nhs forth valley formulary 11 - Community Pharmacy

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Formulary ManagementThe printed version of the formulary will be updated annually at the start of August torespond to the outcome of the Scottish Medicines Consortium assessment of new drugsand local requirements, as discussed and reviewed by the New Drugs Sub Group of theADTC following assessment by the SMC. The formulary is also available on the NHSForth Valley intranet and this electronic version will be updated after each New DrugsMeeting.The formulary process is quite separate from any licensing restriction which might apply,details of which can be found in the BNF or Summary of Product Characteristics. The finaldecision on the formulary status of a new drug is made by the ADTC. Throughout theyear, ADTC decisions of formulary amendments will be routinely communicated to Drugand Therapeutics Committees and Prescribing Groups, CHPs and general practitioners viaADTC News bulletin.There is an area wide process for requesting drugs for inclusion in the Forth ValleyFormulary. This involves the requestor completing a New Drugs Proforma availablewithin electronic versions of the Formulary at the following link.http://intranet.fv.scot.nhs.uk/web/FILES/Pharmacyfiles/requestorproforma2002.docCompleted forms for Primary Care to be submitted to Primary Care Pharmacy Services,Euro House, Stirling and Acute forms submitted to Medicines Information, Forth ValleyRoyal Hospital.Scottish Medicines Consortium (SMC)The remit of the Scottish Medicines Consortium (SMC) is to provide advice to the NHSBoards and their Area Drug and Therapeutics Committees (ADTCs) across Scotland aboutthe status of all newly licensed medicines, all new formulations of existing medicines andany major new indications for established products. Locally the process for consideringSMC recommendations has been finalised and a summary can be found in Appendix 2.Prescribers will be updated via the ADTC News bulletin and the formulary web site.The ADTC advises prescribers not to prescribe any drug that has been rejected by SMCor has not been considered by SMC unless there is evidence to justify prescribing in thelight of particular circumstances of an individual patient.Where a medicine is not recommended for use by the Scottish Medicines Consortium(SMC) for use in NHS Scotland, including those medicines not recommended due to nonsubmission,this will be noted by the Area Drug and Therapeutics Committee New DrugSub Group and the medicine will not be added to the NHS Forth Valley Joint Formulary.Where a medicine that has not been accepted by the SMC or NHS HIS following theirappraisal on clinical and cost-effectiveness, there is a Individual Patient TreatmentRequest (IPTR) process which provides an opportunity for clinicians i.e. hospitalConsultants or General Practitioners to pursue approval for prescribing, on a “case bycase” basis for individual patientsA copy of this policy can be found at the Pharmacy page on the Intranet on the followinglink:http://intranet.fv.scot.nhs.uk/home/Depts/PrimaryPharmacy/Pharm_Primary_Intro.aspFull details of all drugs that have been considered by the SMC can be found on theirwebsite http://www.scottishmedicines.org.uk/Page 6
NICE guidanceNHS Quality Improvement Scotland (NHS QIS) reviews NICE (National Institute forHealth and Clinical Excellence) Multiple Technology Appraisal (MTA) and decideswhether the recommendations should apply in Scotland.Where NHS QIS decides that an MTA should apply in Scotland, the NICE guidancesupersedes SMC advice. Unlike the SMC process, MTAs examine a disease area or a classof drugs and usually contain new evidence gathered after the launch of drugs or neweconomic modelling.SMC is the source of advice for Scotland on new drug therapies and the NICE Singletechnology Appraisal (STA) process therefore has no status in Scotland. If a NICE STAendorses a drug that was not recommended by the SMC, it is open to the manufacturers toresubmit the drug to SMC with new evidence.This information is reviewed by the New Drugs Sub Group on a routine basis.Paediatric DeclarationChildren, and in particular neonates, differ from adults in their response to drugs.Pharmacokinetic changes in childhood are important and have a significant influence ondrug absorption, distribution, metabolism and elimination and need to be considered whenchoosing an appropriate dosing regimen for a child. Where possible, children and neonatalmedications should be prescribed within the terms of the product licence (marketauthorisation). However, many children may require medicines not specifically licensedfor paediatric use.Recommendations have been drawn up by the Standing Committee on Medicines, a jointcommittee of the RCPCH and the Neonatal and Paediatric Pharmacists Group on the useof medicines outwith their product licence. The recommendations are:• Those who prescribe for a child should choose the medicine which offers the bestprospect of benefit for that child, with due regard to cost• The informed use of some unlicensed medicines or licensed medicines for unlicensedapplications is necessary in paediatric practice• Health professionals should have ready access to sound information on any medicinethey prescribe, dispense or administer, and its availability• In general, it is not necessary to take additional steps, beyond those taken whenprescribing licensed medicines, to obtain the consent of parents, carers and childpatients to prescribe or administer unlicensed medicines or licensed medicines forunlicensed applications• NHS Forth Valley and Health Authorities should support therapeutic practices thatare advocated by a respectable, responsible body of professional opinionForth Valley Formulary should not be used in isolation when prescribing medications forchildren/neonates. It is recommended that Medicines for Children (a Royal College ofPaediatric & Child Health Publication) is used where possible or the Childrens BNF orBNF. For neonates e.g. in SCBU, the relevant formularies available on the ward should beused. Many of the drugs stated in the formulary will be used in paediatrics but not at thedosages stated.In addition sugar free medicines should be used as much as possible when prescribing inchildren/neonates.Page 7
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nhs forth valley formulary 11 - Community Pharmacy

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