1. Supporting Realistic Medicine through the delivery of a Single National Formulary

2. Welcome

3. 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.

4. Realistic Medicine and the development of the Scottish Formulary

5. What is Realistic Medicine?

6. Aims of Realistic Medicine

7. 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

8. Current position 11

9. 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”

10. 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

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

12. A consultant’s perspective on the Scottish Formulary

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

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

15. SNF within the wider context
Aims of Quality Prescribing

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

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

18. 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

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

20. 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

21. 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:

22. Gliptins Vildagliptin Gemigliptin Sitagliptin Anagliptin Saxagliptin
Tenegliptin
Linagliptin
Trelagliptin
Alogliptin
Omarigliptin
Evogliptin
Gosogliptin
Dutogliptin
(Accessed 12/6/18)

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

24. 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

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

26. A GP’s perspective on the Scottish Formulary

34. Group discussions

35. 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)

36. Feedback from group discussions

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