Formulary as an inclusive process

When I have spoken to clinicians about formularies and the formulary process, they all describe it as a secret society. That is strange and when you ask GPs they say it is a process which tells them what to do. And when you speak to pharmacists that say it is a well defined process which ensures that evidence based decisions are made. I am sure that when you ask the pharmaceutical industry they describe it as a hurdle that they struggle to influence in order to get a fair hearing for their medicine. Patients probably say that it is a mechanism for denying them access to medicines that might help.

How can everyone have such a different view? That is easy – few of them are actively involved. A comment heard a couple of weeks ago – the decision was made by a ‘couple of pharmacists and a tame GP’. I think that the comment was grossly unfair, but I would wouldn’t I, I was one of the pharmacists.

It had me thinking. Actually, although the membership of the committee may be 30, there was rarely more than 10 attending and there only needed 4 to be quorate. So they were wrong – two pharmacists, a consultant and a GP made it quorate and able to make a decision. A decision that affected 1,000 clinicians.
When CCGs share services it is possible that a committee covers 4m populations and affects 5,000 clinicians

In the new world of CCGs there are several important features:

  • The GPs are in charge
  • There should be greater inclusion of stakeholders
  • The CCG should be more responsive to patients/careers and members of the public.

So what it the right number of people to be involved in the decision?

There must be a better way? There is – talk to Richard at the MMP


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