1. NHS Lanarkshire Joint Formulary Fiona Graham Formulary Pharmacist

2. Aim/background Why have a Joint Formulary? -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 2011/12 = £120M. Cost effective/evidence based choices Abridged version of the BNF NHS Lothian formulary framework

4. Formulary development Lanarkshire’s Area Drug & Therapeutics Committee (Area D&T C) Formulary pharmacist in post July 2005 Formulary sub-groups Cost effective/evidence based choices Joint formulary covers Primary & Secondary Care Guess the % Rx volume split? 1 ry : 2 nd care?

5. Formulary formats Paper copy- 2 nd edition Nov 2007 (1500 copies) Intranet/MedEd site- Drugs & Prescribing Internet- NHS Lanarkshire home page NHS Lanarkshire APP for iDevices GP Rxing systems:100 practices; 360 GPs, locums & Rxing nurses:- –Vamp Vision eformulary diagnosis based. –EMIS eformulary diagnosis based, 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 protocol Gentamicin and vancomycin protocols Antidepressants- Swapping & Stopping- Maudsley guideline

7. Formulary compliance-primary care Prescribing Action Plan 2011/12 GP targets:- –ACE inhibitors% items >98% –Angiotensin 2 antagonists% items >98% –Proton pump inhibitors% items >94% –NSAIDS% items >88% –Antibiotics% items >86% –Antidepressants% items >72% –Wound management formulary % items >75%

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

9. Formulary compliance – 2 nd care Prescribing Action Plan 3 (2011/12) No % formulary compliance targets (yet) Hospital JAC data provides some data 40% of hospital Rxing influences GP Rxing Formulary choices aim to encourage seemless prescribing e.g Isotard XL

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. May or may not go on to the formulary Area D & T Committee Prescribing Bulletin- summary of formulary status of SMC considered drugs.

12. Future for Lanarkshire’s Joint Formulary Intranet/MedEd/Intranet version – most up- to-date. Central servers for GPs prescribing systems Paper copy? APP- just about to be launched in NHS Lanarkshire. Other specialist formularies? E.g paediatric

13. Main challenges for the future National formulary? Change over to EMIS &Vision GP prescribing systems Paper copy vs on-line formulary? % formulary compliance in 2° care? THE END