conforms to the appropriate regulatory standards. Not all of these medical products, devices or appliances are available from the NHS. On receiving a prescription, pharmacy staff will check whether or not an item is allowed to be prescribed on the NHS prior to dispensing using the Drug Tariff.
The Drug Tariff
The Drug Tariff is produced monthly by the Pharmaceutical Directorate of the NHS Business Services Authority and the NHS Prescription Services for the Secretary of State. It is supplied primarily to pharmacists and doctor's surgeries and is available in print and online; any healthcare professional can view the most up‐to‐date online version. Only fully licensed and approved medications and devices, found on the Drug Tariff, can be prescribed within the NHS (unless for research purposes). Information on the Drug Tariff can be found on either the PSNC or the NHS Prescription Services websites. Within each of these sites you will find information on how to use the Drug Tariff, the Drug Tariff Preface and the information within the different Parts of the Drug Tariff. The Drug Tariff Preface is an important section as each month as it contains valuable information on additions, deletions and any other alterations to the Drug Tariff.
What The Drug Tariff does
The Drug Tariff outlines information such as:
what will be paid to pharmacies for the NHS services provided (for example, the cost of drugs and appliances supplied against an NHS prescription);
rules that need to be followed when dispensing items;
drug and appliance prices.
How to tell if a medicinal product is allowed on prescription
The ‘blacklist’ can be found in Schedule 1 to the NHS Regulations 2004 and is found in the Drug Tariff (part XVIIIA); it is a list of medicinal products which cannot be prescribed on the NHS. Any medicinal product not on the ‘blacklist’ can be prescribed on the NHS. Whiskey, for example, is not on the blacklist, so a prescription for this item would be passed for payment by NHS Prescription Services. The prescriber may, however, be questioned during the auditing process about the appropriateness of prescribing this item at NHS expense. As a general rule, if a branded (proprietary) product is listed on the ‘blacklist’ it cannot be prescribed on the NHS. Many of the medicinal products on the ‘blacklist’ are available over the counter for people to buy, while some do not have enough evidence to show their efficacy.
The PSCN flow chart (Figure 2.4) can be used to help identify whether an item is allowed to be dispensed on an NHS prescription form. Different practitioners may use different prescription pads or resources (seen below as FP10, FP10SS, FP10SP*).
If a medicinal product, or device, is prescribed that is not on the Drug Tariff, it cannot be dispensed.
Skills in practice
Go to the Drug Tariff (https://www.nhsbsa.nhs.uk/pharmacies‐gp‐practices‐and‐appliance‐contractors/drug‐tariff) and see which of the following products are blacklisted and should not be prescribed on the NHS.
ferrous sulfate compound tablets BP
Gaviscon granules
Lemsip flu strength
senokot tablets.
Figure 2.4 How to determine if a drug or devise can be prescribed on the NHS.
Other guides to prescribing
The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) clinical guidelines
The Joint Royal Colleges Ambulance Liaison Committee Clinical (JRCALC) Guidelines is a helpful resource for paramedics and other healthcare professionals, in emergency care, on the road and in the community. JRCALC combines expert advice with practical guidance to ensure uniformity in the delivery of high‐quality patient care. The book, available as either a comprehensive reference edition or pocket guide, covers a wide range of topics, from resuscitation, medical emergencies, trauma, obstetrics and medicines, to major incidents and staff wellbeing. It includes an extensive UK drugs formulary and Page for Age drugs tables to assist in making medicines administration simple. A digital version, via an app, of the official JRCALC guidelines is also available for pre‐hospital clinicians to download.
Clinical considerations
There are also numerous prescribing and drug handbooks available, predominantly developed and produced for healthcare staff within the United States (US).
They can be a useful resource, but be aware the recommended medicines within these guides will not be based on UK NICE/SIGN guidelines and/or the medicinal products may not even have a license to be used within the UK.
Prescribing Drug Therapy
You may also come across other prescribing guides (in electronic and paper format) such as ‘Prescribing Drug Therapy’. This guide is written for Advanced Practice Registered Nurse (APRN) students and practitioners in the US who prescribe drugs for acute, episodic and chronic health problems. This guide provides details on treatment details for more than 600 diagnoses for healthcare providers in all primary care settings. Drug information is presented in a condensed and summary format for ease of use. The print format includes an eBook with digital updates to assure immediate access to essential information.
The guide is simple to use with diagnoses listed alphabetically. For each diagnosis there is a list of:
medicinal treatment recommendations;
drug choices listed by generic name;
Food and Drug Administration (FDA) pregnancy category;
generic and over‐the‐counter availability;
adult and paediatric dosing regimens;
brand names, forms of dosage and additives;
other clinically useful information, such as laboratory values to be monitored, patient teaching points and safety information.
Prescribing Drug Therapy also has an alphabetical cross‐reference index of drugs by generic and brand name, with FDA pregnancy category and controlled drug schedule.
The evidence base to prescribing: prescribing guidelines
There are many medications that can be used to treat the same condition; it is important to know which drug to use and when. To assist with choosing the most appropriate medication, in terms of efficacy, safety and cost effectiveness, clinical guidelines (where available) must be adhered to. Clinical guidelines are systematically developed statements to assist practitioners and patients make decisions about the most appropriate healthcare for specific clinical circumstances. Guidelines provide recommendations for effective practice in the management of clinical conditions where variations in practice are known to occur and where effective care may not be delivered in a uniform way. There are many guidelines available, but most are based on a consensus of ‘expert opinion’ or a non‐systematic review of the scientific literature. Prescribing clinical guidelines can be local or national (Table 2.3 provides