Lancashire and South Cumbria ICB Formulary Development

A new formulary for Lancashire and South Cumbria ICB

The Lancashire and South Cumbria Medicines Management Group has formed a Lancashire and South Cumbria Formulary Group (known as the ‘Formulary Group’) and is undertaking to combine the following legacy Lancashire formularies to produce a single Lancashire and South Cumbria ICB formulary:

• Morecambe Bay Joint formulary
• Central Lancashire formulary
• ELMMB formulary
• Cheshire and Mersey formulary (formerly Pan Mersey formulary; West Lancashire)
• Fylde Coast formulary

Primary and secondary care clinicians based in Lancashire and South Cumbria that would like to be involved in the formulary development process should contact mlcsu.medicinesmanagement@nhs.uk with their expression of interest. Attention should be paid to the dates in the following table (also see below) when it is expected the listed clinical specialities will be discussed. A member of the formulary development team will be in touch to discuss your expression of interest as soon as possible. 

Any general queries about the formulary development process should be directed to: mlcsu.medicinesmanagement@nhs.uk. Please mark your email with 'Formulary development' in the subject line. 

Development process

The Formulary Group will oversee the development process which will be completed in the following eight stages (click on each link for further detail):

Stage 1 - Clinical chapter prioritisation

Stage 2 - Cross referencing medicines between legacy formularies and LSCMMG and assigning drugs to a category

Stage 3 - Processing 'Matched' list

Stage 4 - Processing 'Moderate discrepancies' list

Stage 5 - Processing 'Major discrepancies' list

Stage 6 - Upload medicines to Net Formulary

Stage 7 - Finalise formulary additional content

Stage 8 - Finalised chapter presented to the Formulary Group for final approval. 

The terms of reference for the formulary group can be found here and in the document library at the bottom of this page. It is expected that the formulary development process will run to the following schedule:

The formulary alignment process will follow these eight stages: 

Stage 1

Choice of formulary chapter – based on spend/prescribing levels.

Chapters already prioritised (in order) are:

1. Cardiovascular
2. Gastrointestinal
3. Respiratory

A ‘clinical specialist group’ will be identified for each chapter and approached to collaborate on producing the formulary. The clinical specialist group will include specialist clinicians, NHS Trust, and primary care representatives, including GPs.

Stage 2

When the BNF chapter has been identified the relevant section for each legacy formulary will be cross referenced and compared with position held on LSCMMG. GMMMG and Pan Mersey positions will also be checked but for information only.

Four lists of drugs in the following categories will be produced:

1. Matched
2. Minor
3. Moderately matched
4. Major discrepancies

Summary of list categories and associated processes  

Stage 3

The first list to be produced will be the ‘Matched’ list. These drugs will be those matched across formulary i.e., listed with same RAG ratings across all formularies or where there are minor adjustments required to allow alignment across formularies. 

These drugs will be eligible for adoption without further agreement as no new RAG position is being proposed.

Medicines identified at this stage can be added to the new Lancashire and South Cumbria ICB Net Formulary site.

Stage 4

The second list will be for drugs with ‘Moderate discrepancies’ across formularies.  This includes drugs that:

• May have a different RAG rating in a maximum of one area but there is universal agreement across all other formularies. 
• Have RAG ratings that are aligned but additional indications, qualifying criteria, localised text, etc listed.
• May simply not be listed in one region.

Drug in this list will be split into the following categories:

• Those where inconsistencies are expected to be:
  1. oversights,
  2. historic or
  3. simple omissions

An online ‘Microsoft Form’ will be developed for each of these drugs and a virtual consultation will be held (two-week deadline) with clinical group members. Responses will be presented to the clinical group identified for the chapter.

• Those where inconsistencies are considered minor, as above, but clarification via email would be preferable. A two-week deadline for responses will be imposed.

It is expected that following consultation drugs in this category can be assigned to one of the two following lists:

• Drugs that can be added to the matched list and can follow the ‘Grandfathering’ process – see ‘Stage 3’ OR
• Drugs that will fall into the major discrepancies category and will require discussion at the clinical specialist group – see ‘Stage 5’.

Stage 5

‘Major discrepancies’ will be discussed at a meeting of the clinical specialist group. However, if this is not possible, email correspondence with members will be used – see ‘Stage 4’.

A meeting of the clinical specialist group will be scheduled.  This group will include representatives from all regions and will include:

• General Practitioners,
• Specialist physicians and clinicians as appropriate,
• Hospital and practice-based Clinical Pharmacists,

The primary aim of the meeting will be to discuss each of the major discrepancies and reach a majority consensus. Meetings will be held via Microsoft Teams preferentially.

To assist with this, drugs in this category will be tabulated to show where differences have been identified and, where possible, additional context will be added to provide a greater understanding of differences across the region.

If the clinical specialist group cannot reach a decision, the ‘Formulary Group’ will be presented with an outline of the issues raised plus a recommendation. Where the Formulary Group feel able to decide about a discrepancy, then this decision will be accepted as final. 

By exception, if the Formulary Group feel unable to decide, the discrepancy will be discussed at LSCMMG using current procedures (usually New Medicines review or RAG change review process). These procedures are available here.

Once a final decision has been made for all medicines at this stage they can be added to the new Lancashire and South Cumbria ICB Net Formulary site.

Stage 6

All medicines matched or a position agreed at this stage, if not already done so, will be added to the new Lancashire and South Cumbria ICB Net Formulary site.

Stage 7

The Lancashire and South Cumbria Net Formulary site will be refined and relevant and current guidance present on the legacy formulary sites will be incorporated into the single formulary.

Representatives from each of the four Lancashire and South Cumbria legacy formulary committees who were previously involved in producing information uploads will be sought to provide context and rationale for each information upload section.

Stage 8

The draft Net Formulary chapter will be presented at the Formulary Group for ratification and final approval.

Sections of the formulary will be made ‘live’ on the Net Formulary site as they are completed and as agreed with the ICB chief pharmacist and representatives from legacy formulary committees.

Formulary Group document library