- The NHS Constitution
- The National Institute for Health and Clinical Excellence (NICE)
- Individual Treatment Requests
- Local Prescribing Policies
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 appropriately trained clinical 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 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.
Shropshire and Telford Local Health Economy formulary is currently under development. Completed chapters can be viewed using the link in the Shropshire and Telford Local Health Economy section.
Links to other providers' formularies - Midlands Partnership NHS Foundation Trust
The NHS Constitution
The NHS Constitution identifies two key patient rights with regard to medicines
“You have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you.”
“You have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you.”
Local formulary decision making process take these into account. All medicines recommended by NICE are included in the formulary if local prescribers want to use them.
All other medicines are assessed on their clinical evidence as presented to the formulary committee, which will decide whether a medicine should be available locally. Where a medicine is not generally available, or is not included on the formulary, there are mechanisms in place for considering individual circumstances.
The National Institute for Health and Clinical Excellence (NICE)
All medicines that have been assessed under a NICE (National Institute for Health and Clinical Excellence) technology appraisal are added to the formulary. Use of the medicine is generally restricted to the clinical indications that are described in the NICE guidance and so a medicine may be available for some conditions (i.e. those considered by NICE) but not for others.
Individual Treatment Requests
Local decision making processes around medicines cannot take into account all situations. There are many situations where an individual patient’s circumstances are exceptional and such situations are considered on an individual basis. If a prescriber thinks that a particular medicine should be used, they can apply to the local CCG using this process. Individual Treatment Requests are considered by a specialist panel who will take into account the clinical evidence for the treatment, its cost effectiveness along with any national or local policies regarding the medicines.
Local Prescribing Policies
Local prescribing policies may be developed to cover situations where there is no national guidance (for example NICE guidance) but where there is a local demand for the treatment. A local policy differs from the formulary in that it will normally contain far more detail about the clinical condition, the group of patients that are covered by the policy, and the treatment criteria.