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Medicines Management and Optimisation

The use of medicines is the most common therapeutic intervention in the NHS. Around 15-20% of a commissioning organisation’s money is spent on medicines.

Medicines management is a term which encompasses all aspects of the supply, use and disposal of medicines.

Medicines optimisation is about ensuring that the right patients get the right choice of medicine at the right time. It aims to help people get the most from their medicines, take medicines correctly, avoid taking unnecessary medicines, improve medicines safety, and reduce wastage.

Effective medicines management and optimisation contributes towards:

  • Improved health of individuals and the population as a whole
  • Improved patient care and satisfaction
  • Reducing medication-related harm
  • Making best use of available resources
  • Making better use of professional skills
  • Delivering high quality, effective, safe healthcare


A formulary is a locally-developed document which lists the medicines that are deemed suitable for prescribing within the local NHS. It may also include some other products which can be provided on prescription e.g. dressings.

The formulary which is used within Birmingham and Solihull is the Birmingham, Sandwell, Solihull and environs Area Prescribing Committee (BSSE APC) formulary. The committee consists of representatives from primary care, the local hospitals, the providers of mental health care and community services.

Medicines that are included on the BSSE APC formulary are assessed by a committee of clinicians and medicines experts for their suitability for local use. The committee will generally consider medicines in terms of safety, clinical effectiveness, and cost effectiveness and patient factors. The commissioning organisation will also consider affordability.

All NICE-approved medicines (i.e. those with a positive NICE technology appraisal) are automatically included in the formulary.

Many medicines accepted for use will be prescribable by GPs, hospital doctors and other healthcare professionals who are qualified to prescribe, but some medicines will have local restrictions on their use. Some will be prescribable in limited circumstances, and some will only be prescribable in hospital settings. Some medicines won’t be included on the formulary at all. All prescribers are expected to take into account whether the medicine they intend to prescribe is on the formulary.

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