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Delivering a Pan Birmingham Joint Formulary through the APC
We established a new Area Prescribing Committee (APC) for Birmingham and developed a Joint Forumulary to promote safe, evidence-based and cost-effective prescribing.
Historically there had been several attempts to have a unified joint formulary that would bring together acute and non-acute trusts to work together across the Birmingham health economy. MLCSU was commissioned to establish and provide secretariat support to a new Area Prescribing Committee (APC) and develop a Joint Formulary that harmonised three acute trusts and five non-acute trusts with the aim of promoting safe, evidence-based and cost-effective prescribing within the local community.
The process involved extensive engagement of executives and senior level representatives from the member CCGs, NHS trusts and other key stakeholders such as a patient and public representative, NHS England and local authority. Once a mandate had been obtained to facilitate the development of the Birmingham, Sandwell, Solihull and Environs (BSSE) APC, a task group was set up to lead on development of all processes and materials. This group was facilitated by MLCSU and included senior membership from CCGs and NHS trusts.
The group met six times between July 2013 and March 2014. The secretariat function was provided by a senior commissioning pharmacist and administrator and involved taking the minutes at meetings, producing various other documents as well as independent drug evaluations for new drug applications. The commissioning pharmacist also provided wider expertise on policies and NICE TA (Technology Appraisal) to support transparent and informed decision making processes. There were robust mechanisms for identifying the appropriate network of clinicians to engage with for each piece of work.
The BSSE APC has met monthly since June 2014 with excellent attendance and engagement, and considerable throughput of work. The result was a harmonised Joint Formulary available on the Net formulary platform with all 15 British National Formulary chapters now harmonised and published. The formulary website has had 119,000 visits to date.
Key decision makers are granted the opportunity to contribute to and co-produce new guidance. In addition, 39 Effective Shared Care Agreements (ESCAs) and 26 Rationales for Initiation Continuation and Discontinuation (RICaDs) documents have been revised and published to date. These documents support the safe transfer of prescribing from secondary care to primary care for the benefit of patients. As a result of feedback from members, we also facilitated access to APC documents via a cloud-based Sharepoint on Office 365.
After 10 years plus of being told that a single formulary for Birmingham was not possible, we finally managed to deliver just that – in fact a single formulary for Birmingham, Solihull and Sandwell. MLCSU added huge value to the process of setting up both the formulary and the supporting Area Prescribing Committee by co-ordinating all of the initial discussions, working up the documentation and processes and keeping everyone focused on the outcomes. They continue to play and important role in the APC, having been instrumental in its setup, by managing the routine administration of the committee and freeing up its members to concentrate on the business of the APC.
Mark DasGupta, Associate Director, Medicines Management, Birmingham CrossCity Clinical Commissioning Group
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