Pan-London formulary project works to reduce health inequalities across the capital

A project led by the Medicines Optimisation and Pharmacy Procurement (MOPP) team at NHS London Procurement Partnership (NHS LPP) is paving the way to help reduce health inequalities across London boroughs.

The pan-London Medicines Formulary project launched in early 2021 in response to key priorities set out by the London Regional Medicines Optimisation Committee (RMOC) to improve prescribing across the capital, reduce unwarranted variation and ultimately improve the patient experience. To achieve these desired outcomes and work to reduce health inequalities, NHS LPP has developed and is delivering a pan-London medicines formulary through collaborative working across the formulary, commissioning and interface teams and clinical networks in each Integrated Care System (ICS).

The project aims to necessitate central leadership in order to drive work across organisational boundaries. As the membership organisation for London’s health economy, NHS LPP is positioned to help London NHS organisations work together to deliver positive patient outcomes.

Jas Khambh, Chief Pharmacist and Clinical Director at NHS LPP, said: “Covid-19 has highlighted some of the health and wider inequalities that persist in our society and the disproportionate impact on particular groups, so we are proud that our work with the pan-London formulary project will work to address some of these issues.

“The project has worked to meet the diverse needs and improve the lives of all adults living in London. With life expectancy on the rise, lengthening the potential time spent in poor health, it’s a great time to address health inequalities across the London boroughs. This project will enable more seamless care across ICBs through the standardisation of treatment choices across London, which will reduce health inequalities.”

The project was split into the below three phases:

  • Phase one: A pilot proposal focused on key clinical topic/areas with input from lead stakeholders from each ICS and regional systems. Consultation took place with stakeholders to establish the direction for this once-for-London work. The NHS LPP team met each ICS which was critical to understand individual system and patient needs.
  • Phase two: Two pilots commenced, which were:

- An ophthalmology formulary alignment. Due to concerns regarding patient pathways to access prescribed eye products and specialist engagement, an ophthalmology formulary was prioritised. Additionally, the volume and cost for ophthalmology prescribing were significant.

- A hospital-only medicines list alignment was identified as having a timely positive impact on the system and patients and therefore also prioritised. Working groups were formed which were facilitated by the NHS LPP MOPP team, and qualitative and quantitative measures were established to guide and inform the process.

  • Phase three: Formation of a hub and spoke model amongst the newly forming and established Area Prescribing Committees. The central group supporting this, called the London Formulary and Medicines Group (LFMG), was granted appropriate advisory authority via the RMOC (London) which was supported by lead ICS stakeholders.

Jas said: “To ensure this project achieved its key objectives, it was essential to have inclusive and collaborative involvement and engagement from relevant stakeholders, as well as patients and carers, and establish means to ensuring enhanced coordination for the initiative at a London Regional level.

“Throughout the project we’ve also had strong clinical leadership supporting good practice initiatives, which is essential to continue providing support to the medicines optimisation and formulary teams as the ICS footprint develops.”

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