The use of medicines is the most common therapeutic intervention in the NHS. Around 15 to 20 per cent of a Clinical Commissioning Groups’ money is spent on medicines. Medicines Management is a term which encompasses all aspects of the supply, use and disposal of medicines. Effective Medicines Management contributes towards:
• Improved health of individuals and the population as a whole
• Improved patient care and satisfaction
• Making best use of available resources
• Making better use of professional skills
• Delivery of Clinical Governance
Prescribing is a key component of Medicines Management. Doctors and other professional staff (collectively called “prescribers”) can prescribe medicines (and certain non-medicines) for patients in their care using a written order, or prescription. Whilst prescribers have the freedom to prescribe whatever they think is appropriate for their patients, they are expected to take into account the evidence for the clinical and cost effectiveness of the medicines they prescribe.
A formulary is a locally maintained document which lists the medicines that are deemed suitable for prescribing within the clinical commissioning group. Medicines that are included on the local formulary are assessed by a committee of clinicians and medicines experts for their suitability for local use. The committee will generally assess medicines in terms of safety, clinical effectiveness, cost effectiveness and patient preferences. Most medicines accepted for use will be prescribable by primary and secondary care but some will have local restrictions on their use. Some will be prescribable in limited circumstances and some will only be prescribable in hospital settings. Some medicines won’t be included on the formulary at all. All prescribers are expected to take into account whether the medicine they intend to prescribe is on the formulary. Use of the formulary is not mandatory but prescribers are strongly encouraged to consider formulary medicines first.
In Birmingham South Central Clinical Commissioning Group, there are three main formularies based around our three main hospitals, but smaller providers also publish their formularies. An exciting piece of work is currently underway with all local providers and CCGs working together as an Area Prescribing Committee to harmonise local formularies with the ultimate goal of having just one adult formulary across Birmingham, Solihull and Sandwell as well.
The new Birmingham, Sandwell, Solihull and Environs Joint formulary can be accessed via the link below. It is not complete yet, but the page also contains links so that you can find the current formularies for our local hospital trusts as well: