Cluster page — medicines optimisation
Formulary adherence at PCN scale
Why adherence matters
Formulary adherence is the upstream lever for both cost and safety
The Joint Formulary is the ICB's single most important MO tool — it codifies the prescribing choices agreed between primary care, secondary care and the ICB medicines optimisation team for every indication. A PCN with disciplined formulary adherence reliably out-performs peer PCNs on prescribing cost, prescribing safety (because first-line agents have the most familiar monitoring profile) and prescribing complaint rate.
Driving adherence is mostly a workflow problem, not an education problem. PCNs that build formulary prompts into the EMIS/SystmOne prescribing template, run quarterly outlier audits, and feed back individually to prescribers consistently move first-line rates by 10–20 percentage points within 12 months.
Adherence workplan
What a PCN formulary programme looks like
- Quarterly outlier audit against ePACT2 and ICB comparator
- EMIS/SystmOne prescribing template aligned to formulary first-line
- Individual prescriber feedback for top 10 outlier items
- Switch programmes for legacy non-formulary high-volume items
- New-start auditing — track first-line rate for new prescriptions only
- Specialist letter triage — convert non-formulary recommendations where clinically equivalent
- PCN clinical meeting education slot on quarterly formulary updates
Adherence KPIs
Benchmarks
Frequently asked questions
Formulary adherence — FAQs
What is the ICB Joint Formulary?+
The single formulary agreed across primary and secondary care in an ICB footprint — defines first-, second- and third-line therapy by indication, restricted medicines, shared-care arrangements and exception process. PCN prescribing should align unless individual clinical exception is documented.
How is formulary adherence measured?+
First-line prescribing rate (proportion of new starts on the formulary first-line agent) and overall formulary alignment rate (proportion of all prescribing that sits on the formulary). Both benchmark against ICB peer-PCN comparator.
What drives non-adherence?+
Historic prescribing habit (legacy regimens carried forward), specialist letter recommendations not aligned to local formulary, patient-initiated requests for branded products, and locum/short-tenure prescribing without formulary visibility.
How do PCN pharmacists improve adherence?+
Quarterly outlier audit, embedded formulary prompts in the EMIS/SystmOne prescribing template, individual prescriber feedback, switch programmes for high-volume non-formulary items, and educational sessions at PCN clinical meetings.
Talk to our Service Development team
30-minute discovery call. We'll show you how BCS maps to your PCN's specific priorities.