NHS trusts — drug and therapeutic centres

< Influencers contents | Print this page

Formulary management

Formulary management in NHS trusts is an important role carried out by hospital pharmacists. Joint formularies between primary and secondary care continue to be proposed. This is not a new idea and in fact goes back to the late 1980s.

Most prescribing in the UK occurs in primary care — probably around 85 per cent of the cost and volume of drugs. However around 20 per cent of GP prescribing is hospital-initiated and some 40 per cent is probably still influenced by hospitals. Despite this, primary and secondary care has traditionally produced separate formularies that can cause problems when patients transfer between the two. For instance, GPs may sometimes be reluctant to prescribe hospital-initiated treatment with which they are unfamiliar.

Joint formularies

For hospitals, so-called loss leaders and cost shifting continue to cause concern. The Lothian joint formulary in Scotland is often mentioned as an example of a joint formulary. Produced by the Lothian area drug and therapeutics committee, it lists first and second choice drugs for use in both primary and secondary care.

The role of primary care pharmacists and hospital clinical pharmacists in formulary implementation should not be underestimated. They play a key role in promoting joint formularies to their medical colleagues.