Using the Formulary

1. Therapeutic Sections
These include which medicines that are recommended for use. These are classified green (on formulary and preferred), yellow (on formulary and second line), purple (on formulary and third line), orange (specialist initiation), red  (secondary care only) and Grey (Not approved for formulary/not recommended). Information on medicine choice and links to other websites are included, e.g. NICE, MHRA etc.

2.K&M  ICB Guidelines

Includes local Kent and Medway ICB primary care, but not exclusively, orientated prescribing guidance and information. Other items found here could be shared care protocols, High cost Drug manuals, Care home information and general shared information from the K&M ICB information related to medicines and prescribing.

3. Acute Trust Guidelines

Includes local secondary care trust orientated prescribing guidance. Each trust has a dedicated page for trust specific guidelines. Just click on the appropriate trust to take you to their page.

How to locate a medicine or keyword

1. Type the name of the drug or word into the search box on the top right of the screen. This will give the chapter(s) in which the drug/keyword is listed. OR

2. Click on the therapeutic sections button on the left hand side of the home page to reveal BNF chapter headings. Then click on the relevant chapter which will display the drug groups in that chapter then click on the relevant drug group.

3. To find a drug or keyword mentioned within a PDF document, search as for 1, then click the documents option and re-click on search.

Colour status'

In most cases, the dominant colour status across the five formularies has been taken forward into the new Kent and Medway Joint Formulary. There will be changes so please take time to familiarise yourself with the colours. You will find on the bottom of each page a colour key that displays the prescribing status of every item on the formulary.

For medicines that may appear to have changed status in particular from RED - Secondary care only to AMBER - Specialist initiated, please note the following. There is no expectation that all patients receive transfer of care instantly and this will be a process to make treatment more accessible for patients across Kent and Medway, patients should be stable before any change is made to the prescribing of medicines with clear communication of the ongoing treatment plans. The same applies for medicines that were GREEN – on formulary and is now a different colour AMBER – Specialist initiated. There is equally no expectation to refer these patients to secondary care or to switch the patient to an on-formulary option.

Green, yellow and purple

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

Amber

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

Amber with Shared Care

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

Specialist initiation

These medicines are recommended or initiated by a specialist and primary care prescribers may continue to prescribe on specialist advice.

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. Monitoring of either medicine or disease does not necessarily require specialist skills or equipment. It may be appropriate that:

• The medicine should be prescribed by a relevant specialist as per the shared care protocol (if one exists), with monitoring of effectiveness and toxicity, until treatment is stable at which point the patient can be transferred to their own GP. A shared care icon will be present for such medicines.
• It is reasonable for a GP to write the first prescription after discussion with a relevant specialist clinician.
• It will be reasonable for some of these medicines to be initiated by prescribers from more than one speciality.

For medicines that require a shared care protocol please see here for more detailed information.

Red

Initiation: Secondary care only  
Repeat Prescribing: Secondary care only  
Ongoing Monitoring: Secondary care only

If an item is marked as secondary care only this means it can only be prescribed by and received from a secondary care provider such as a hospital trust, this may include inpatient and outpatient prescribing. The trust will be able to provide information about the prescribing of the item and how it can be accessed. These drugs can not be prescribed within primary care.

Non Formulary Prescribing

It is important that prescribers recognise the considerable cost implications of prescribing non-formulary drugs and the likelihood that funding may be required for some expensive drugs. The medicines included in this formulary have been selected on the basis of clinical effectiveness, cost effectiveness and patient acceptability. 

Unlicensed Medicines

Prescribing of unlicensed medicines should usually remain the responsibility of the clinician initiating treatment. The Trust will accept responsibility for the continued supply. GP's are not obliged to continue prescribing of unlicensed medicines, as this carries greater clinical responsibility. Prescribing of licensed drugs being used for unlicensed indications may possibly be continued in primary care but this should be discussed and agreed with the GP

Prescribers should adhere to the formulary status and recommendations listed in this formulary.

Please note;

• If an item cannot be found on the formulary it has not been approved for use within Kent and Medway.
• In exceptional circumstances a non-formulary drug may be prescribed where other options have proven to be ineffective or not tolerated.
• If a patient is stabilised on a non-formulary drug for a condition where changing treatment would be inappropriate e.g. epilepsy, the medication should be continued, when the patient transfers between care settings.

Using icons

There are links to EMC and NICE for further information where applicable.

	Link to EMC website		Unlicensed Drug
	Link to NICE website		Brand Specific Prescribing Required
	Preparations to be initiated by Opthalmology specialists only		Preparations classified as 'Controlled Drugs'
	Carbon footprint indicator		Blueteq required. Click icon to redirect to website to complete.
	High-Cost Drug		Available for purchase over the counter without a prescription.
	Cytotoxic Drug		Maidstone and Tunbridge Wells NHS Trust ONLY
	Drug subject to a shared care agreement		East Kent Hospital University Foundation Trust ONLY
	Unlicensed use		Dartford and Gravesham NHS Trust ONLY
	Supply/Restriction warning		Medway Foundation Trust ONLY

Guidelines

Links to guideline documents or relevant internet pages are displayed in each chapter.

Antimicrobial prescribing

Antibiotic prescribing information for primary care use is found in the Antimicrobial Prescribing Guidance section which is located in the ICB Guidelines section of the formulary.

Maidstone and Tunbridge Wells antimicrobial prescribing guidance can be found here

Alternatively, enter your search term in the search box as described above.

Feedback

The NHS Kent and Medway Medicines Optimisation Team are always happy to receive any feedback on the formulary. Please contact the local Medicines optimisation Team, or acute Trust formulary pharmacist, if you wish to provide feedback in relation to the formulary.

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