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Cheshire and Merseyside Formulary Harmonisation

Background​

With the advent of the NHS Cheshire and Merseyside Integrated Care Board (ICB), there was a need to harmonise the legacy Cheshire and legacy Merseyside formularies. ​

ML Medicines Optimisation Team provides the secretariat for the newly established Cheshire and Merseyside Area Prescribing Group (CMAPG) and the five subgroups that feed into the APG. Previously, ML has provided the secretariat for the Pan Mersey Area Prescribing Committee and subgroups. ​

ML develop a project group with NHS Cheshire and Merseyside ICB and aligned five pharmacists from the ML team to support the harmonisation project.​

Action​

We developed a set of rules for the harmonisation to ensure consistency in BNF chapter review. Where an appropriate action was not clear, this would be escalated to a harmonisation working group.​

A paper describing the general process and rules, also defining when actions would be taken for review by the working group and how information would be reflected in the harmonised formulary, was agreed at CMAPG in August 2023. This was then presented to the ICB Clinical Effectiveness Group for consideration and approval to ensure support and buy-in from the ICB.​

This paper highlighted the next steps:​

  • Establish the working group governance, membership, and purpose ​
  • Produce draft formulary as chapter reviews are completed ​
  • Present finalised chapters to APG with summary of rationale ​
  • Publish completed formulary

Impact​

The working group membership was established to include pharmacists from primary and secondary care and from across Cheshire and Merseyside. The governance and purpose of the group were also been agreed.​

Spreadsheets were created for each BNF Chapter. These included the legacy Cheshire and Merseyside formulary positions plus an individual column for each matching rule. ​

Drugs that cannot be matched using the harmonisation rules can be extracted into reports for the harmonisation working group to discuss. Decisions made by the working group are recorded during the meeting.​

Where a decision cannot be made by the working group, both legacy positions will be recorded in the new harmonised formulary until the full formal chapter review is carried out by the Formulary and Guidelines subgroup. The formal chapter review will take place as soon as possible after a chapter is harmonised. ​

The team identified further harmonisation rules as the project continued and the working document was updated accordingly.​

Colleagues working on the harmonisation of two historic formularies within Cheshire and Merseyside have undertaken significant work in terms of planning, system consideration, engagement, and delivery of work to date. The team have been flexible in their approach, welcomed feedback with a focus and commitment to get the job done and to deliver the best outcomes for patients, clinicians and the system. The task has not been simple but the commitment, teamwork and leadership within the team has been excellent.​

​

Susanne Lynch, Chief Pharmacist​
NHS Cheshire and Merseyside​