ABOUT THE BIRMINGHAM, SANDWELL, SOLIHULL AND ENVIRONS JOINT FORMULARY
The Formulary is being developed by the Birmingham, Sandwell, Solihull and environs (BSSE) Area Prescribing Committee (APC) with the aim of promoting safe, evidence-based and cost effective prescribing within the local community.
It is formatted in accordance with BNF chapter classification for ease of use and includes:
- Hyperlinks to e-BNF, e-BNFc and to the electronic medicines compendium which holds Summaries of Product Characteristics
- First and Second choices where possible to assist cost-effective prescribing
- Restricted medicines with approved indications and/or prescriber requirements
- Links to relevant local and national guidelines
Please note: patients should not make decisions on their treatment based on comments recorded in meetings but should discuss any concerns with their prescriber.
Key to Formulary recommendations
All drugs included in the Formulary are allocated a traffic light status. The traffic light status offers guidance on where clinical and prescribing responsibilities lie in regard to the initiation and maintenance of prescribing.
||Medicines suitable for routine use within primary care. Initiation and maintenance of prescribing by Specialists, GPs and other qualified clinicians.
||Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry.
||Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.
||Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry.
||Medicines for initiation and maintenance prescribing by Specialists only.
||Positive NICE TA and/or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information.
||Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use.
The term 'Specialist' refers to Consultants, General Practitioners and Independant Prescribers with a Specialist Interest.
The BSSE Formulary is not intended to be a static document. Requests for new medicines to be added to the Formulary may be made by Consultants, GPs and other appropriate senior clinicians within the BSSE health community. These are considered in line with the criteria outlined in the application form and based on the identified funding priorities within the health economy.
The APC will only consider applications which have been via the local approval process and signed by the Chair of the relevant advisory/decision making committee in secondary care. For primary care initiated drugs, applications will be via the CCG Medicines Leads.
Application forms and further details of the process are available by emailing firstname.lastname@example.org
This Formulary is currently under construction and will be populated as the BNF chapters are reviewed. Trust formularies should be referred to for chapters that have not been reviewed.
Representatives from Pharmaceutical Industry wishing to contact the BSSE APC can do so via the APC generic email email@example.com. This does not however guarantee an appointment for a meeting or telephone call.
Prescribing in children
The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.
The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.
Prescribing should be in accordance with the formulary. However, it is recognised in exceptional circumstances that a Formulary may not provide the most appropriate treatment for every patient or all clinical conditions. Patients who have been previously established on non-formulary drugs may normally continue with their treatment. A change to a formulary drug should only be considered where the patient will gain clinical benefit; for example, if the non-formulary drug is less effective or has poor adherence.
See also NHS guidance Items which should not be routinely prescribed in primary care. The BSSE APC have implemented this NHS guidance for the 18 “low value” treatments featured. See the individual formulary entries for further information. The guidance does not remove the clinical discretion of the prescriber in accordance with their professional duties.
Further information regarding processes for non-formulary prescribing are detailed in the APC Policy under Exceptional and Immediate Clinical Need (Section 3.5)
Ethical and religious implications of animal derived substances in medicines
Drugs with animal and human derived content are widely used in medicine and surgery across the world. However, information regarding the origins of specific ingredients is not always available to health practitioners. A religious/ethical perspective concerning the use of animal and human derived drug ingredients has not thoroughly been investigated. This article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220589/ from December 2013 demonstrates the breadth and complexity of this issue.
The APC accepts that individuals may wish to avoid using medication that is in any way derived from animal and human origin (or containing alcohol) in order to support their ethical or religious views. When this view is expressed to prescribers, they will seek to find a formulary product with a suitable formulation. However, it is important to note that often, suitable alternatives may not be available. Following discussion with their doctor/prescriber - the individual should then make an informed decision regarding their choice to take the prescribed medication or not.
Medicine formulations are subject to change, therefore the APC does not identify specific products as being suitable for individuals with any specific religious or ethical view.
Individuals may seek the advice of their local community pharmacist regarding the suitability of medicines.
Below are website links to BSSE APC member CCGs and Trusts.
The copyright protected material on this site may be reproduced free of charge in any format or medium. This is subject to the material being reproduced accurately and not used in a misleading context. References to and quotations of prescribing recommendations must faithfully reflect the meaning intended by the Committee. The wording used must be unambiguous and match fully and precisely with the context and content of the original recommendation. The source of any reference or quotation must be identified and wherever reasonably practicable supplied in its original form.