Supporting Realistic Medicine through the delivery of a Single National Formulary

1. Supporting Realistic Medicine through the delivery of aSingle National Formulary

2. Welcome

3. Today’s session In this interactive session, delegates will take part in group discussions to consider how to implement the new approach throughout Scotland by considering current practice and what will help facilitate the roll-out of the national formulary and how it can be embedded.

4. Realistic Medicine and the development of theScottish Formulary

5. What is Realistic Medicine?

6. Aims of Realistic Medicine

7. Benefits of the Scottish Formulary • Support the reduction of unwarranted variation in prescribing practice, reducing medicine harm and continuing to improve patient outcomes. • Help to achieve more equitable, greater value-based care so that the potential population benefit from medicines can be maximised. • Supports the principle that services and functions of the health service which can be delivered more efficiently at national level will be done on a ‘Once for Scotland’ basis

8. Current position 11

9. Defining the Scottish Formulary • How do the existing formularies describe themselves? “list of medicines approved for local use” “promoting high quality, safe and cost-effective prescribing” “evidence-based formulary ” “drug prescribing guidance” “provide appropriate treatment for the vast majority of patients” “based on local expert opinion and practice” “a tool to assist” “primary and secondary care”

10. Development approach Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter Business As Usual Arrangements Development Process Chapter Groups Evidence & Guidance Data Analysis IT Platform Comms & Engagement SMC Decisions Appeals Process

11. Development process

12. A consultant’s perspective on the Scottish Formulary

13. Scottish Formulary and the Scottish Diabetes Group perspective Brian Kennon Consultant Diabetologist, QEUH, Glasgow National Lead for Diabetes

14. SIGN 154: Diabetes • SIGN update on the pharmacological management of T2DM • Evolving evidence base • New class of agents • Several studies assessing CV outcomes

15. SNF within the wider context Aims of Quality Prescribing

16. Ensuring spending is effective…. 8% of medicines spend on DM

17. Guidelines & Clinical Practice Analogue Insulin use as basal insulin in T2DM

18. Potential Benefits of a SNF • Reduce variation across health board areas • Improve safety as complex area • challenging for specialists & non-specialists • Dynamic process • beneficial with rapidly evolving evidence base • Avoid unnecessary duplication of effort • 14 health boards often reviewing the same information • Potential to link in with procurement • maximise cost effectiveness

19. Scottish FormularyDiabetes and Endocrine John Chalmers Clinical Lead for NHS Fife Diabetes MCN

20. Management of Type 2 Diabetes: Fife 1988 • Newly diagnosed Type 2 Diabetes • Normal BMI • Obese • Metformin • Sulphonylurea • Combination of Metformin+Sulphonylurea • Insulin Professor IW Campbell Personal Communication 1988

21. SIGN 154 Scottish Intercollegiate Guidelines Network (SIGN). Pharmacological management of glycaemic control in people with type 2 diabetes. Edinburgh: SIGN; 2017. (SIGN publication no. 154). [November 2017]. Available from URL: http://www.sign.ac.uk

22. Gliptins • Vildagliptin • Sitagliptin • Saxagliptin • Linagliptin • Alogliptin • Gemigliptin • Anagliptin • Tenegliptin • Trelagliptin • Omarigliptin • Evogliptin • Gosogliptin • Dutogliptin https://en.wikipedia.org/wiki/Dipeptidyl_peptidase-4_inhibitor (Accessed 12/6/18)

23. Choice of Agent • Published Evidence • Meta analysis • CV Outcome Studies • Evidence of efficacy • SMC Guidance • Licensed Indication • Prescriber experience • Patient preference • Cost

24. Scottish Formulary: Diabetes and Endocrine • Chapter Lead • Chapter Development Group • Specialists • Endocrine, Diabetes, Bone, O&G • GPs, Nurses, Pharmacists • SMC, Industry, National Procurement • Effective Prescribing and Therapeutics Team

25. Scottish Formulary: Benefits • Patients: Consistent approach across Scotland • Non specialists • Medical Students • Trainees • “Cross-border” • Effective Prescribing • IT Platform

26. A GP’s perspective on theScottish Formulary

34. Group discussions

35. 13 25 9 30 29 28 27 End 1 2 3 4 5 7 8 6 24 23 22 21 20 10 18 17 19 15 14 26 12 11 16 Group discussions Time remaining: Minutes Which communication methods should be utilised when engaging with Board colleagues around implementation? (prioritise your suggestions) Which roles within your Board should we be directly communicating with regarding the implementation of the Scottish Formulary? (prioritise your suggestions) Which existing processes within your Board should we be considering as part of the implementation plans? (consider what happens now and what processes you feel will change when the Scottish Formulary is introduced) What do you feel are the key points to be considered in communications with patients around the Scottish Formulary? (prioritise your suggestions)

36. Feedback from group discussions

37. Thank you for your contributionKeep up to date at:http://www.therapeutics.scot.nhs.uk/SNF