The use of medicines is the most common therapeutic intervention in the NHS. Around 15-20% of a clinical commissioning group’s money is spent on medicines.
Medicines management is a term which encompasses all aspects of the supply, use and disposal of medicines. Effective medicines management contributes towards:
- Improved health of individuals and the population as a whole
- Improved patient care and satisfaction
- Making best use of available resources
- Making better use of professional skills
- Delivery of Clinical Governance
Prescribing is a key component of medicines management. Doctors and other professional staff (collectively called “prescribers”) can prescribe medicines (and certain non-medicines) for patients in their care using a written order, or prescription.
Whilst prescribers have the freedom to prescribe whatever they think is appropriate for their patients, they are expected to take into account the evidence for the safety, clinical effectiveness and cost effectiveness of the medicines they prescribe.
A formulary is a locally maintained document which lists the medicines that are deemed suitable for prescribing within the clinical commissioning group.
Medicines that are included on the local formulary are assessed by a committee of clinicians and medicines experts for their suitability for local use. The committee will generally assess medicines in terms of safety, clinical effectiveness, cost effectiveness and patient preferences.
Many medicines accepted for use will be prescribable by GPs and hospital doctors, but some will have local restrictions on their use. Some will be prescribable in limited circumstances and some will only be prescribable in hospital settings. Some medicines won’t be included on the formulary at all. All prescribers are expected to take into account whether the medicine they intend to prescribe is on the formulary.
You can access our formulary website to view all current formulary information by clicking the link below:
Local prescribing policies
Local prescribing policies may be developed to cover situations where there is no national guidance but where there is a local demand for the treatment. A local policy differs from the formulary in that it will normally contain far more detail about the clinical condition, the group of patients that are covered by the policy, and the treatment criteria.
The Repeat Prescription Management Code of Practice is best practice guidance for pharmacy repeat prescription ordering services (RPOS).
RPOS are not an NHS service and are not offered by all pharmacies. GPs are not contractually obliged to participate in such schemes and patients do not have to use them.
However, where such schemes are operating, the Code of Practice is mandatory in Birmingham CrossCity CCG for all parties; that is patients, pharmacies and GP practices.
Medicines that are unused and thrown away cost the NHS in England £300 million of tax payers’ money every year. Locally, across Birmingham CrossCity CCG, that equates to up to £4.5 million every year.
Did you know £4.5 million could pay for:*
- 177 more community nurses or
- 1213 more hip replacements or
- 297 more drug treatment courses for breast cancer or
- 4500 more drug treatment courses for Alzheimer's or
- 4682 more cataract operations.
*based on average costs
In order to reduce waste and improve patient safety, we are asking patients to take these simple steps when ordering repeat medicines (prescriptions):
- Only order what you need - check which medicines you have at home before re-ordering.
- Some medicines may not need to be re-ordered every time if you don’t take/use them every day or you already have enough. Did you know that if you don’t order a medicine, it will still appear on your repeat prescription next time?
- Speak to your GP practice if your repeat prescription needs updating.
- Having regular discussions with your pharmacist and GP will mean you get the right help with taking your medicines. Speak to your pharmacist about a medicines use review, to discuss getting the most from your prescription medicines.
- Did you know medicines cannot be re-used once they have left the pharmacy? So check your prescription bag before you leave.
- Return any unwanted medicines to a Pharmacy for safe disposal. Never dispose of them by putting them in the bin or flushing them down the sink or toilet. Unused medicines kept at home are a safety risk to children and to others.
If everyone makes small changes, then together we can make a massive difference to reduce the waste of medicines in our NHS.
We have developed a leaflet and poster that explains using the Repeat prescription service and the issues around medicines waste here:
The NHS Constitution
The NHS Constitution identifies two key patient rights with regard to medicines:
“You have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you.”
“You have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you.”
NICE – medicines and prescribing support
All medicines that have been assessed under a NICE Technology Appraisal are added to the formulary. Use of the medicine is generally restricted to the clinical indications that are described in the NICE guidance and so a medicine may be available for some conditions (i.e. those considered by NICE) but not for others.
With the integration of the former National Prescribing Centre into NICE, there is now a webpage offering advice and support for delivering quality, safety and efficiency in the use of medicines. Visit the NICE guidance webpage.