Sandwell & West Birmingham Formulary

Introduction

Welcome to Sandwell & West Birmingham CCG Formulary

Useful Links

Covid-19 Resources

Managing worry about COVID-19 and Type 1 diabetes COVID-19 and diabetes - At a glance factsheet Clinical guide for the management of people with diabetes during the coronavirus pandemic (19 March 2020)

COVID-19 SITUATION v1.3 Lower Limb Amputation Prevention Guidance COVID-19: information for the respiratory community Drug monitoring: factors to consider during Covid-19

Advice and guidance regarding DMARDs during COVID-19 NICE IMPORTANT ADVICE TO KEEP YOU SAFE FROM CORONAVIRUS (COVID-19) - Letter for Patients

PCCF 2019/2020 Statement: click here.

Useful Links

SWBCCG Homepage	UKMI	BNF
NICE Guidelines	Drug Tariff	Scottish Guidelines Network
Clinical Knowledge Summaries	NHS Choices	EMC
Medication Review Guidance	A Good Practice Guide To Repeat Prescribing	A Good Practice Guide To Patient Returned Medication
Items which should NOT be routinely prescribed in Primary Care Policy	Conditions for which over the counter (OTC) medicines should NOT be routinely prescribed in Primary Care Policy	DECISION TO DECLINE PRESCRIBING OF MEDICINES RECOMMENDED BY HOSPITAL SPECIALISTS
Yellow Card Scheme	Central Alerting System (CAS) Homepage

News Feed

NICE have now published the COVID-19 rapid guideline: Managing suspected or confirmed pneumonia in adults in the community

Please refer to NICE guidance (above) for full details. Extract from this document:

As COVID19 pneumonia is caused by a virus, antibiotics are not effective.
Do not offer an antibiotic for the treatment or prevention of pneumonia if COVID 19 is the likely cause, and symptoms are mild.

Inappropriate antibiotic use may reduce availability if used indiscriminately
Broad spectrum antibiotics may lead to a C-Diff infection as well as increasing antibiotic resistance

Offer an oral antibiotic for treatment of pneumonia in people who can or wish to be treated in the community if:

The likely cause is bacterial or
The cause is unclear and symptoms are more concerning or
They are at high risk of complications. For example, they are older or frail, or have a pre-existing comorbidity such as immunosuppression or significant heart or lung disease (e.g. bronchiectasis or COPD), or have a history of severe illness following previous lung infection.

When starting antibiotic treatment, the first-choice oral antibiotic is:

Doxycycline 200 mg on the first day, then 100 mg once a day for 5 days in total (not in pregnancy)
Alternative: amoxicillin 500 mg 3 times a day for 5 days.

Additional notes:

Inappropriate use of antibiotics can cause more harm than good
Follow current NICE guidance and do not change evidence based prescribing behaviours and advise self-care where clinically appropriate
Only prescribe rescue packs, including antibiotics, if they are part of the patients existing asthma/COPD plan
NHS England are due to advise no prepack antibiotic use in care homes
The antibiotic supply line is already stressed with out of stocks. Prudent use is advised
Refer to guidelines and prescribe no more than the usual quantity as over-prescribing will put more pressure on the national supply chain.

Management of a suspected case of COVID-19 Flowchart

BSSE APC Primary Care Clinical Pathway for Atrial Fibrillation Detection and Management (Nov 2019)

Welcome to the Sandwell and West Birmingham CCG Health Economy Formulary. This formulary has been overseen by Sandwell and West Birmingham DTC which consists of a number of GPs, consultants and pharmacists from the health economy. Choices are based on clinical evidence, safety and cost-effectiveness. The formulary aims to provide information on the medicines recommended for prescribing within Sandwell and West Birmingham CCG.

Prescribing in children

The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.

The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.

Ethical and religious implications of animal derived substances in medicines

Drugs with animal and human derived content are widely used in medicine and surgery across the world. However, information regarding the origins of specific ingredients is not always available to health practitioners. A religious/ethical perspective concerning the use of animal and human derived drug ingredients has not thoroughly been investigated. This article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4220589/ from December 2013 demonstrates the breadth and complexity of this issue.

The APC accepts that individuals may wish to avoid using medication that is in any way derived from animal and human origin (or containing alcohol) in order to support their ethical or religious views. When this view is expressed to prescribers, they will seek to find a formulary product with a suitable formulation. However, it is important to note that often, suitable alternatives may not be available. Following discussion with their doctor/prescriber - the individual should then make an informed decision regarding their choice to take the prescribed medication or not.
Medicine formulations are subject to change, therefore the APC does not identify specific products as being suitable for individuals with any specific religious or ethical view.

Individuals may seek the advice of their local community pharmacist regarding the suitability of medicines.