1. VICTORIA MACKINNON Prescribing Adviser NHS Lanarkshire

2. Purpose of a formulary Huge number of licensed drugs in the UK Formulary = limited list of drugs Aims to ensure prescribing is: – Evidence based – Cost effective – Seamless between 1 o and 2 o care

3. Benefits of a joint local formulary Promotes ownership by local prescribers in primary and secondary care Reference source Supports budget planning and the introduction of new drugs Is there a place for a national or WOS formulary?

4. Influences Scottish Medicines Consortium (SMC) Area Drug and Therapeutic Committees (ADTCs) Formulary sub-groups MHRA advice Local policies and protocols HIS advice on NICE guidance

5. Advises ADTCs on new drugs, two weeks in advance of public announcement. ADTC Prescribing Bulletin highlights formulary decisions in NHS Lanarkshire. – Green = accepted for general use and added to the Formulary – Orange = accepted for restricted use and added to the 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 – Red= Not accepted for use in Lanarkshire and not added to the Formulary

6. Budget planning Primary care = 80% of prescribing spend Primary care spend for NHS Scotland in 2013/14 ≈ £970M Ave. annual cost per patient = £176.23 Scope to make savings by: - reducing unnecessary waste - reducing the use of drugs less suitable - increasing generic prescribing - only prescribing expensive versions of drugs when there is a good clinical reason, for specific patients

7. NHSL Formulary – not just a list of drugs Antibiotic policies and guidelines High risk drugs: gentamicin, vancomycin, lithium, anticoagulants Antidepressants – stopping and swapping Wound management and simple dressings Gluten free foods formulary

8. Formats Previously paper based Website App for mobile devices Regular updates in prescribing newsletters GP Practice computer systems – Vision: Diagnosis based and A-Z list – EMIS: Synonym based and A-Z list

9. Compliance with the formulary Monitored in primary care via prescribing data. Prescribing Information SysteM for Scotland [PRISMS] Quarterly data for primary care prescribers Prescribing Information System [PIS]

10. What about secondary care? A challenge! Notes based Out-patient recommendations HMUD Electronic prescribing

11. ANY QUESTIONS?