The North Staffordshire Joint Formulary (NSJF) has been developed jointly between North Staffordshire CCG, Stoke-on-Trent CCG, University Hospital of North Midlands NHS Trust, Midlands Partnership NHS Foundation Trust and North Staffordshire Combined Healthcare NHS Trust. It is applicable to all prescribers working within primary care or hospitals across North Staffordshire and Stoke-on-Trent.
The main aim of the Joint Formulary is to promote safe, effective and economic prescribing in both general practice and hospital. Use of the Joint Formulary will also help to ensure seamless prescribing for patients between Primary and Secondary Care, thereby reducing the confusion and possible errors that can happen when medications are changed.
Information and recommendations presented have been produced following consultation with local specialists and primary care colleagues and with others who have a particular interest and/or knowledge in specific areas of therapeutics. Each section of the Joint Formulary has been approved by the North Staffordshire and Stoke-on-Trent Area Prescribing Committee. The Joint Formulary is an evolving and dynamic document and it is regularly reviewed and updated.
Formulary Content and Layout
The therapeutic sections of the Joint Formulary are based on the chapters of the British National Formulary. Generic names have been used for most entries. The Joint Formulary is not designed to replace the BNF and prescribing information given is minimal. All prescribers should continue to refer to the current BNF for information on indications, dosage, side-effects, drug interactions and more comprehensive information on a wider range of medicines.
Medicines included in the Joint Formulary are categorised according to a traffic light system:
Medicines that can only be prescribed within Secondary Care.
Examples of medicines which fall into this category are:
Certain new medicines and new indications for older medicines where there is at present no experience of use in Primary Care.
Medicines or dressings not available or prescribable in Primary Care.
Where a medicine has been classified as Amber E, but an approved shared-care guideline is not yet available.
Amber medicines are further divided into 2 types:
AMBER E: Medicines which can be prescribed within Secondary Care, but are only considered suitable for prescribing in Primary Care under an approved shared-care agreement (ESCA) or Rationale for Initiation, Continuation and Discontinuation (RICaD).
This replaces Amber 1 on the North Staffs Formulary
AMBER: Medicines which can be prescribed within Secondary Care, but are only suitable for prescribing in Primary Care after specialist referral.
There is no need for approved shared care guidelines for medicines in this category.
This replaces Amber 2 on the North Staffs Formulary.
Medicines which can be prescribed in either Primary or Secondary Care.
These medicines have been reviewed by the New Medicines Committee and the Area Prescribing Committee and found not to be suitable for inclusion in the Joint Formulary. The reason for non-formulary inclusion may include:
Inadequate or weak evidence for efficacy
No clearly defined local need
Lack of long term safety data
No perceived benefit over established formulary alternatives Prescribers can consider these medicines where formulary alternatives are unsuitable, ineffective or not tolerated.
First choice medicines for certain therapeutic groups and any restrictions placed upon prescribing are indicated in the box after the medicine name. Where modified release preparations of a formulary drug are available a comment will clarify its status. Newly licensed modified release preparations of existing formulary drugs will remain non-formulary until a review is carried out and recommendations are published. All medicines which are approved via a NICE Technology Appraisal (TA) are incorporated automatically into the Joint Formulary within 3 months of the TA being published. NICE TA’s indicated are stated in the medicine information box. Any prescribing guidance issued by the Area Prescribing Committee is also included.
Unlicensed medicines, and licensed medicines for unlicensed indications (off-label medicines), are not routinely included in the Joint Formulary, however there are a small number of exceptions where it has been agreed by the Area Prescribing Committee that there is no licensed medicine available to meet a particular clinical need and an unlicensed or off-label medicine is currently the only treatment option. If a medicine is unlicensed or being recommended off-label this is indicated in the Joint Formulary. Prescribers of unlicensed and off-label medicines carry full liability for any adverse outcomes which may result of such prescribing. Prescribers are responsible for the patient’s welfare and in the case of adverse events may be called upon to justify their actions.
The formulary is expected to cover the majority of prescribing and it is estimated that it will provide clinically appropriate options for treating 80% of patients. All patients are individuals, however, and it is recognised that there will be some situations where prescribing outside the formulary may be necessary. In Secondary Care, consultants may initiate a non-formulary medicine only with the agreement of their Clinical Director. The form, Supply Request for a Non-Formulary Medicine, must be completed by the consultant and countersigned by their Clinical Director (or designated deputy). The completed form must then be attached to the patient's prescription chart before it is sent to pharmacy. Pharmacy are not authorised to supply a non-formulary medicine without this form. Forms are available on the Pharmacy section of the Hospital Trust intranet. Patients admitted to hospital on a non-formulary medicine may continue to be prescribed this medicine without completion of a form. When a non-formulary medicine has been initiated during an in-patient episode, the discharge letter should clearly indicate the reasons for this choice. In addition, reference should be made to the North Staffordshire and Stoke-on-Trent Area Prescribing Committee policy on Clinical and Prescribing Responsibility before initiating Red or Amber drugs during an in-patient stay. When a consultant considers recommending a non-formulary item following an outpatient consultation, the reasons for this choice should be clearly explained to the patient's General Practitioner. Reference should also be made to the North Staffordshire Area Prescribing Committee policy on Clinical and Prescribing Responsibility. Drugs classified as "Red" should not be recommended for prescribing in Primary Care. Drugs classified as "Amber" require either an approved Shared Care Agreement, or authority from the GP to continue prescribing. The patient should not be used as a method of communication in these circumstances.
Additions to the Formulary
Consultants or General Practitioners within the North Staffordshire and Stoke-on-Trent Health Economy may submit an application to the Medicines Optimisation Interface Pharmacist for their relevant organisation to have a preparation considered for inclusion in the Joint Formulary. Applications will be reviewed by the New Medicines Committee who will make a recommendation to the Area Prescribing Committee as to whether or not the new medicine should be included in the Joint Formulary. The Area Prescribing Committee will make the final decision.
The committee reviewing the application must be satisfied that medicines approved for inclusion in the Joint Formulary are more clinically effective or safer than existing formulary options. The reviewing committee will in addition consider cost-effectiveness. All supporting evidence should be referenced and at least 2 key references should be supplied with the application.
The Formulary application form and the Declaration of interest proforma can be obtained via the link on the home page.
Within Secondary Care the documents are available on the Pharmacy Section of the Trust intranet.
Feedback and enquiries on all aspects of the Joint Formulary are welcomed. Fill in the form via the Feedback tab on the home page.
Contact for UHNM formulary additions
Xin Wei Tan
Secondary/Primary Care Interface Pharmacist
University Hospital of North Staffordshire
Contact for Primary Care formulary additions
Staffordshire CCGs Interface Pharmacist
Medicines Commissioning Team.
North Staffordshire and Stoke Clinical Commissioning Group
Stoke on Trent
National Institute for Clinical Excellence (NICE)
British National Formulary (BNF)
Medicines and Healthcare products Regulatory Agency
Electronic Medicines Compendium
Every care has been taken in the compilation and publication of the content on our website. However, both the North Staffordshire and Stoke-on-Trent Clinical Commissioning Groups (and its constituent members) will not be held responsible for any loss, damage or inconvenience caused as a result of any inaccuracy or error within these pages.
Members of the Public
Please note that all material in the North Staffordshire Joint Formulary is aimed at healthcare professionals only. Members of the public seeking advice on any medicine-related matters are therefore encouraged to always speak with their doctor, pharmacist or nurse.
Links are provided for information and convenience only. The North Staffordshire and Stoke-on-Trent CCGs cannot accept responsibility for the sites linked to, or the information found there. A link does not imply endorsement of a site; likewise, not linking to a particular site does not imply lack of endorsement. Links to NHS member organisation policies or guidelines may not be accessible from all locations.
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