ABOUT THE FRIMLEY HEALTH FORMULARY
This formulary is for use by prescribers across Frimley Health.
The development of the formulary has been overseen by the Frimley Health Area Prescribing Committee and choices are based on clinical evidence as well as primary and secondary care opinion. The formulary aims to provide information on medicines available to prescribers in Frimley Health, reflecting safe, evidence-based, cost-effective choices.
The Formulary is not intended to be a static document. If you would like a drug to be considered for inclusion in the Formulary please email mohammed.asghar@.nhs.net for a copy of the New Medicine Submission Form which you should then fill in
· Searchable by medicine name / class / condition or BNF chapter/subsection
· Hyperlinks to BNF, children’s BNF and to the <span "="">electronic medicines compendium which holds Summaries of product Characteristics
· First-line and Second-line choices shown where possible to assist cost-effective prescribing
· Restricted medicines show approved indications and/or prescribers
· Traffic light status displayed
· Links to relevant local and national guidelines
· Feedback section for users – send us your comments!
· Frimley Health NHS Foundation Trust
. North East Hampshire and Farnham CCG
. East Berkshire CCG
. Surrey Heath CCG
Traffic Light System for Drug Classification
It is intended that this system will provide guidance on the use of medicines across the interface between primary and secondary care. It provides a framework for defining where clinical and therefore prescribing responsibility should lie through categorisation of individual drugs.
For specialist use in secondary care on the grounds of one or more of the following:
. Only available in hospital: those drugs, dressings or appliances which are not available or prescribable in general practice or require special home care packages.
. New classes of drugs and new indications for older drugs: where clinical experience is limited in general practice.
. Clinical trial drugs: which are being used in the hospital.
. Medicines that require preparation by the hospital pharmacy: unless an acceptable procedure for supply through a community pharmacist can be arranged.
. Drugs being used outside licensed indications that are not in common usage and/or doses.
. Unlicensed drugs, in certain cases.
. Complex monitoring & specialist drugs: patients attending the hospital frequently for complicated treatments and specialist investigations with the consultant monitoring progress.
Amber with shared care
Prescribing to be initiated by a hospital specialist but with the potential to transfer to primary care when:
. an individual GP has agreed to accept clinical responsibility for an individual patient.
. agreed shared care arrangements have been established and the GP is willing to take over shared care.
. the patient’s condition and/or treatment has been stabilised.
. In one off situations, a specific GP can agree to enter into a ‘shared care arrangement’ without a formal shared care guideline providing a letter is sent to the GP giving appropriate advice and guidance.
. The request is accompanied by a written proposal that the GP is happy to accept.
This may take the form of a shared care guideline or other written communication. For a drug that is regularly transferred from secondary to primary care then a formal shared care protocol should be set up, however for a one off arrangement with one GP then a letter containing appropriate advice and guidance should be sufficient. The key principle is that the GP is provided with the information and given the opportunity to accept prescribing responsibility before the transfer takes place. These drugs should be initiated and prescribed by a secondary care specialist until the patient is stabilised on treatment in order to monitor the patient’s response, adjust dosage and treat side effects. Once the patient is stabilised the GP can be asked to agree shared care.
Amber without shared care
Drugs that in principle are in the amber category but GPs are generally happy to prescribe on specialist advice without the need for a formal shared care agreement. A minimum of one month supply of medication will be provided by the initiating consultant.
If the GP feels unable to accept prescribing responsibility for a drug in the amber category then clinical responsibility for prescribing that drug rests with the consultant.
These are drugs that can be initiated and continued in primary, secondary or tertiary care.
By default any drugs not listed under red or amber should be considered green.
The list is advisory only but is intended to clarify expectations of prescribing responsibility. Frimley Health NHS Foundation Trust Primary/Secondary Care Interface Prescribing Committee will review the status of the red and amber drugs on request. Any request from clinicians for transfer from the red to amber category must be accompanied by a shared care protocol. When new drugs are added to FH formulary at the Area Prescribing Committee the category the drug falls into will be specified. Drugs when used outside the terms of the product licence will also need to be classified appropriately hence some older drugs will be listed. This list will be reviewed annually.
A lot of medicines initiated by the paediatricians in secondary care are unlicensed but their use is medically accepted practice. Providing that the drug, indication and dose is included in the Children’s BNF, a formal shared care protocol is not required in order for the transfer across to primary care to take place.
Much prescribing in palliative care is unlicensed but is considered medically accepted practice. Providing that the drug, indication and dose is included in the Palliative Care Adult Network Guidelines ( https://book.pallcare.info/ ) or the Berkshire Adult Palliative Care Guidelines Best Practice Document (Chapter 1: Pain, Chapter 2: Other symptoms https://bit.ly/2WNnMS9 Chapter 3: End of Life Symptom Control https://bit.ly/2vYNUh9 ) then such use is accepted practice within the Frimley Health Formulary.
Some of the drugs, used for specific indications, which are included in the traffic light system are initiated only by tertiary centres. These drugs have not been classified as either red or amber. If a shared care protocol is already set up at the tertiary centre for the drug then transfer across from the tertiary centre to primary care is appropriate providing that the request is accompanied by a written proposal and the GP is happy to accept.
The hospital drug and therapeutics committee makes decisions on which drugs should be included on the hospital formulary using evidence-based medicine. When a patient sees a consultant all relevant therapeutic options may be discussed. In rare instances it may be
felt that a drug that is not on the formulary is the most suitable therapy for a particular patient. Where possible this should be agreed and supplied through the hospital pharmacy using the formulary exception form. A consultant may recommend a non-formulary drug to a GP but needs to give a clear explanation as to why this drug is being recommended instead of a formulary alternative. The GP is free to accept or disregard this advice.
NICE TA compliance
A list of NICE TA compliance can be found here
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Members of the Public
Please note that all material in this site is aimed at healthcare professionals. Members of the public seeking advice on any medicine-related matters are encouraged to speak with their GP, pharmacist or nurse.
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