Select Committee on Health Minutes of Evidence

Memorandum by the British National Formulary (NC 3)

  The British National Formulary is intended for use by prescribers in the NHS as well as by pharmacists, nurses and other health-care professionals and it presents, in a readily accessible way, up-to-date key information on the prescribing, dispensing and administration of medicines. It is designed to provide clear guidance on the selection of medicines. All medicines that are generally prescribed in the UK are included and those that are considered less suitable for prescribing are clearly identified. The BNF reflects current best practice as well as legal and professional guidelines relating to the use of medicines.

  The BNF is a joint publication of the British Medical Association and the Royal Pharmaceutical Society of Great Britain. It is published under the authority of a Joint Formulary Committee which comprises representatives of the two professional bodies and of the Department of Health. The Departments of Health in England, Northern Ireland, Scotland and Wales receive BNFs for distribution, through local health authorities and trusts, to NHS doctors, pharmacists, wards and clinics. A small proportion of each edition is supplied for retail sales—for example, for use by private hospitals.

  The Joint Formulary Committee supports the aims and objectives of NICE and recognises that it fulfils an essential role by contributing to the prioritisation of resources. NICE guidance and the BNF can complement each other by providing health-care professionals with reliable, up-to-date and robust advice.

  Advice on appropriateness of a particular intervention needs to be couched in practical information (such as doses for different patients and warnings about the safe use of the product). The BNF provides this necessary context and also ensures that advice is consistent with advice on related products and on related conditions. This is particularly important as a NICE appraisal tends to relate to just one member of a group of similar products. NICE advice cannot be used in isolation.

  In the BNF, basic information about drugs is drawn from the manufacturers' product literature, from medical and pharmaceutical literature, from regulatory and professional authorities, and from the data used for pricing prescriptions. Advice on the therapeutic use of medicines and on the choice of drugs is constructed from clinical literature and reflects, wherever possible, an evaluation of the evidence. In addition, the Joint Formulary Committee receives expert clinical advice on all therapeutic areas, particularly those that are not yet supported by good evidence; this ensures that the BNF's recommendations are relevant to practice. Many individuals and organisations contribute towards the preparation of each edition of the BNF. Biannual publication allows the BNF to reflect promptly changes in product availability as well as emerging safety concerns and shifts in clinical practice. The current mechanism for constructing NICE appraisals does not allow such a responsive approach.

  All information published in the BNF is regularly vetted by three tiers of experts: the editors, the advisers, and the Joint Formulary Committee. BNF staff editors are pharmacists with a sound understanding of how drugs are used in clinical practice. The BNF uses over 50 expert clinical advisers (including nurses and dental surgeons) throughout the UK to help with the production of each edition. In addition to regular advisers, the BNF is always able to call upon other clinical specialists for specific projects. All this provides a more thorough and arguably more practical approach to providing clinical information than the limited "snapshot" that NICE provides.

  The BNF also works closely with a number of expert bodies that produce clinical guidelines. Drafts or pre-publication copies of guidelines are routinely received for comment and for assimilation into the BNF.

  BNF editors carefully process all NICE appraisals. Such processing includes carefully checking that the advice is consistent with the evidence presented, and more importantly, that it is feasible to apply the advice to clinical practice. Where appropriate, advice from NICE is summarised in the BNF and shown in a tinted panel. This allows BNF readers to learn about the advice in the context of their day-to-day clinical activity.

  On rare occasions, the Joint Formulary Committee has agreed to omit mention of particular NICE guidelines because of concerns about the quality of the advice. The BNF has identified a number of difficulties with NICE appraisals. Therefore, in summarising NICE advice, the BNF addresses any ambiguity (after discussion by the Joint Formulary Committee in the light of expert advice and after taking account of product licences). Furthermore, where there is disagreement on aspects of the advice, the BNF provides further information to ensure that clinical care is not compromised. For comparison of some examples of the advice provided by NICE and the BNF please refer to Appendix 1.

January 2002

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