This will signify that a product has been approved for use within secondary or tertiary care, or by a primary care hosted specialist service only and should not be routinely prescribed in primary care.
RED drugs may be used within ULHT, NWAFT or LPFT subject to approval for use within each trust. ULHT, NWAFT and LPFT reserve the right to determine whether or not RED drugs will be used within their trusts.
RED classification does not automatically signify that a drug will be available within secondary/tertiary care.

7. Formulary Traffic Light Status Information
Red Red
This will signify that a product is not recommended for prescribing in both primary and secondary care.
Note that all new products are classified as RED-RED pending assessment by PACEF.
OTC
Please note that the Lincolnshire Joint Formulary is currently being updated to flag those medicines that are also available to buy Over the Counter (OTC) either at Pharmacies or General Sales Outlets

8. Prescribing Process Flow - Start
Prescribing clinician decides patient would benefit from medication for their condition
Is the medication an
approved item in the Lincolnshire Joint Formulary?
Yes No
The item will be classified as Green, Grey, Amber or Red on the Formulary
The item will be classified as Red Red on the Formulary
Proceed to Formulary Approved Item slide
Proceed to Non-Formulary slide

9. Prescribing – Formulary Approved item
Is the medication available to buy “Over the Counter” as a self care medication?
Yes No
The item will be classified as Green, Grey, Amber or Red on the Formulary
Issue a prescription for the item(s) in line with any Formulary advice – Note that if a PbR Excluded Drug is being prescribed in Secondary Care then a Blueteq Financial Approval form MUST be completed.
Proceed to Formulary Item OTC slide

10. Prescribing – Formulary item – OTC
Is it clinically appropriate for the Patient to buy based upon vulnerability and the severity /acuteness of their conditions?
Yes No
Provide written advice to the patient to purchase self care item(s) –
(self care pads)
Issue a prescription for the item(s) in line with any Formulary advice
The item is available to purchase OTC for Self Care

11. Prescribing – Non Formulary item – OTC
Is it clinically appropriate for the Patient to buy based upon vulnerability and the severity /acuteness of their conditions?
Yes No
Provide written advice to the patient to purchase self care item(s) in line with formulary advice (pads)
Proceed to Prescribing – Non Formulary item – Not OTC slide
The item is available to purchase OTC for Self Care

12. Prescribing – Non-Formulary item
Yes No
Proceed to Non Formulary Item – OTC slide
Proceed to Non Formulary item – not OTC slide
The item is either classed as Red Red or not included currently in the Formulary
Is the medication available to buy “Over the Counter” as a self care medication?

13. Prescribing – Non Formulary item – Not OTC
Is there another Formulary product that is suitable?
Yes No
Prescribe the Formulary product(s)
Consult Optum MMO team for advice – or
The item is not available or not appropriate to purchase OTC for
Self Care
Optum may advise that an Individual Funding Request needs to be completed

14. OTC ~ Self care medication pads
To be used in Secondary and Primary Care when giving
patient written advice on buying self care medication.
Please see the PACEF web site County Wide Prescribing
pages for a download pdf file of the A5 non-prescription pad.