Safe Transfer of Prescribing Formulary Requirements
For questions about our formulary, please contact Liz Dobson, Lead Governance and Clinical Economy Pharmacist.
Email Elizabeth.Dobson@berkshire.nhs.uk
Clozapine
Information Sheets available to support patient care (DTC, September 2021)
Read about Clozapine Information for Primary Care (pdf)
Read about Pathway for People taking Clozapine who are admitted to Acute Trusts (pdf)
Lidocaine plasters
Restricted to inpatient CHS use only and discontinued before discharge. Consultant initiation for elderly patients recovering from fractures, when trying to avoid opioids.
The restrictions reflect the off-label use, cost, and NHS position statement about unsuitability to prescribe in primary care (DTC, November 2021).
Read about Items which should not routinely be prescribed in primary care (england.nhs.uk - opens new browser tab)
Read about SPS Evidence Review of Lidocaine Plasters (england.nhs.uk - opens new browser tab)
Melatonin liquid Restricted to
Melatonin 1mg/ml liquid (Unlicensed Special) may be prescribed by our LD, CAMHS and Community Paediatrician Specialists, for children with a confirmed diagnosis of neurodevelopmental conditions (ASD, ADHD, LD) and for whom all other melatonin solid dosage forms are unsuitable. This is usually restricted to those who receive their medication via tube-feeding or have other exceptional circumstances.
We will supply Martindale brand for all ages of children, as either:
- single doses for pre-EEG sedation
- ongoing treatment (in multiples of 200ml bottles)
We have reviewed our formulary choices and moved away from the off-label use of Colonis® liquid in children. The full rationale for this change is provided here.
(DTC March 2022)
If there are supply problems with the Martindale brand of Melatonin 1mg/ml liquid (Unlicensed Special) then a suitable alternative will be arranged in line with our Unlicensed Use of Medicines Policy CCR167, available to all Berkshire Healthcare staff on our Nexus system.
Visit the Neonatal & Paediatric Pharmacists Group (NPPG) website to read more about choosing oral liquid medicines for children (pdf) (opens new browser tab)
Quetiapine XL
Due to the significant cost difference between this and the instant-release preparation, this was given a red formulary status in Primary Care. This is now under review due to the availability of less expensive XL preparations.
These drugs require a formal protocol to be in place to outline the responsibilities of the Specialist/GP.
Berkshire West: Although the documents below have been clinically approved at the Prescribing Oversight Committee (POC) in Berkshire West, due to a lack of a mechanism to resource ‘Shared Care’, Berkshire West CCG were unable to formally ratify the updated versions of these documents. This is being addressed through BOB ICS workstreams with a view to aligning processes and documentation across the system. In the interim, and for the foreseeable future, where it is in the patient’s best interests, a GP may still treat a patient under Shared Care with the specialist, in which case our documents below may be used.
Frimley (East Berkshire): Documents have been clinically reviewed and formally ratified for use in East Berkshire.
Lithium
Updated January 2022 (next review January 2024). This Shared Care Agreement is now fully ratified for use across Berkshire (May 2023).
Read Prescribing Arrangement for Lithium use in Berkshire (pdf)
View the online video links for Lithium (pdf)
Attention Deficit Hyperactivity Disorder Medication (methylphenidate, atomoxetine lisdexamfetamine, amphetamine, guanfacine)
Children's ADHD Service
Read Children’s ADHD Prescribing Guidelines (pdf), Updated May 2021 (next review September 2023); Berkshire West: See notes above.
Adult ADHD Service
Read Shared Care Protocol: Methylphenidate for patients within adult services Approved May 2023 (next review May 2026) Ratified across Berkshire
Read Shared Care Protocol: Lisdexamfetamine (or dexamfetamine) for patients within adult services Approved May 2023 (next review May 2026) Ratified across Berkshire
Read Shared Care Protocol: Atomoxetine for patients within adult services Approved May 2023 (next review May 2026) Ratified across Berkshire
Read Shared Care Protocol: Guanfacine for patients within adult services Approved May 2023 (next review May 2026) Ratified across Berkshire
Read Adult ADHD Clinic – Shared Care Actions Form (pdf)
Long-acting Antipsychotic Depots
Read Antipsychotic (LAI) Shared Care Prescribing Arrangement (pdf)
(Reviewed November 2017 - review November 2019)
Due to differences in contractual agreements across East and West Berkshire, there are variations in level of responsibility taken for; prescribing, administration and monitoring between GPs, Consultant Psychiatrists and Community Mental Health Teams (CMHT)
These medicines may be initiated, or recommended for initiation, by a specialist without the need for a formal written protocol.
| Medicine | Berkshire West CCG | Frimley CCG (East Berkshire) |
|---|---|---|
|
Dementia medication A formal Shared Care Agreement is no longer required, NICE NG97. A visual summary of NICE guidance NG97: Visual Summary was published in BMJ indicating who may prescribe dementia medication. There is also a NICE Technology Appraisal NICE TA217. As such the Berkshire Healthcare Shared Care Agreement expired 1/4/2020 and has been replaced with Dementia Pathway. Read about NICE NG97 (NICE website, opens new browser tab) Read about NG97: Visual Summary (pdf on BMJ website, opens new browser tab) Read about NICE TA217 (NICE website, opens new browser tab) |
See notes in first column; formulary status still lists ‘A-PG’ however, this is currently under review as the Shared Care Agreement expired 1/4/2020 and has been replaced with Dementia Pathway. (still pending formal ratification by Berkshire West POC) |
Formulary statuses have been updated in line with Dementia Pathway
|
|
Melatonin tablets The formulary position has recently been updated and extended to allow for prescribing by GPs ‘on the recommendation from and following a confirmed diagnosis of neurodevelopmental (ASD, ADHD, LD) conditions by a specialist.’ |
On the recommendation from and following a confirmed diagnosis of neurodevelopmental (ASD, ADHD, LD) conditions by a specialist.
Includes children/ adults:
|
On the recommendation from and following a confirmed diagnosis of neurodevelopmental (ASD, ADHD, LD) conditions by a specialist. Includes children/ those transitioning to adulthood
Medicines Optimisation Board, November 2021 |
| Medicine | Berkshire West CCG and Frimley CCG (East Berkshire) |
|---|---|
|
Majority of Oral Antipsychotic drugs (including lurasidone) |
Patients are offered a choice of antipsychotics by their specialist and choice is determined by tolerability and efficacy. Once stabilised on treatment, people may be transferred to their GP for prescribing and annual health check. There are guidelines available for the Prescribing and Monitoring of Oral Antipsychotics, approved at DTC July 2020; however, these are not yet formally ratified with the CCGs (under review). Read Prescribing and Monitoring of Oral Antipsychotics (pdf) |
| Sodium valproate/ Valproic Acid |
MHRA risk materials: Valproate and it’s derivatives are known human teratogens i.e. they carry a risk of abnormal pregnancy outcomes. For further information about the effect of valproate on pregnancy outcomes, see use of sodium valproate in pregnancy. Read about Use of sodium valproate in pregnancy (UKTIS website, opens new browser tab) Female patients and their carers should be counselled on the risk of valproate treatment during pregnancy. Ensure female patients are provided with relevant resources, to support their understanding of the risks and to ensure the terms of the manufacturer’s product license are met (see below). Read Valproate Pregnancy Prevention Programme PREVENT Guide for Healthcare Professionals (DOC. on medicines.org.uk, opens new browser tab) Read Annual Risk Acknowledgement Form [Specialist] (DOC. on medicines.org.uk, opens new browser tab) In particular, the prescriber must ensure the patient understands:
Read Valproate Patient Guide (DOC. on medicines.org.uk, opens new browser tab) Read Valproate Card (DOC. on medicines.org.uk, opens new browser tab)
For more information see the Healthcare Professional Guide above,
For support for contraception (including outreach nurses), contact the following teams. Florey Clinic Call 0118 322 7202 Email (West Berkshire) rbb-tr.contraceptiveservices@nhs.net Visit the Florey Clinic webpage (Safe Sex Berkshire website, opens new browser tab) Garden Clinic (Safe Sex Berkshire) Call (Slough) 0300 365 7777 Visit the Garden Clinic webpage (Safe Sex Berkshire website, opens new browser tab)
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| Medicine | Berkshire West CCG | Frimley CCG (East Berkshire) |
|---|---|---|
|
Majority of antidepressants (including vortioxetine), according to Antidepressant Treatment Algorithm Read Antidepressant Treatment Algorithm (Berkshire West CCG website, opens new browser tab) |
Approved POC, November 2021 | Approved MOB, October 2021 |
| Memantine - as an add-on |
Formularly status under review see notes 'Dementia Medication' A visual summary of NICE guidance NG97: Visual Summary was published in BMJ Read NG97: Visual Summary (pdf on BMJ website, opens new browser tab) |
Memantine as add-on therapy for patients with an established diagnosis of Alzheimer's disease and already taking an acetylcholine esterase inhibit. |
