How to use the Joint Formulary

The Gloucestershire Joint Formulary has been developed in agreement with Gloucestershire Clinical Commissioning Group, Gloucestershire Hospitals NHS Foundation Trust, and Gloucestershire Health and Care NHS Foundation Trust.

Layout

The chapters appear in the same order as the BNF. Where appropriate, local and national guidelines are included; please ensure only guidelines relevant to your sector of work are followed.

Searching for individual drugs

Individual drugs can be located using the search, which will identify which chapter(s) the drug appears in. Once on the relevant chapter, either scroll down to find the drug or click 'Ctrl' and 'F' and type the drug name.

Classification

Formulary approved drugs have been separated into the following categories according to effectiveness, safety and cost:

• Recommended: First-line choice
• Alternative: To be used if there is a good reason why the first-line choice is unsuitable (e.g. contraindicated, not tolerated, not effective etc.)
• Specific Indication: Drugs that may only be used in specific situations

Colours

• RED – Hospital / Specialist only
  • only a specialist team prescriber should prescribe, and remains responsible for making arrangements for ongoing prescribing and supply.
  • Gloucestershire Specialists should not request RED drugs to be prescribed by prescribers in primary care.
• AMBER – Specialist initiated / advised (with Shared Care Guideline (usually requires more complex or frequent monitoring))
  • Should usually be initiated and titrated (according to the SCG) by the specialist team before shared care is requested and considered by the primary care prescriber, who can then choose to accept prescribing responsibility and arrange appropriate ongoing prescribing and monitoring, as per the agreed shared care guideline.
  • The responsibilities of reviewing & monitoring will be described in the SCG.
  • A Primary Care Prescriber may occasionally be prepared to initiate prescribing on the advice of the specialist (continue using the shared care guideline), if clinically suitable to do so based on their own knowledge and agree to work through the titration and initial monitoring responsibilities.
  • Amber Status clarifies responsibilities while improving medicine access and patient convenience, for appropriate specialist-initiated medicines which can be managed in primary care when accompanied by access to ongoing specialist support via shared care.
• YELLOW – Specialist initiated / advised (without Shared Care Guideline (usually requiring no special monitoring))
  • GP/primary care prescriber may commence prescribing of yellow medications if satisfied to prescribe, following specialist recommendation.
  • The main emphasis of yellow is to ensure specialist input.
  • Monitoring tends to be less complex than amber medicines.
  • Yellow provides a position for less-complex medications used where specialist recommendation is required to be initiated in primary care to drive improved access to appropriate medicines.
• GREEN Any appropriate prescriber can initiate prescribing of a “green” medication if clinically appropriate and within their clinical competence.
• Treatment Guidelines – please ensure only guidelines relevant to your sector of work are followed