NICE (National Institute for Health and Clinical Excellence, www.nice.org.uk) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. NICE guidance is based on the best available evidence of the most effective care, looking at clinical and cost effectiveness, and aims to ensure treatment is available equally across different regions (i.e. avoids so called ‘postcode prescribing’).
The Foundation Trust has a responsibility to implement NICE guidance to ensure patients receive the best and most appropriate treatment and that NHS resources are not wasted by inappropriate treatment.
Under the NHS Constitution, patients have the right to drugs and treatments recommended by NICE if their doctor thinks it is clinically appropriate. The statutory obligation is for NHS organisations to fund new drugs and treatments within three months of the date of issue, unless specifically exempted. However, access can vary in different areas with some patients waiting longer than others. The Department of Health wants to reduce this variation and is therefore reviewing the mechanisms for implementation used in different trusts. Ashford and St. Peter’s has a process in place to enable access to all NICE-approved medicines.
It is essential that members of the Trust Drugs and Therapeutics Committee discuss every medicine before it is used in the Trust in order to assess governance and safety issues. Many of the drugs are highly specialized and staff might require training and further guidance. We may also need to produce new information to explain the medicine to patients.
If a clinician wishes to use a NICE-approved medicine a request is made to the Trust Drugs and Therapeutics Committee, and approval (within the terms of the guidance) is automatic. At this point the medicine is added to the Trust main formulary list along with any specific local commentary.
All remaining NICE approved medicines are placed in one of two lists:
- NICE approved medicines not yet requested for use in the Trust (29/03/2019)
These are medicines that may be used in the Trust but have not yet been requested by a clinician and consequently have not been discussed at the Drugs and Therapeutics Committee. The reason for not yet using the medicine will always be clinical.
- NICE approved medicines for indications not currently treated in the Trust (29/03/2019)
The fact that a medicine appears on list a) or b) does not exclude it from being used in the Trust.
In some cases NICE recommends that certain drugs should not be used. In this case, these drugs may still be available on an individual basis via an individual funding request if exceptional circumstances exist. This decision rests with the relevant Primary Care Trust (PCT).
The formulary comprises a list of medicines which have been approved by the Drugs and Therapeutics Committee (DTC) for prescribing within the Trust.
The purpose of the formulary is to ensure evidence-based and cost-effective prescribing and provide information relating to drug use. All prescribing from within the Trust (i.e. in-patient, out-patient and FP10 prescribing) must comply with the formulary. Advice given to GPs with regard to drug treatment options must also be in line with Trust formulary recommendations. This will be monitored on an ongoing basis.