Formulary management

The Formulary is produced under the auspices of the TAM Subgroup of the NHS Highland Area Drug and Therapeutics Committee (ADTC).  The contents reflect wide consultation with practitioners.  Output from the Scottish Medicines Consortium, local and national advice on medicines in relation to clinical effectiveness, cost-effectiveness, comparative safety, patient acceptability and environmental impact together with the work of special interest groups in Highland and clinical networks, are also taken into account.  If you wish to request a change or addition to the Formulary refer to the flowchart of the assessment process. For further information or to provide feedback, which is always welcome, please email the Formulary Pharmacist at: nhsh.formulary@nhs.scot

Argyll and Bute

Those working in Argyll and Bute Health and Social Care Partnership (H&SCP) should follow Greater Glasgow and Clyde (GG&C) adult medicines formulary (http://www.ggcprescribing.org.uk/). For emergency sedation prescribers in Argyll and Bute should follow NHS Highland rapid tranquilisation guideline.

Drug names

ADTC supports a policy of generic prescribing for the majority of medicines.  It is noted that in some cases, the generic versions of a medicine may not have exactly the same indications listed on the market authorisation as the original branded medicine, but as bioequivalence to the original branded medicine must have been demonstrated as part of the generic market authorisation process, ADTC considers that any additional risks of prescribing and dispensing the medicine generically are negligible.  Exceptions to the generic prescribing policy are:

• when the pharmacokinetic profiles of different brands of the same medicine differ widely
• medicines with a narrow therapeutic index, where any variation in the drug concentration in the blood increases the risk of toxicity or treatment failure for the patient.
• where there is an overriding difference in cost, environmental impact or patient acceptability between products. 

Where Formulary medicines should be prescribed by brand name, this will be indicated in the prescribing notes of the Highland Formulary.  This advice does not override an individual clinician’s decision to prescribe what they believe to be the most appropriate treatment. 

Medicines in children

Unless otherwise stated, the doses given are for adults with normal hepatic and renal function.  Consult the BNF for Children for advice on prescribing for children and local paediatric drug guidelines on the Hospital Paediatrics section of the intranet.

Adverse drug reactions

These can be reported by any healthcare professionals and by patients to the Medicines and Healthcare Products Regulatory Agency (MHRA).  Yellow report cards can be found at the back of the BNF or reports can be submitted online at:  http://www.yccscotland.scot.nhs.uk/Pages/default.aspx.

Report: 

• All suspected serious adverse drug reactions to any drugs / vaccines / complementary remedies
• All adverse reactions suspected to be associated with black triangle medicines (including those considered to be non-serious)
• All adverse reactions that occur in children associated with either established or new medicines and vaccines

The black triangle symbol indicates that the MHRA is intensively monitoring the safety of that product.  

Also refer to ‘Prescription writing’ section in current BNF and General Medical Council guidance ‘Good practice in prescribing and managing medicines and devices’.

NHS Highland statement of guiding principles for prescribing

1. Prescribing should be based on safety, efficacy and cost-effectiveness.
2. Medicines should be prescribed only when they are necessary and, in all cases, the benefit of administering the medicine should be considered in relation to the risk involved.
3. The Highland Formulary should constitute the core of all prescribing. It is based upon current evidence, national guidance, local expertise and patient acceptability.
4. Cost-effectiveness matters. As a guiding principle, the most cost-effective medication should be prescribed for a patient. Specifically, prescribers should not prescribe drugs, medicines or appliances whose cost or quantity, in relation to any patient, is in excess of that which is reasonably necessary for the proper treatment of that patient. Such prescribing denies resource for other essential services.
5. The ‘approved’ (non-proprietary or generic) name of a medicine should be used unless there are important differences in formulation and/or bioavailability. Where a generic product is not considered suitable and it is desirable to recommend a particular brand of a drug, this is specified in the Highland Formulary.
6. Prescribers should always prescribe within their clinical competency.
7. When prescribing, clinicians must avoid making assumptions about people with protected characteristics eg gender, age, black and ethnic minority people, and must be alert to any specific considerations required.

Unnecessary or cost-ineffective prescribing cannot be justified:

• unnecessary prescribing exposes patients to risk without benefit
• cost-ineffective prescribing deprives patients in need of new, effective but expensive medicines with the potential to extend life and/or improve quality of life.

Medicines Information

Reference is made throughout the Formulary to information and advice available from Medicines Information. This service can be accessed as follows:

• Argyll and Bute H&SCP:
  Royal Alexandra Hospital, tel: 0141 887 9111 (switchboard), email: medinfo@ggc.scot.nhs.uk.
• Highland H&SCP:
  Raigmore Hospital, tel: 01463 704000 email: nhshighland.medicineinformation@nhs.scot.

NHS Highland does not support the commissioning or funding of homeopathy therapies.

Extract  from Highland NHS Board minutes 5th October 2010:

"Following discussion, the Board concluded that there was settled, clear and unambiguous clinical opinion that homeopathic treatments should not be used in the NHS. An important factor in the decision was the fact that patients offered an ineffective treatment, such as homeopathy, might then delay getting the most appropriate help for their condition, with possible serious
consequences."

Further information:

• Specialist Pharmacy Service, Clinical Evidence for homeopathy, 2017
• NHS Inform: Homeopathy
• Royal College of General Practitioners position statement on homeopathy, November 2015

Disclaimer

While every effort has been made to ensure that the information contained within the Formulary is accurate, no responsibility or liability can be accepted by those involved in its production for any loss, injury or damage which is suffered as a consequence of any errors, omissions or inaccuracies contained within it.  In particular, prescribers should always check the suitability of the drug and dosage based on the information provided by the manufacturer.