Managing medicines: NICE and RMOCs

Last updated: Sunday, July 11, 2021

The National Institute for Health and Care Excellence or ‘NICE’ produces guidance and advice to improve health and social care in the NHS in England. Most NICE guidance is also adopted in Wales.
NICE publishes many different types of guideline, but in this short introduction we will describe two types that pharmacists look at regularly:

  • Technology Appraisals (‘TAs’). These are recommendations following a review of clinical and economic evidence. Appraisals aren’t just concerned with medicines, but they are common subjects. Each TA commonly provides recommendations for one medicine for a specified condition, but sometimes multiple medicines for the same condition. In England, NHS organisations must implement a TA within 3 months of its publication. Essentially this means that the medicine(s) recommended in the TA must be added to the formulary and available to patients within that timeframe. However, exceptions are possible if it’s not likely that the organisation would ever use the medicine(s), e.g. mental health trusts would not be expected to add a medicine for kidney transplants to their formulary. NICE recommendations are summarised in the BNF, and there are also summaries for patients on the NICE website. You can read in detail how TAs are produced here. NICE produce TA guidance for most new medicines in England but not all. If no TA is available, organisations may need to review the clinical and economic evidence themselves and decide at a local level whether or not the new medicine will be available to patients.

  • NICE clinical guidelines are recommendations on how healthcare and other professionals should care for people with specific conditions. The recommendations are based on the best available evidence. They cover the use of medicines, but also other aspects and interventions such as education, prevention, surgery, and diagnosis. You can read more detail about how these guidelines are developed here.

The e-LfH platform has a group of learning resources about decision-making and evidence-based healthcare in the context of NICE guidance. It is aimed at medical students, but pharmacists may also find it helpful.

Regional Medicines Optimisation Committees (RMOCs)

There are four RMOCs in England (South, North, Midlands & East, London) which bring together decision makers and clinicians from across each geography. Although there are four committees, the RMOCs operate together as a single organisation and have a shared work programme. The RMOCs produce once-for-England guidance on a range of Medicines Optimisation topics for adoption by NHS organisations regionally and locally. You can read more about RMOCs, how they operate, their work programme and publications on the Specialist Pharmacy Service website.

Scotland and Wales

Note that in Scotland, an organisation called the Scottish Medicines Consortium (‘SMC’) has a national role in reviewing medicines. In Wales, there is the All Wales Medicines Strategy Group (AWMSG).

  • Does your formulary show all the medicines that have been approved by NICE? 

  • Find a medicine that has recently been recommended in a NICE TA, and ask a clinical pharmacist or formulary pharmacist how it was implemented at your hospital.

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