Devon Partnership NHS Trust
Devon Partnership NHS Trust (DPT) provides services to the people of Devon excluding Plymouth. A health community-wide Prescribing forum was created to manage the introduction of mental health-related NICE guidance into practice. This was done involving representatives of the two commissioning PCTs, the mental health trust, GPs, psychiatrists, pharmacists and nursing staff.
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Aims and objectives
The aim of the Prescribing Forum was to provide a forum to implement the pharmacological elements of NICE guidance relating to mental health into local formularies.
- To identify differences in local formularies relating to mental health.
- To produce new guidelines based on NICE guidance which inform local formularies and provide consistency in approach across the county.
- To ensure all clinicians are stakeholders in the forum through widespread consultation and engagement with the guideline development process and implementation.
- To safely introduce new medicines to the care pathway in a way that places the individual at the centre of the process and not the bureaucracy.
Reasons for implementing your project
DPT was working with 4 local formularies (South Devon, Exeter, Plymouth and North Devon). The Plymouth Formulary was based on their services needs and not affected significantly by this work. Each one had a separate process for introducing new medicines and incorporating NICE guidance into local guidelines. Significant differences were identified in the various formularies relating to evidence of the implementation of NICE guidance and choice of medicines available to patients and prescribers. This was unsatisfactory and a new process was necessary. To expedite this and minimise the risk of postcode prescribing the Prescribing Forum was created. This had an obvious impact on reducing the burden on busy healthcare professionals attending multiple meetings to discuss the same workload and ensured an overarching strategy was developed across Devon for the introduction of NICE-based prescribing guidelines.
How did you implement the project
The Prescribing Forum met monthly with a clear work plan to incorporate NICE guidance into one set of guidelines that would inform local formularies.
The forum produced draft guidelines that were sent to all GPs and consultant psychiatrists for consultation and their feedback was acted upon accordingly.
The new guidelines were launched to primary and secondary care practitioners and formulary pharmacists updated their publications to reflect the changes.
The biggest barrier was in satisfying the two host PCT existing medicines committees of the forums ability to make sound evidence based decisions. This confidence was eventually earned and the work of the forum quickly gathered momentum. The actual costs were not measured however it is reasonable to assume that fewer man hours were spent in meetings developing these guidelines than would have been if separate formulary processes were performed.
We now have 7 prescribing guidelines implemented covering the pharmacological management of schizophrenia, depression, anxiety disorders, insomnia, dementia, behavioural and psychological symptoms of dementia and bipolar disorder. These incorporate more than a dozen separate NICE guidelines or TAGs. The process is locally held up as an example of true cross-sector collaboration and the standard of work produced the benchmark for future care pathway development in this area.
Key learning points
- Ensure a clear process for ratifying decisions from the outset.
- Establish a group that represents the views of mainstream practitioners and is professionally respected by their peers.
- Avoid rehashing work completed by other organisations that have assessed new medicines but rely instead on their reputation (e.g. UKMI, London New Drugs Drug, DTB).
- Expect the process to be difficult but always be patient and consistent with your approach.
Lead Clinical Pharmacist
Devon Partnership NHS Trust
Is the example industry-sponsored in any way?