GGC Medicines


Adult Therapeutics Handbook

NHSGGC Adult Formulary

NHSGGC Adult Formulary

www.ggcmedicines.org.uk

NHS Greater Glasgow and Clyde aim to promote high-quality, cost-effective prescribing in all areas of care. This Therapeutics Handbook is one such tool for prescribers to help ensure that they are consistently giving patients evidence-based treatment.

Good prescribing dictates that the choice of therapy should be made on the basis of sound clinical evidence of efficacy, safety and also takes into consideration patient acceptability and cost effectiveness. The Greater Glasgow and Clyde Adult Formulary takes the above into account when considering a medicine for inclusion and therefore prescribing from the Formulary is consistent with good clinical practice.

All licensed medicines referred to in this handbook are included in the NHSGGC Adult Formulary.

Structure of the Formulary

The NHSGGC Formulary contains two main sections, the Preferred List and the Total Formulary.

The Preferred List is composed of approximately 350 medicines which represent the first-line agents for many classes of medicine and cover many common conditions and diseases. It is primarily aimed at the generalist prescriber, and those specialists prescribing outwith their specialty. For that reason, various therapeutic areas are not suitable for inclusion in the Preferred List, for example oncology medicines.

The Total Formulary comprises all other Formulary medicines and generally contains specialist medicines and second and third-line agents from classes included in the Preferred List.

Non-Formulary prescribing and processes

The need for prescription of medicines from out with the Formulary (non-Formulary prescribing) is recognised, but it is expected that:

  • Formal treatment guidelines / protocols will exclude non-Formulary drugs.
  • Non-Formulary status will apply to new medicines until accepted by the Scottish Medicines Consortium (SMC) and the Area Drug and Therapeutics Committee (ADTC). Further information regarding the SMC, including all previous decisions, can be found on their website: www.scottishmedicines.org.uk
  • Non-Formulary prescribing may be necessary and approved in exceptional circumstances only for individual patients.
  • If a non-Formulary prescription is proposed in the best interests of an individual patient, existing non-Formulary processes should be followed.

There are agreed non-Formulary processes in place within both the acute and primary care sectors of the health board. Within acute sites, there are three categories of non-Formulary prescribing / medicines. The processes that need to be followed for each category differ.

Level 1 Non-Formulary Medicines

Most non-Formulary prescribing is monitored retrospectively using pharmacy system data and no action is required from the prescriber.

Level 2 Non-Formulary Medicines

Whilst it is impractical for an Individual Patient Treatment Request (IPTR) form to be completed for all non-Formulary medicines, a completed form is requested for a small number of medicines that are not recommended for use by the SMC. These medicines can be found on the IPTR list available on the GGC Prescribing website www.ggcmedicines.org.uk

The treating consultant will need to complete an IPTR 2 form when a supply is required from hospital pharmacy and approval by the relevant clinical director needs to be sought prior to requesting the supply.

Level 3 Non-Formulary Medicines

These medicines, along with level 2 medicines, can be found on the IPTR List, and because they are not recommended by the SMC and incur a considerable cost even at low levels of prescribing, they require the more detailed IPTR 3 form to be completed by the consultant and use authorised by a directorate-level IPTR panel prior to being supplied by pharmacy.

The processes listed above for IPTR 2 and 3 are current at the time of printing but may be subject to review later in 2014. Information on any changes can be found on the GGC Medicines website (www.ggcmedicines.org.uk).

The information obtained from the non-Formulary processes are collated by the Formulary Team and are used to inform ADTC and its sub-committees and individual directorates about trends regarding non-Formulary prescribing that need addressing.

Where to find Formulary information

The Greater Glasgow and Clyde ADTC has a website containing useful Formulary information at: www.ggcmedicines.org.uk

Alternatively, the Formulary Team (see Appendix 6 for contact details), based within the Area Medicines Information Centre in Glasgow Royal Infirmary, are happy to answer any specific queries where the information is not readily available.