Introduction to the NWL Integrated Formulary

Transcription

1 Introduction to the NWL Integrated Formulary What is the Integrated Formulary? The Integrated Formulary (IF) is a list of medicines for adult patients and is for use in North West London. The list is in BNF section order. The IF does not include medicines that are only needed for hospital inpatients. It is intended to cover: prescriptions written in primary care prescriptions or recommendations by hospital doctors in respect of outpatients or patients leaving hospital after an admission. In these situations prescribers are asked to take the IF into account when exercising their clinical judgement. The IF has been developed at the request of NWL s Clinical Executive Committee which includes the chairs of all NWL shadow Clinical Commissioning Groups. Additional notes on the scope of the Integrated Formulary The IF covers all 15 chapters of the British National Formulary (BNF), but is designed to be used in conjunction with the BNF. Prescribers should refer to the BNF and medicines summaries of product characteristics for prescribing information, and take note of any relevant safety alerts; The IF does not generally include unlicensed preparations, although a few exceptions have been made for various reasons; The IF does not include medicines on the NWL red list of medicines that a hospital doctor should not ask a GP to prescribe; Shared care documents In NWL a number of medicines are on the red list of medicines that a hospital doctor should not ask a GP to prescribe, unless a shared care document has been agreed by the patient s hospital and PCT/CCG. Where such agreed documents exist, the medicine(s) they relate to are included in the IF but annotated for use only in line with agreed shared care documents. Initially, the IF covers prescriptions for adults only. It will probably be expanded to cover children later. The IF should be taken fully into account by prescribers when exercising their clinical judgement. However, it does not override the individual responsibility of prescribers to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer and informed by the summary of product characteristics of any medicines they are considering. The IF is for use in North West London. It should be taken into account by prescribers in the following hospitals and prescribers whose practices are members of the following CCGs: 1 of 5

2 Acute and mental health trusts Clinical Commissioning Groups Imperial College Healthcare NHS Trust Brent CCG Royal Brompton and Harefield NHS Harrow CCG Hillingdon Hospitals NHS Ealing CCG Ealing Hospital NHS Trust Hillingdon CCG North West London Hospitals NHS Trust Great West CCG Central and North West London NHS Hammersmith and Fulham CCG West London Mental Health NHS Trust West London CCG Chelsea and Westminster Hospital NHS Central London CCG West Middlesex University Hospital NHS Trust NICE technology appraisal guidance and the IF Medicines recommended by NICE technology appraisal guidance (TAG) are regarded as included in the IF from the date the TAG is published, unless: the medicine will only be prescribed for hospital inpatients or it is deemed to be a medicine that should only be prescribed by a hospital specialist (in which case it will be added to the NWL red list of medicines that a hospital doctor should not ask a GP to prescribe). If neither of these apply, when a TAG recommends use of a medicine that is not already in the IF, the medicine will appear in the next published iteration of the IF. Updated iterations will be published several times a year. Specialist initiation A number of medicines in the IF are marked specialist initiation. These words should be interpreted as an attempt to reduce the risk of harm and taken into account by prescribers when exercising their clinical judgement. Appropriate action in response to a specialist initiation annotation may lie anywhere in a spectrum between: 1. The medicine should be prescribed by a relevant specialist for at least x months with monitoring of effectiveness and toxicity, until treatment is stable at which point the patient s GP can be asked whether s/he will take over prescribing, and 2. It is reasonable for a GP to write the first prescription after a telephone conversation with a relevant specialist clinician. Different GPs might reasonably take different decisions regarding whether or when to prescribe, depending on their knowledge and experience. Legal responsibility for prescribing lies with the doctor who signs the prescription. 2 of 5

3 The specialist initiation annotations say nothing about who is or is not a relevant specialist in respect of a medicine. It will be reasonable for some of these medicines to be initiated by prescribers from more than one speciality. Patients currently taking a non-if medicine People currently receiving a medicine that is not included in the IF should have the option to continue until they and their clinicians consider it appropriate to stop. Other prescribing of medicines not included in the IF The IF includes a broad range of medicines but occasionally a prescriber may conclude that a non-if medicine is needed for a patient. Prescribers should be prepared to justify the choice of a non-if medicine if called upon to do so. Hospital doctors should communicate the reason for the non-if choice to the patient s GP and ideally seek the GP s agreement before prescribing. Initiation or recommendation of non-if medicines may be challenged. CCG Boards may challenge practices with high levels of non-if prescribing; GPs, primary care prescribing advisers and CCG Board members may challenge hospital doctors who prescribe or recommend non-if medicines. A feedback form that GPs can use is at appendix A. Unlicensed medicines The NWL Prescribing Policy (a document relied on in contracting between NHS NWL and NWL acute and mental health trusts) includes: Prescribing of unlicensed medicines should usually remain the responsibility of the clinician initiating treatment. The Hospital Trust will accept full responsibility for the continued sourcing, quality and supply, which should be under the control of the Hospital Trust pharmacy department. Clinicians cannot make the same assumptions of safety, quality and efficacy with unlicensed medicines as they can with licensed medicines. Localising the NWL Integrated Formulary The IF is intended to facilitate a degree of local flexibility. For example: Local trusts and CCGs may develop protocols to restrict the use of certain IF medicines in their area, for example by restricting the initiation of certain medicines to consultants in defined specialties; The IF should be used in conjunction with locally developed therapeutics guidelines, e.g. local antibiotic guidelines; Medicines approved by local trust New Drugs Panels (NDPs) or Drug and Therapeutics Committees (DTCs) but rejected by the Integrated Formulary NDP can still be prescribed in the trust. However, hospital clinicians should not ask primary care prescribers to prescribe such medicines. 3 of 5

4 Proposing addition of medicines to the Integrated Formulary If the requestor is a secondary care doctor Proposals should be submitted to the trust New Drugs Panel (NDP) or equivalent in the usual way. If approved by the trust panel and if the medicine is in-scope for the NWL Integrated Formulary, the proposal should be passed electronically to the Integrated Formulary NDP Secretary. There will be no requirement to re-work the proposal except as noted below. All supporting documentation submitted as part of the original application to the trust NDP will continue to be valid and will be used to support Integrated Formulary NDP decision making. However, one caveat applies and one additional estimate is required: Caveat: cases must be supported by 2-5 peer reviewed published papers. Additional estimate: requestors should use data on the prevalence of diseases and their knowledge of the treatment options to estimate the number of people per 100,000 population for whom the requested medicine may be appropriate. This estimate must be submitted with the request. The request will then be included on the agenda for an Integrated Formulary NDP meeting. The original requestor will be invited to attend the Integrated Formulary NDP meeting. If the requestor is a NWL GP In order to minimise the number of requests that are unlikely to be agreed, the applicant will be expected to demonstrate the following minimum level of support: Endorsement by at least two NWL GPs in addition to the requestor, one of whom must be his or her CCG s Prescribing Lead GP; Endorsement by at least one NWL hospital consultant in the relevant specialty; 2-5 peer reviewed published papers. An electronic request form will be available from the Panel Secretary. Provided the requirements detailed above are met, requests from GPs to add medicines will be considered by the Integrated Formulary NDP. The requestor will be invited to attend the IFNDP meeting. Planned Integrated Formulary developments A series of consultations will be held with the aim of defining 1 st, 2 nd and 3 rd line medicines from various therapeutic groups. A consultation is likely to be undertaken to identify changes that would be needed (e.g. formulations that would need to be added) in order for the Integrated Formulary to be usable for paediatric patients as well as adults. For further information Please contact your Trust or PCT chief pharmacist in the first instance. 4 of 5

5 Appendix A Feedback form for use by GPs who believe that a hospital doctor should not have recommended or asked him or her to prescribe a specific medicine Feedback form for GP who declines to pr 5 of 5