This Formulary has been developed by the Medicines Optimisation Committee ("MOC") of South Staffordshire & Shropshire Healthcare NHS Foundation Trust, through the Formulary sub-committees. This sub-committees were time-limited, multi-disciplinary and utilised clinical expertise across the area. Its remit was to review the existing Formulary specifically looking at any new guidance/evidence and also, where appropriate look at positioning of drugs within the Formulary. It is intended to fit with current good clinical practice across the Trust, and the evidence base. Responsibility for Formulary maintenance now reverts back to the on-going remit of the MOC. The Formulary is available online at link to netFormulary. netFormulary is new software which allows the Formulary to be kept up to date in real time and also has links to relevant guidance, MHRA drug updates, ensuring clinicians have timely access to the information they need.
The Formulary has been developed in collaboration with colleagues in primary care, so representatives from Shropshire County, South Staffordshire and Telford & Wrekin PCTs were members of the sub-committee.
The aim of the Formulary
The aim of the Formulary is to advise clinicians on evidence based drug treatments, (which are cost and clinically effective) for the common mental disorders encountered in clinical practice.
The vast majority of prescribing for mental disorders in primary and secondary care should be covered by this Formulary, and it will be wide-ranging, in order to achieve this. netFormulary has electronic links to prescribing resources, such as NICE guidance and local guidelines/ pathways. From a cost-effectiveness and evidence-based perspective, it is important to ensure that formulary drugs are positioned appropriately, and adherence to this positioning will produce a number of benefits to the health economy. To facilitate this, formulary drugs clearly state their position in treatment for a particular indication (e.g. first line).
All drugs should be prescribed generically unless a particular preparation needs to be specified because of variations in bioavailability between different brands. It is recognised that on occasion, non-formulary items will be legitimately requested although in such circumstances Pharmacists may seek a rationale from the prescribing clinician, e.g. a patient has been admitted on a particular drug and is stabilised on it. Newly introduced medicines into the UK will not be stocked by the Pharmacy, until Formulary inclusion has been agreed by the Medicines Optimisation Committee. In urgent cases, consultants can seek approval from the Medical Director and Chief Pharmacist (who have joint authority from the Committee) by completing an Individual Patient Request for Non Formulary Drug form pdf (27k).
It is anticipated that this Formulary will evolve through debate and suggestion and as new drugs become available. Genuine ownership of the Formulary by clinicians in South Staffordshire and Shropshire who prescribe for people with mental health problems will help to refine it and enhance its relevance to everyday clinical practice.
The Formulary includes a price banding system which will identifies whether each drug is low, medium or high cost, and a traffic light system to highlight drugs that are appropriate for prescribing under a shared care arrangement (classed as amber). Essential Shared care Agreements will be electronically linked to the appropriate parts of the Formulary.
Requests for amendments to the formulary can only be made by Medical Lead/Consultant and should be submitted using the Application to Amend the Formulary Form pdf (69k).
Paliperidone 3 Monthly Injection
It has been agreed by the Medicines Optimisation Committee (MOC) that the paliperidone 3 monthly injection is included in the Formulary. Prior to initiating paliperidone 3 monthly injection consultants or specialist doctors are required to complete a Paliperidone 3 Monthly LAI Referral Form
Arirpiprazole Long Acting Injection (LAI)
The Medicines Optimisation Committee has agreed to include aripiprazole LAI onto the Formulary. Prior to initiating apripiprazole LAI consultants or specialist doctors are required to complete an aripiprazole referral form pdf (142k)