The National Institute for Health and Clinical Excellence (NICE) is to produce a best-practice guide to help NHS trusts and clinical commissioning groups (CCGs) develop local formularies.

While local formularies have an important role in underpinning the safe and effective use of medicines there is currently no standard process or advice for putting together a local formulary, and this has led to variations across the country, says NICE.

Reporting on Sir Ian Carruthers' recent review of adoption and diffusion of innovation in the NHS, the Department of Health (DH) has pointed out that not all local formularies currently include all NICE technology appraisals, and this can lead to a postcode lottery where patients miss out on drugs approved by NICE. Also, in some cases, local formularies are duplicating NICE assessments and challenging appraisal recommendations, which acts as a barrier to the uptake of NICE-approved medicines, it adds. 

"Local formulary processes should not seek to duplicate NICE assessments or challenge an appraisal recommendation and must never act as a barrier to the uptake of NICE-approved medicines. Rather, they should be seen as supporting timely and planned implementation of NICE technology appraisals," the report emphasises.

"Formulary processes should proactively consider the impact of new NICE technology appraisals, and all NICE technology appraisal recommendations should - where clinically appropriate - be automatically incorporated into local formularies. This process should take place within 90 days to support compliance with the three-month funding direction and the NHS Constitution, ensuring that these medicines are available for clinicians to prescribe, should they choose to do so, in a way that supports safe and clinically-appropriate practice," it adds.

"NICE will embark on a specific piece of work to look at how local formularies are put together," said Dr Gillian Leng, the Institute's deputy chief executive. "At the moment, there is no standard process for them and there tends to be a lot of variation and inconsistencies across England."

The Institute will hold a workshop to develop the best-practice guide, and this will then go out to consultation before being published later this autumn, said Dr Leng. "NICE-approved drugs should not be excluded from local formularies on the grounds of cost. We want all patients to have access to medicines that we consider to be effective," she added. 

The DH also plans to introduce, within three months, a NICE Compliance Regime for the funding direction attached to NICE technology appraisals to ensure rapid and consistent implementation through the NHS.

In addition, to support the take-up of NICE guidance, the DH will establish a NICE Implementation Collaborative (NIC), bringing together the NHS Commissioning Board, NICE, the Chief Pharmaceutical Officer, the main industry bodies, the NHS Confederation, the Clinical Commissioning Coalition and the Royal Colleges. 

The DH report emphasises the government's commitment "to ensuring that NHS patients have access to clinically and cost-effective drugs and technologies, and that NICE appraisal guidance is promptly delivered throughout the NHS."

"There should be no local barriers to accessing technologies recommended in NICE appraisals, beyond a clinical decision relating to an individual patient," it adds.

- Last month, NICE signed an  agreement with publisher Elsevier to fund a national subscription to the online version of The Lancet via NHS Evidence, the online service provided by NICE. The three-year agreement will provide all NHS staff who have an Athens password access to the latest copies of The Lancet, as well as back copies from the last four years.

Dr Leng said the agreement represents a more efficient use of NHS funds, will save organisations money and open up online access for health and social care professionals to one of the world's most respected medical journals.

"Providing quick and easy access to the latest evidence to help professionals deliver high-quality care is a key responsibility for NICE, and we are delighted to have secured this agreement," she said.