The Formulary consists of medicines, which have been recommended by the Joint Formulary Committee in conjunction with Consultants, GPs and other prescribers.
The contents of the formulary are supported by:
Sunderland Clinical Commissioning Group
City Hospitals Sunderland
Northumberland, Tyne and Wear NHS Foundation Trust
The range of medicines included in this formulary is intended to encourage safe, effective and economical prescribing. Having a common range of medicines available for use in the Sunderland area should help enable safe and effective transfer of prescribing from secondary to primary care. This should facilitate continuity of treatment and minimise supply problems. These medicines are routinely available to prescribe within the Sunderland health community, but the use of some may be restricted to particular specialities for safety reasons. Medicines in the formulary are listed in chapters and subsections that generally correspond with those in the legacy British National Formulary (BNF).
Where appropriate the formulary gives information as to which drugs are regarded as being the first choice and alternatives. However, it is not intended to be a comprehensive prescribing guide or to replace the BNF or BNF for children. Where no ranking of drugs is stated, products are listed alphabetically. Products are flagged to indicate if they are designated as hospital only (‘Red’), suitable for shared care (‘amber’), or ‘green plus’ (see table 1 below for definitions of “RAG” status). Drugs not identified in the formulary by a red, amber or green+ symbol are classified as green, and may be freely prescribed in primary care. Hospital doctors should not ask GPs to prescribe hospital only medicines (‘red’ drugs) unless there is a very exceptional reason and agreement with the GP.
Recommended International Non-proprietary Names (rINNs) are used throughout the text, but proprietary names are used for some combination and modified release products, where brand name prescribing is recommended, or to clarify which product is listed.
REQUESTS FOR PRODUCTS TO BE INCLUDED IN THE FORMULARY
Requests for products to be added to the formulary must be approved by the Joint Formulary Committee. Requests must be made by a consultant, general practitioner, or other appropriate senior professional, e.g. CCG Pharmaceutical advisor, dentist, optician, senior dietician and non-medical prescribers. Wherever possible the request should be submitted electronically by email. A copy of the form ‘Application for a new product to be added to Sunderland Joint Formulary’ can be found on the Joint Formulary website and also on the CHS intranet page under ‘Joint Formulary Committee’.
PRESCRIBING NON-FORMULARY DRUGS
All prescribers in primary and secondary care are strongly encouraged to prescribe drugs included in the formulary wherever possible. The formulary is designed to meet the needs of the majority of adult patients. There will be instances where prescribing outside of the formulary will be necessary and appropriate. The justification for prescribing non-formulary drugs should be documented in line with CHS/CCG arrangements. Data regarding formulary compliance will be monitored and feedback will be given to prescribers. Following the initial launch of the joint formulary, data will be collected over a six month period with regards to non-formulary prescribing. Feedback will be given at the end of the data collection period.
UNLICENSED MEDICINES AND USE OF MEDICINES FOR UNLICENSED INDICATIONS
This formulary contains a number of unlicensed medicines, and medicines that have been approved for unlicensed or ‘off-label’ indications. Many unlicensed medicines are formulations of well-established drugs that are included the BNF, whereas others are products that are less well known, but considered to be of benefit in the treatment of patients with conditions where licensed medicines cannot be used or fail to produce an adequate response.
Unlicensed medicines included in the Formulary are marked using the notation U.
When prescribing an unlicensed or a licensed product ‘off-label’ for an unlicensed indication it is important prescribers are aware that it is not only they who take on additional responsibilities regarding the patient’s safety and welfare, but the burden is shared with others involved in supply and administration.
While further information and guidance can be obtained from the GMC website, or the CHS Intranet page for CHS clinicians, prescribers are reminded of the following when prescribing unlicensed or off-label licensed products:
• The clinical and/or pharmaceutical benefits, not cost, must outweigh the potential risks of treatment and be justifiable.
• They should not be used if there is an equally appropriate licensed medicine that would meet the patient's needs.
• Patients, their carers and/or healthcare staff should be given sufficient information to use the product correctly and safely (manufacturer’s information leaflets may not be adequate when a medicine is used for an unlicensed indication).
• Where common practice is not being followed, the reasons for prescribing the medicine should be recorded. Documented patient consent should be obtained in high-risk situations.
NICE approved treatments
All medicines recommended for use in NICE Technology Appraisals are included in the Sunderland Joint Formulary where appropriate.
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