NB. This Formulary is currently under construction and will be populated on a phased approach , as the BNF chapters are reviewed. The following Chapters are now live-Gastrointestinal, Cardiovascular , Infections , Respiratory, Endocrine, Musculoskeletal and Joint diseases , Skin ,Anaesthesia , Palliative Care ,Central Nervous System (CNS) and Ear, nose and oropharynx. For all other chapters, please refer to Trust/Place legacy formularies via the links below:
Royal Wolverhampton NHS Trust and Wolverhampton Place
The Dudley Group NHS Foundation Trust
Joint Walsall Formulary
Sandwell Place
Sandwell and West Birmingham NHS Trust
Welcome to the Black Country Joint Formulary. This formulary is being developed by the Black Country Integrated Medicines Optimisation Board (BC IMOB) with the aim of promoting safe, evidence-based and cost effective prescribing within the System. Choices are based on clinical evidence, safety and cost-effectiveness. The formulary aims to provide information on the medicines recommended for prescribing within the Black Country ICB .It is formatted in accordance with BNF chapter classification for ease of use.
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.
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Description |
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Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications |
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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. |
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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. |
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Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a specialist. |
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Medicines for initiation and maintenance prescribing by Specialists (hospital or GPs with Special Interest) only |
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Positive NICE TA and /or awaiting local clarification on place in therapy; Please contact your Medicines Optimisation team for more information. |
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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 Independent Prescribers with a Specialist Interest.
Prescribing in children
The BC IMOB 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 BC IMOB 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.
Exceptional Circumstances
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.
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 BC IMOB 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 BC IMOG 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. |
