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The medicines formulary

The formulary comprises a list of medicines which have been approved by the SE Essex Medicines Management Committee (SEEMMC) for prescribing within the Trust.

The purpose of the formulary is to ensure evidence-based and cost-effective prescribing and provide information relating to drug use. All prescribing from within the Trust (i.e. in-patient, out-patient and FP10 prescribing) must comply with the formulary. Advice given to GPs with regard to drug treatment options must also be in line with Trust formulary recommendations. This is monitored on an ongoing basis by the Department of Pharmacy. 

To ensure patient care is consistent, representatives from the local CCGs are members of SEEMMC. They ensure any drugs that are approved for the hospital formulary are managed appropriately e.g. clarifying hospital specialist & GP responsibilities. 

The SEEMMC has signed up to the NICE guidance on Good Formulary Practice 

The trust formulary can be accessed through the links at the bottom of this page.  

NICE Technology Appraisals for Medicines 

NICE (National Institute for Health and Clinical Excellence) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. NICE provide guidance in the form of Technology Appraisals. These are based on the best available evidence of the most effective care, looking at clinical and cost effectiveness, and aims to ensure treatment is available equally across different regions (i.e. avoids so called 'postcode prescribing'). 

The Foundation Trust has a responsibility to implement NICE Technology Appraisals to ensure patients receive the best and most appropriate treatment and that NHS resources are not wasted by inappropriate treatment.Under the NHS Constitution, patients have the right to drugs and treatments recommended by NICE if their doctor thinks it is clinically appropriate. The statutory obligation is for NHS organisations to fund new drugs and treatments within three months of the date of issue, unless specifically exempted. Southend has a process in place to enable access to all NICE-approved medicines. 

It is essential that members of the SEEMMC discuss every medicine before it is used in the Trust in order to assess governance and safety issues. Many of the drugs are highly specialized and staff might require training and further guidance. We may also need to produce new information to explain the medicine to patients. 

If a clinician wishes to use a NICE-approved medicine a request is made to the SEEMMC, and approval (within the terms of the guidance) is automatic. At this point the medicine is added to the Trust main formulary list along with any specific local commentary. 

All remaining NICE approved medicines are placed in one of two lists: 

  • NICE approved medicines not yet requested for use in the Trust 

These are medicines that may be used in the Trust but have not yet been requested by a clinician and consequently have not been discussed at the Medicines Management Committee. The reason for not yet using the medicine will always be clinical. 

  • NICE approved medicines for indications not currently treated in the Trust 

The fact that a medicine appears on list a) or b) does not exclude it from being used in the Trust. 

In some cases NICE recommends that certain drugs should not be used. In this case, these drugs may still be available on an individual basis via an individual funding request if exceptional circumstances exist. This decision rests with the relevant Clinical Commissioning Group (CCG). Click on the link below for current Trust status of NICE Technology Appraisal medicines

Current Trust status of NICE Technology Appraisal medicines

The Medicines Formulary 

Introduction 

The formulary comprises a list of medicines which have been approved by the SE Essex Medicines Management Committee for prescribing within the Trust. 

The purpose of the formulary is to ensure evidence-based and cost-effective prescribing and provide information relating to drug use. All prescribing from within the Trust (i.e. in-patient, out-patient and FP10 prescribing) must comply with the formulary. Advice given to GPs with regard to drug treatment options must also be in line with Trust formulary recommendations. This will be monitored on an ongoing basis. 

Drugs are arranged in sections corresponding to those in the British National Formulary (BNF) 

Operation of the Formulary 

Drugs listed are available for general prescribing unless specific restrictions are indicated. 

Drugs which are not listed in the formulary will be obtained only in the following circumstances: 

Patients receiving a non-formulary drug on admission 

Treatment with a non-formulary drug may be continued in this case. Patients' own supplies should always be used before requesting a supply from pharmacy and it should be borne in mind that there may be a delay in obtaining a non-formulary drug. An appropriate alternative should be considered in situations where treatment may otherwise be interrupted. 

An admission to hospital represents an opportunity to review a patient's existing drug therapy and, if appropriate, treatment may be changed to a drug that is on the Trust formulary. 

Drugs required for a specific patient in exceptional circumstances 

Any drug which is not on the Trust formulary and which is required before the date of the next Medicines Management Committee meeting may be requested using the Medicines Management Committee procedure for Urgent/Compassionate use: 

Contact the Chair of the SE Essex Medicines Management Committee (currently Dr John Day) with:

  • Details of the case
  • Reasons for why other treatment options not appropriate
  • Evidence for proposed treatment
  • Anticipated cost (liaise with Clinical Lead Pharmacist, James Kent or deputy, Simon Worrall for advice if required)

If pharmacy have not been involved in the discussion at this point, the chair will liaise with the Clinical Lead or deputy to ensure the decision is communicated, and where necessary, prompt supply of the medicine is organised. 

Such an application will be considered for "one-off" occasions of drug use. A full application must be made for drugs which are required for addition to the formulary (see below). 

Additions to the Formulary 

The addition of new drugs to the formulary, and consequently to pharmacy stock, will be made only with the agreement of the Medicines Management Committee. In order to request an addition to the formulary, a New Drug Submission form must be completed in full and supporting evidence attached. 

In addition, a submission form must be completed for any new indications for an existing formulary medicine. 

New drug applications must be received (appropriately completed and signed) in pharmacy at least 2 weeks before the date of a Medicines Management Committee meeting in order for the item to be included in the agenda. Medicines Management committee meetings are held every 2 months (usually the 3rd Wednesday of that month between 12.30-2.30) 

The new drug submission form is available in the formulary section on the intranet. It is advised that clinicians inform pharmacy (e.g. relevant business unit pharmacist) before completing a submission form to ensure that the appropriate processes are followed. 

The following criteria will be considered by the committee when assessing the submission: 

  • patient safety
  • clinical effectiveness
  • cost effectiveness or resource impact
  • strength of evidence
  • place in therapy relative to available treatments
  • national guidance and priorities
  • local health priorities
  • equity of access
  • stakeholder views 

The committee will prioritise submissions for consideration using the following criteria: 

  • impact on patient care 
  • timelines for new medicines reaching the market 
  • severity of disease and patient numbers affected 
  • clinical effectiveness 
  • patient safety 
  • gaps in treatment or other available treatments 
  • cost effectiveness 
  • resource impact 
  • inappropriate variation in local current practice 

Drug Supply and Expenditure 

Patients' own medicines should be obtained and used before any drug is requested from pharmacy. 

The Trust and local CCGs have agreed that a medicines supply of 2 - 4 weeks should be prescribed on out-patient and discharge prescriptions. 

It should be noted that items prescribed on FP10 (HP) forms and dispensed in a community pharmacy are charged to the Trust. Therefore the rules with regard to Trust formulary prescribing and length of treatment must be followed. Prescriptions should be issued from out-patient clinics only when drug treatment is required to start immediately. In all other circumstances treatment recommendations should be communicated to the patient's GP using the out-patient clinic communication form. Patients should be encouraged to keep up to date with their usual medication supplies and informed that these may not be supplied from out-patient clinics. 

A breakdown of drug expenditure (including FP10 expenditure) is reported quarterly to each Business Unit. Non-formulary and other inappropriate prescribing will be identified and reported to the Business Unit leads. 

Further Information 

Clinical and pharmaceutical information provided within the formulary is intended as a guide only. Always check relevant information sources before prescribing or administering any drug.

For enquiries relating to the content of the Trust formulary please contact: 

Simon Worrall, Assistant Clinical Lead Pharmacist, secretary to the SE Essex Medicines Management Committee (simon.worrall@southend.nhs.uk; 01702 435555 ext 6867)

For enquiries relating to formulary applications, high cost drugs or other general prescribing issues please contact: 

James Kent, Clinical Lead Pharmacist, deputy chair of the SE Essex Medicines Management Committee (james.kent@southend.nhs.uk; 01702 435555 ext 5221 )

The formulary below will be updated quarterly.