MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Formulary

Introduction

All material in this formulary is aimed at health professionals, but is information currently held within the public domain. Members of the public seeking advice on medicine-related matters are encouraged to speak with their GP, pharmacist or nurse, or contact NHS 111 service.


Welcome to the West Kent Interface formulary (IF), which contains the list of medicines approved for prescribing within the NHS West Kent Health Economy. The IF also links to approved prescribing recommendations and guidelines.
The IF is produced as a joint venture between primary and secondary care. The aim is that the IF will cover 80-90% of prescribing. We recognise that there will be instances where prescribing outside of the IF will be both necessary and appropriate.

NICE technology appraisal guidance

Medicines recommended by NICE technology appraisal guidelines(TAG), will be incorporated into the IF within 90 days of the TAG's publication.
When a TAG recommends use of a medicine that is not already in the IF, the medicine will added to the appropriate section of the IF. Additions will be published following formal agreement of NICE recommendations at the MTW Drugs and Therapeutics and Medicines Management Committee (DTMMC) as well as ratification by the appropriate governing body of the CCG and Acute Trust.


Specialist initiation

A number of medicines in the IF are colour coded as amber. Amber medicines MUST be initiated or recommended by a specialist (GP or hospital clinician). Monitoring of either medicine or disease does not necessarily require specialist skills or equipment. However, shared care arrangements will exist where intense monitoring may be required. Appropriate action in response to 'specialist use' may lie anywhere in a spectrum between:

• The medicine should be prescribed by a relevant specialist as per the shared care protocal (if one exists), with monitoring of effectiveness and toxicity, until treatment is stable at which point the patient can be transferred to their own GP, and

• It is reasonable for a GP to write the first prescription after discussion a relevant specialist clinican.

It will be reasonable for some of these medicines to be initiated by prescribers from more than one speciality.


Non-formulary prescribing

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. Initiation of a non-IF medicine within the Trust requires completion of a non-IF request form which is available from the Pharmacy Department. Non-formulary drugs are not routinely stocked in the pharmacy department; there may therefore be a significant delay in obtaining the product. Hospital doctors or other specialists should communicate the reason for the non-IF choice to the patient's GP and ideally seek the GP's agreement before prescribing or recommending if treatment is to continue in the community. Initiation or recommendation of non-IF medicines may be challenged. 

It is important that prescribers recognise the considerable cost implications of prescribing non-formulary drugs and the likelihood that funding may be required for some expensive drugs.

Patients may be admitted on non-formulary drugs and it is recognised that disruption to long-term treatment should be kept to a minimum. If it is considered clinically unreasonable to change to a drug included in the Formulary then the patient's own supply should be used where possible. The item should only be obtained from pharmacy if the patient's supply is unavailable and switching to a formulary drug is not possible.


Unlicensed medicines

Prescribing of unlicensed medicines should usually remain the responsibility of the clinician initiating treatment. The Trust will accept responsibility for the continued supply. GP's are not obliged to continue prescribing of unlicensed medicines, as this carries greater clinical responsibility. Prescribing of licensed drugs being used for unlicensed indications may possibly be continued in primary care but this should be discussed and agreed with the GP.