Memorandum by the British National Formulary
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 salesfor 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.