This formulary has been developed and reviewed by the NHS Somerset Medicines Management team, in liaison with Secondary Care NHS Trusts.
It is intended to guide evidence-based and cost-effective prescribing across Somerset. Key points to note with regard to the formulary are:
- It is intended to only cover first and in some cases second-line drug choices (other than where stated) in uncomplicated patients.
- It is expected that practices will find the options provided are appropriate for the treatment of most new patients.
- It is acknowledged that patients who are intolerant / unresponsive to formulary drugs, may require alternatives which are non-formulary.
- It is anticipated that medication reviews will provide an opportunity to transfer appropriate patients from non-formulary to formulary drugs.
- New products will by default be non-formulary initially and prescribers are thus asked to refrain from prescribing new drugs until they have been assessed and approved for addition to the formulary either by the Somerset Prescribing Forum or the Prescribing and Medicines Management Committee.
- Drugs which are classified as amber under the Somerset Traffic Light System are not generally included in the formulary. They should be initiated by (or on the advice of) an appropriate specialist. There may be arrangements for Shared Care.
- The formulary is primarily aimed at prescribing for adults, guidance on prescribing for children can be found on our medicines used in childhood webpage and BNF for children.
- Full prescribing information about products in the formulary is available in the BNF, available online or as an app for many mobile devices.
It is acknowledged that to be effective the formulary needs to be accessible and thus an electronic rather than paper format is preferred by many. To aid decision support at the point of prescribing, this formulary will therefore be made available on general practice clinical systems. It is expected that this formulary will then be set as the default for all users within practices, including partners, retained doctors, locums and non-medical prescribers.
The formulary will be reviewed at approximately six-monthly intervals, taking account of emerging evidence, product availability, and pricing. Prices quoted in this edition are taken from the most recent editions of the Drug Tariff and MIMS monthly price list.
There are often cost-effective alternatives to pharmaceutical specials, including crushing tablets or prescribing licensed liquid preparations of similar medicines. Guidance on the use of pharmaceutical ‘specials’ is available on the Medicines Management website. Prescribers may also contact the Prescribing & Medicines Management Team with any queries.
Drug monitoring: We recommend this collaborative document for suggestions on the monitoring of certain drugs.
Drug interactions: The BNF provides a good guide to drug interactions.
By rationalising the choice of drugs prescribed in Primary Care through adoption of the formulary and by improving liaison with Secondary Care, it is hoped that prescribing across the Somerset health community can become more rational, cost-effective and seamless. In further support of this objective, the Out of Hours formulary is reproduced as an appendix to this document, and the Palliative Care handbook can be found here.
NHS Somerset Medicines Management Team