The ICB pharmacy directorate team have developed and maintain a suite of SystmOne formularies which reflect the Derbyshire traffic light classifications (RED, AMBER, GREEN, GREY and Do Not Prescribe) as well as for specific areas where prescribing the preferred item can be problematic (Continence, Adult and Infant Nutrition, Stoma, Woundcare and NRT and substance misuse).
The formularies are updated monthly following decisions made at the Area Prescribing Committee before being imported into the 101 SystmOne practices in the ICB. They are also shared via a memorandum of understanding (MOU) with the wider healthcare community (acute, community and mental health trusts) using Community SystmOne. This ensures best practice is shared collaboratively across the health system, ensures consistency and reduces duplication of effort.
The formularies have been developed to ensure prescribers have the relevant information before making their prescribing decision to help ensure the right decision is made first time. By maintaining RED and DNP formularies the prescriber can instantly see that an item is not intended for primary care prescribing. Medicines with a GREY classification can be prescribed in specific circumstances and this exceptionality is included as a message line, with a prescribing line included for items that are routinely prescribed in primary care.
The ICB has a small formulary working group of pharmacists and technicians who meet quarterly to discuss on-going development of the formulary.
Over the years a comprehensive set of formulary principles have been developed to ensure consistency and a clear rationale for decisions made. The entire ICB pharmacy team can feedback on the formulary and raise queries via a formulary query log which is reviewed monthly. Feedback and suggestions from the end users are also fed in via this route to facilitate cross functional working and collaboration with all our stakeholders.
Decisions made by the Area Prescribing Committee and other relevant groups are reviewed at the monthly formulary update by a team of two pharmacists. This update produces a list of formulary changes that are implemented and checked by a team of technicians on a rotational basis. Once the final check has taken place the updated formulary is shared with the wider ICB team for uploading at individual practice level. The monthly formulary changes are also shared with the ICB team who maintain the Optimise Rx software to ensure messaging is consistent.
The formulary is a key tool to improve medicines optimisation. It provides prescribers with clear information at the point of prescribing to ensure primary care prescribing is appropriate, as well as helping to support the choice of local formulary options with appropriate directions and for patients and indications to aid concordance where appropriate.
