Using the Formulary

The Sussex Partner Formulary is broken down into chapters, based on the categories used in the British National Formulary (BNF). It comprises a list of drugs recommended in each section. Each drug is colour-coded to facilitate prescribing decisions.

Before any treatment is recommended or initiated (in any healthcare setting), a patient centred discussion relating to the risks and benefits of treatment, and patient consent to the treatment plan must have taken place.  This should be documented in all clinic letters and / or patient medical record.

The prescriber should always ensure they have the expertise required prior to undertaking prescribing. In its guidelines on responsibility for prescribing between hospitals and general practitioners, the Department of Health has advised that legal responsibility for prescribing lies with the doctor who signs the prescription.

If you wish to make a formulary application to the Sussex Health and Care Partnership Area Prescribing Committee, please contact the SHCP APC secretariat for further information: sxicb.sussexapc@nhs.net

Green: items requiring non-specialist items

Initiation: Any care setting 
Repeat Prescribing: Any care setting  
Monitoring: Any care setting

Suitable for non-specialist initiation.

Purple: items requiring specialist recommendation or initiation WITHOUT shared care guidelines

Recommendation / Initiation: Specialist only
Repeat Prescribing: Any care setting  
Monitoring: Any care setting

The items are recommended or initiated by a specialist and primary care prescribers may continue to prescribe on specialist advice without the need for a Shared Care Protocol (SCP).  However, an information sheet setting out responsibilities may be available. Some specialist-initiated drugs require dose titration and/or specific ongoing monitoring.

A specialist is not necessarily a consultant, rather a prescriber with specialist skills e.g., specialist registrar, nurse specialist, GP with Extended Role, community psychiatric nurse, tissue viability nurse, pharmacist.

Primary care prescribers may be asked to take on additional monitoring once the patient has been stabilised on treatment by the specialist service.  Information on the initiation process and whether an information sheet is available will be detailed on the formulary entry.

Further clarification on Purple medicines with respect to supply requirements from outpatient clinics:

The default requirement for purple medicines is that they do not need to be initially supplied to the patient when they are recommended to a GP by a specialist prescriber. However, with some purple medicines there is a need for the patient to be stabilised on their new medicine, prior to GP prescribing. If this is the case, the need for initial prescribing and supply by a specialist will be specified on the formulary or in any accompanying information sheet. If medication is required on initiation, sufficient supply for the patient’s immediate needs should be made, at least up to the point where the clinic letter has reached the GP and the GP can then prescribe on an ongoing basis.

Amber: items requiring specialist initiation WITH shared care guidelines

Initiation: Specialist only 
Repeat Prescribing: Any care setting  
Ongoing Monitoring: Any care setting 

For items which require specialist initiation and/or dose titration and specific ongoing monitoring. Initiation may require the specialist to undertake dose stabilisation, initial monitoring and prescribe the item for the defined period set within the Shared Care Protocol (SCP) or until the until the patient is stabilised, after which, the primary care prescriber should receive the approved SCP request letter / handover document to safely continue prescribing the medicine. 

For all SCPs, primary care prescriber agreement should be requested by the specialist and confirmed/declined by the primary care prescriber on a patient-by-patient basis BEFORE the transfer of prescribing responsibility, in line with Regional Medicines Optimisation Committee (RMOC) guidance on shared care. 

Primary care will be expected to undertake some specific drug monitoring under the SCP.  Where monitoring requirements are complex, these will be defined in the SCP.  Responsibility for monitoring should remain with the prescriber.  NOTE: Not all AMBER classified drugs require significant monitoring and those that do, and are part of any LCS, will be clearly documented. 

A specialist is not necessarily a consultant, rather a practitioner with specialist skills e.g., specialist registrar, nurse specialist, GP with Extended Role, community psychiatric nurse, tissue viability nurse. 

Red: specialist ONLY items

Initiation: Specialist only  
Repeat Prescribing: Specialist only  
Ongoing Monitoring: Specialist only

For initiation and continuation (including monitoring) by a specialist only and the medicines supplied by a hospital or specialist setting for the duration of treatment.

A specialist is not necessarily a consultant, rather a practitioner with specialist skills e.g., specialist registrar, nurse specialist, GP with Extended Role, community psychiatric nurse, tissue viability nurse.

Mixed Status:

This is used where an item has a different status for different indications or geographical locations in Sussex.  See individual drug entries for more details. 

Not recommended: not routinely supported

Not recommended for use in any care setting across the Sussex Integrated Care System.  These items have been considered by the Sussex Health and Care Partnership Area Prescribing Committee as NOT routinely supported for initiation in any health setting for NHS patients.  If prescribers wish to initiate or are requested to prescribe an item which appears in this list, please contact the Medicines Optimisation Team.

Items are not recommended unless approved via an Individual Funding Request (IFR).  Clinicians can make a request to the IFR Panel for treatment to be funded by the NHS Sussex outside its established policies on one of two grounds, namely:

The patient is suffering from a presenting medical condition for which the NHS Sussex has a policy, but where the requested treatment has not been agreed to be funded under the policy (“An exceptionality request”)

The patient is suffering from a medical condition or clinical presentation for which the NHS Sussex has no policy or established treatment path which defines which treatment is funded for such patients (“A no policy request”)

For further details on the IFR process, please see here: https://www.sussex.ics.nhs.uk/nhs-sussex/policies-and-procedures/

This recommendation is not intended to affect treatment that was started in the NHS before the not recommended status was applied.  People having treatment outside this recommendation may continue without change until they and their NHS clinician consider it appropriate to review or stop. 

Non-formulary: items which do not appear in the Sussex Partner Formulary

Any items not listed in the Sussex Partner Formulary have NOT been considered by the Sussex Health and Care Partnership Area Prescribing Committee and are therefore NOT routinely supported for initiation / recommended for use in any care setting across Sussex Integrated Care System for NHS patients.

If prescribers wish to initiate or are requested to prescribe a non-formulary item, the SHCP APC would welcome a formulary application to be submitted.  Please contact the SHCP APC secretariat for further information: sxicb.sussexapc@nhs.net

Feedback

The NHS Sussex Medicines Optimisation Team are always happy to receive any feedback on the formulary.  We can also be contacted to obtain Blueteq logins and information on how to submit a formulary application. Please use the feedback button at the top of the page if you wish to contact the team in relation to the formulary.

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