National Institute for Health and Care Excellence

Consultation on an Enhanced British National Formulary from NICE Consultation Comments Table Consultation dates: 3 February – 31 March 2014

"Comments received in the course of consultations carried out by NICE are published in the interests of openness and transparency, and to promote understanding of how recommendations are developed. The comments are published as a record of the submissions that NICE has received, and are not endorsed by NICE, its officers or advisory committees."

Comments received from Organisations Organisation Consultation question 1: Consultation question 2: Consultation question 3: NICE Response

What are your views on the What do you think are the most Do you think we have vision for an enhanced BNF as important elements of an enhanced overlooked anything? described? BNF?

ABPI We are fully supportive of the The enhanced BNF must be up to The vision describes ‘authoritative Thank you for your comments, BNF exploiting the advantages date. A key source of new information, medicines information and fully they have been considered along offered by digital media and the and a check on whether the referenced clinical evidence such with the other comments received vision to ‘provide the right information contained in the BNF is as NICE guidance’ as in the consultation, to inform the information in the right format at accurate, is the marketing underpinning the content. We development of the enhanced the right time’. It is wholly authorisation holder of the medicine. It believe that, as the British BNF. appropriate that modern digital will be essential that processes are in National Formulary, it would be technology platforms and place that enable pharmaceutical appropriate to acknowledge in the functionality should be employed companies to highlight areas of factual vision similar sources of for a medicines information inaccuracy so that changes can be medicines information in Scotland resource that is so important to made where necessary. It is currently (SMC and SIGN) and Wales prescribers and NHS personnel very difficult for companies to make (AWMSG) to avoid perceptions of with an interest in medicines. The any inaccuracies known, which does any bias towards NICE and/or use of rigorous, open and little to serve prescribers or their English sources of information. transparent processes that meet patients, and we would call on the NICE accreditation standards will developers to ensure that an Paragraph 3.3 covers addressing be a substantial enhancement appropriate and open process is in conflicting advice. We would ask and should ensure content is of place. whether the intention is to develop the highest possible quality. a hierarchy of evidence sources.

[Insert footer here] 1 of 383 We believe the BNF should remain as If so, this should be explicit and Summaries of Product an information resource and that it will need to be done with the Characteristics and other should not develop, deliberately or engagement and support of information on medicines are unwittingly, into a decision-support tool stakeholders, and may need to be subject to frequent change, and that advises on which medicine to the subject of a future change is continuous over the select. The BNF should be an enabler consultation. entire lifecycle of a medicine. of good decision-making by providing Digital media should offer the comprehensive and up-to-date It will also be important to most cost effective means to keep information, leaving the clinician free to consider how “general” information up to date if effective make a choice that is in the best prescribing information can processes, including company interests of the individual patient. As effectively be communicated to engagement, are put in place to said above, we would recommend that users of the enhanced BNF, enable this. We would a link to the SmPC of the medicine is alongside specific information recommend that a link to the routinely included in the information about individual medicines. For SmPC of the medicine is a routine provided. example, it is necessary for all inclusion in the information biological and biosimilar

provided. medicines to be prescribed by brand name in order to avoid

automatic substitution and to support pharmacovigilence and monitoring requirements or that the patient must be involved in any decisions about treatment switching made by physicians. It will be important that this general prescribing information can be “connected” and displayed alongside information about specific medicines where necessary.

Finally, we would ask that an explicit statement be made that access to the BNF will continue to be available to industry, including pharmaceutical companies.

[Insert footer here] 2 of 383 Ambulance o Digital is obviously the right o Accessibility, cost (to ensure cost o Brief interactions ‘management’ Thank you for your comments, Pharmacists direction of travel but not entirely doesn’t limit access), concise yet advice added to the current they have been considered along Networks at the expense of a hard copy remain a comprehensive medicines ratings of frequency and with the other comments received which needs to be updated at resource, easily searchable (using seriousness such as those offered in the consultation, to inform the least as regularly as is the case medicines and disease states as in Stockley’s Alerts; development of the enhanced currently. This is to ensure search terms), useful links, expert o Dose calculations – based on BNF. NICE acknowledges that resilience (IT failure) and also opinion where evidence is inconclusive weight and/or age – with a sense digital infrastructure and access to access in those locations where or insufficient (but noted as such). checker; portable devices throughout the internet and telephone (app) o Interface/Link/Inter-operatability NHS is not fully developed. access is limited or unreliable. to ‘high quality information’ for Distribution of print formats will healthcare professionals as well continue in line with user as for patients such as the requirements, subject to ongoing Injectable Medicines Guide monitoring and review by the (Medusa), Over The Counter NICE Board. Medicines, Palliative Care Guidelines / information and Toxbase, as well as the NICE Guidelines/TAs. Some sections of the BNF are not very comprehensive due to the desire for the BNF to be concise but it would be useful for links to more comprehensive resources; o More information about unlicensed dosing (adults); o Download to “local” formulary to include links to local policies; o An e-learning training pack on ‘how to navigate and use the BNF’.

[Insert footer here] 3 of 383 Association of Better digital platforms for the The suggestion of providing new The importance of integration of Thank you for your comments, Scottish BNF offer the opportunity to functionality and improving the BNF guidance from NICE & other NICE they have been considered along Medicine provide significant new through updated and revitalised digital accredited sources is recognised with the other comments received Information functionality over and above that platforms is to be welcomed. but as the BNF is used by in the consultation, to inform the Pharmacists currently available. As a first step, However, the BNF is a successful healthcare professionals development of the enhanced they might improve integration of brand because it is concise, throughout the UK, it should be BNF. The uptake of digital formats information, for example authoritative, and accessible. These recognised that in NHS Scotland and distribution of print formats of improving linkages and core values must not be threatened Scottish Medicines Consortium the BNF will be subject to ongoing presentation between contextual either by addition of new functionality Advice & SIGN guidelines have monitoring by the NICE Board. text, information in appendices, or by the work involved in achieving precedence. National guidance and information in individual them. It is therefore essential for the from NICE, SMC & SIGN should monographs. In addition, they success of this initiative that future have equal prominence on the could allow better control of digital platforms, that, as well as digital platform to ensure best UK revisions and updates with adding functionality and provide clinical practice is equally potentially positive impacts on updates in a timely manner, the BNF accessible to all. It is also patient safety. They might also continues to provide safe information important that, to have maximum enable embedding of BNF content in an easy to use and concise relevance to healthcare in e-prescribing systems as readable format. The ability for professionals, clinical opinion and decision support directly, which continuous updating of products on advice within the BNF takes should be considered. However, digital platforms is to be welcomed, cognisance of expert opinion from whilst the overall vision is to be and if such platforms were the across the UK. A move to digital welcomed, it should also be noted universal access point to BNF only platforms for delivery of BNF that a valued attribute of the BNF information in the future, this would content is the right way forward. currently is its ability to reflect represent a real change with patient However, from a users both an assimilation of the safety benefits. Also particularly perspective, the ability to achieve evidence-base as well as practical welcome is the suggestion that the this; in particular the barriers, both and pragmatic interpretation of BNF is enhanced such that it is a cultural and practical, to achieving the data and clinical advice. It resource aimed not only at such a switch need to be would be a significant loss if this professionals but also at patients. For identified and understood. These clinical advice function were to be the BNF to link to information that include the implications for rural lost or had less prominence. enables healthcare professionals and communities, where internet Similarly, the BNF has a patients to reach decisions together access may not be as reliable. potentially crucial role in would be potentially hugely beneficial, Notwithstanding this, providing operationalizing the evidence- particularly as healthcare professionals appropriate education and driven recommendations of evolve their approaches to thinking support is in place, a complete others: for example, providing about choices between treatment switch to digital only delivery guidance on appropriate options. within 5 years seems potentially alternative courses of action feasible. The BNF book has a

[Insert footer here] 4 of 383 where the regulator identifies number of useful spin offs, e.g safety concerns for an individual distribution and use in the medicine. developing world through the Pharmaid programme. It would be a shame if the Pharmaid programme & other worth while uses were affected detrimentally by the switch to digital versions only.

British Medical The concept of advanced digital Thank you for your comments, Association functionality to the BNF is to be they have been considered along largely welcomed. Integration of with the other comments received interactive medicines information, in the consultation, to inform the with access to latest guidelines development of the enhanced from NICE and other accredited BNF. NICE acknowledges that sources, into existing clinical digital infrastructure and access systems can only help to build on to portable devices throughout the the benefits of the print version. It NHS is not fully developed. is a powerful tool for patient safety Distribution of print formats will as well as an aide memoire and continue in line with user up to date resource, and these requirements, subject to ongoing key features must persist in any monitoring and review by the new iterations. NICE Board.

The printed edition is within arm’s reach of almost all UK GPs every day, and a move to an electronic version should complement but not necessarily replace this option. Although portable and desktop technology use is widespread, it is not always universal, and uptake is variable.

[Insert footer here] 5 of 383 Adoption should be user led and not technology led. As the recent floods have demonstrated, we cannot take internet, hosted clinical system, or mobile internet access for granted.

There is a lack of cross platform communication between devices and systems which would serve to hinder adoption e.g. access via a clinical system in the consultation room would leave an audit trail, however access via a smart phone or tablet on a home visit would not usually integrate with the clinical system, and so the BNF would be no different to a paper copy. As the technology and functionality evolves and improves this should drive the adoption of the electronic version, and until and even beyond a critical mass of use, the paper copy must remain available in its new annual version. It is also very important for an enhanced BNF to be available to GPs in all settings, and not just face to face consultations. Locums, out of hours GPs, and those working in other urgent care settings would need equal access to the enhanced services available, as well other prescribing and non- prescribing staff members.

The effect on the consultation

[Insert footer here] 6 of 383 needs to be considered also. Patients often feel alienated by GPs making use of computers - the unwanted third party in the consultation room. Patients are familiar with GPs using the BNF to help guide their therapeutic decisions and ensure patient safety, and the loss of this ritual as another computer database is consulted would have an impact. The views of patient groups would be helpful in this area.

Aggregation of clinical guidance from a variety of sources would be welcome in order to support decision making, but as is stated in the consultation document, conflicts of advice need to be clearly flagged. Evidence based medicine is not absolute in all areas, and where authorities differ clinicians need to have access to a variety of resources. Guidance should not be restrictive and allow clinicians to take the individual circumstances of the patient, and their own clinical judgement into account and if necessary make prescribing and clinical decisions that are outside guidelines.

Incorporating commonly used medical devices and other items into the enhanced BNF would be a useful development. There are many widely used items that clinicians may not be completely

[Insert footer here] 7 of 383 familiar with the use of, and accredited guidance linked to their prescription would be a helpful adjunct.

Regular update of the enhanced BNF, incorporating most up to date safety information, guidance, and prescribing information would be a beneficial enhancement. It is vital to ensure that clinicians are kept up to date with these changes as well as additions to the formulary to support development and adoption of best practice in a timely way. Simply making 'under the hood' changes to the BNF without notifying clinicians would be insufficient to enable this to take place, and a regular digest detailing changes, as well as contemporary notices of important changes would be vital. British Dental The development of an updated The integration of point of care The complete switch to a digital Thank you for your comments, Association digital format for the BNF has decision making tools would be useful format may lead to infection they have been considered along many advantages but a complete and could be used for CPD purposes control issues where a single with the other comments received switch to a digital format appears but only if mechanisms for verification computer or tablet is used by in the consultation, to inform the premature. Wifi or mobile signals are made available. Easy many clinical staff. The development of the enhanced are often unavailable in a ward identification of the most significant incorporation of fully referenced BNF. NICE acknowledges that setting and there will be the need drug side-effects and interactions, evidence could lead to an digital infrastructure and access to to have up to date printed copies alongside the drug listed and unmanageable expansion in the portable devices throughout the as a backup system in case of described would be very helpful for printed copy. The introduction of a NHS is not fully developed. unreliable or non-existent internet practitioners. simple grading system for the Distribution of print formats will access. The number of monitors evidence base should be continue in line with user located in many clinical areas is considered rather than adding all requirements, subject to ongoing already insufficient to allow for the relevant references to the monitoring and review by the rapid access for many uses BNF. The incorporation of NICE Board.

[Insert footer here] 8 of 383 including patient appointments, common medical devices should digital radiography, initially be limited to the online haematological results and versions to prevent over- pathology reports. Adding the expansion of the printed version. additional requirement for prompt access to a digital BNF will make the situation worse. This is particularly true in hospitals and during student/staff training. Digital formats need to be carefully designed to duplicate the rapid overview currently possible from viewing a printed copy. In a clinical setting, speed of access to a printed version as compared with an electronic version can be a significant issue. In rural settings available internet connections often lack sufficient speed to allow effective access. The integration of NICE guidance is sensible but the BNF needs to retain editorial independence. There will be instances where NICE guidance has become outdated and the BNF should reflect the latest most up to date guidance. The BNF as a UK guidance should also reflect evidence from relevant national bodies for example the Scottish Dental Clinical Effectiveness Programme (SDCEP). British Generally, feedback from The importance of providing BPS is working with the Medical Thank you for your comments, Pharmacologic members of BPS, as clinical information in a way that is focussed Schools Council (MSC) on the they have been considered along al Society pharmacologists working in the on enabling practical usage in a busy Prescribing Safety Assessment with the other comments received NHS, has been largely positive clinical environment is crucial. This (PSA). We have submitted a joint in the consultation, to inform the and supportive of the vision for means providing the necessary response with MSC specifically development of the enhanced

[Insert footer here] 9 of 383 the enhanced BNF. A key information succinctly and providing regarding PSA. We would like to BNF. The uptake of digital concern has been ensuring the further information via links. There is a take this opportunity to re-iterate formats and distribution of print enhanced BNF meets the needs need to balance the provision of best support for this joint response and formats of the BNF will be subject of prescribers on the wards. information with the risk of providing an to highlight the importance of to ongoing monitoring by the unwieldy mass of information and a ensuring the BNF is able to NICE Board. NICE acknowledges While the potential benefits of an maze of hyperlinks. This balance will integrate with other systems (such that digital infrastructure and enhanced electronic version of be crucial to the vision of providing the as the PSA). The PSA is an access to portable devices the BNF are noted and very right information in the right format. important assessment of medical throughout the NHS is not fully encouraging, there has been a students prescribing developed. Distribution of print general consensus that In terms of usage, it is important to competencies, and is a useful formats will continue in line with prescribers value and often use ensure the electronic version works means for students to become user requirements, subject to the paper copies. This is due to seamlessly. Some suggestions for familiar with use of the BNF prior ongoing monitoring and review by familiarly with the format, steps for improved user experience to getting onto the wards as the NICE Board. provision of user-friendly are: Foundation doctors. information and reliability in all Since they work offline, a situations (i.e. no concern about  Ensuring log in requirements The need to avoid reiterating or connection to the internet is not losing internet coverage etc.). The are minimal (e.g. eliminate the reinventing current resources has required once the BNF and BNFC electronic BNF should be need to log in mid-search due been somewhat overlooked. apps are downloaded onto a considered to an excellent to time out) There is a role in bringing mobile device. additional tool for prescribers, but together information and giving we feel strongly that it should not prescribers easy access to further NICEs role in providing access to be a replacement for the paper  Updating the app automatically information. To this end, the BNF in all formats is limited to copy. The electronic versions and (rather than running the integration with useful databases the UK. paper copies should have a monthly updates when the app such as ToxBase, Electronic similar look and feel, so that is open) so information is Medicines Compendium prescribers feel confident in using provided quickly (summary product characteristics) all versions. etc. would be beneficial.  Ensuring good searchability – providing the BNF as This consultation does not look to ‘searchable and browsable in the role of the BNF outside of the multiple ways’ will be a very NHS and UK. The BNF is a highly useful functionality. regarded resource and is utilised internationally. There may be scope to consider the wider world  Ensuring the level of potential of an enhanced BNF, information ‘pushed out’ does and the contribution to medical not damage the user care in developing countries friendliness of BNF by particularly. overloading healthcare

[Insert footer here] 10 of 383 professionals with a huge Some specific suggestions for amount of information. means to achieve the vision for the enhanced BNF include:

 Provision of brief summaries of the mechanism of action of each drug class

 Including information on mechanisms for individual drug interactions

 Provision of a refined grading system plus practical advice on management of interactions would be helpful – a useful feature could be ‘inputting’ drugs into the eBNF that a patient is on and then receiving a list of potential interactions. The current system of investigating potential drug interactions is crude.

 Ability to input diseases and current medications that a patient is on so BNF could highlight any potential omissions or treatment changes. This could be a particularly neat mechanism to refer to NICE guidelines.

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 Ability to compare drugs and formulations e.g. to allow clinicians to identify a least costly alternative without having to navigate through hyperlinks British The BNF is a valued and The BPS/MSC believe that the look For the BNF to be an authoritative Thank you for your comments, Pharmacologic recognised brand for all and feel of the product should be as source, its format should be they have been considered along al Society and prescribers (and increasingly familiar as possible whether accessed reliable enough to enable using it with the other comments received Medical those learning to prescribe). The by the web, App or otherwise. In the in high-stakes assessments. in the consultation, to inform the Schools Prescribing Safety Assessment current system the core data is derived Therefore it would be important development of the enhanced Council (PSA) is an online assessment from print, consequently its that all BNF and NICE guideline BNF. developed by the British functionality is constrained largely by pages are securely encrypted on Pharmacological Society and the parameters of the print version. By https. Thank you for your offer to be a Medical Schools Council that moving the foundations of the service test case to see how the BNF provides a reliable and valid into an electronic core system, the The BNF should be readily data can be integrated with other assessment of prescribing skills interaction and functionality of the accessible free of charge to systems, it will be kept on record. for final year medical students formulary is open to reimagining and medical students (and students of allowing them to demonstrate that BPS/MSC would be keen to feed into other healthcare professionals). they are safe and competent the scope, specification and design of Any supplement to the BNF that prescribers. This obviously the new system. We would also aids transparency regarding that includes being able to utilise the suggest including young health care advice given is to be welcomed BNF and therefore the BNF is professionals in this reimagining, a but must be thought out carefully available to all candidates during recent feedback comment from one of to avoid the risk of over the assessment – either via hard our students: complexity. copy or online. The online BNF system is very poorly Those charged with teaching We believe that the PSA, in laid-out. The information is all there but students about the BNF should be particular, has strengthened it's difficult to access and can take up a supported with educational recognition of 'BNF searching' as lot of time unnecessarily. It needs a resources if the format changed. a key skill for new graduates. The more intuitive design. PSA has been piloted since 2010 Ensuring that NICE/BNF acting as a lever to ensure Students also mentioned struggling to establishes elastic architecture Medical Students become familiar locate and identify drug interactions that will exceed required capacity with the BNF before they enter easily. Including this cohort help NICE for large scale events as the PSA Foundation School. Feedback ensure it is fit for its users. plans to try to reduce the number from the current PSA sittings of delivery dates therefore

[Insert footer here] 12 of 383 indicate this is something that Specific points: increasing the number of students resonates with students too: who will be accessing the Include high quality prescribing resource, thus affecting "I think this was a useful exam information to help improve patient bandwidth requirements. and helped me get used to using outcomes by supporting We would like to reassert our the BNF" and "Good exam. very health professionals to choose the support of the BNF vision and useful to have an assessment on right medicine, at the right time for the actively invite NICE to collaborate our use of the BNF before getting right patient, including patients with with the BPS/MSC on the PSA to on the wards." more than one medical condition – this ensure that we can raise the element reflects the mission of the profile of the BNF further amongst The current success of the PSA PSA and therefore ensuring that the prescribers and ensure its suggests that it could be BNF is suitable for our platform and readiness to be used in expanded to assess other that there is a mechanism for BNF assessments for all healthcare prescribing disciplines increasing content to be updated is crucial and professionals. the exposure of the BNF. As an will be of benefit to health online assessment we welcome professionals. and embrace the move to online technologies especially ones that Enable download to local formularies – we believe will, in the not too we would strongly a support this move distant future, reflect the day to and would welcome discussing this day experience of healthcare with NICE and would gladly offer to be professions on the ward. a test case to see how the BNF data can be integrated into other systems. We hope that NICE/BNF will In previous discussions with RPS/BNF therefore facilitate collaboration we started to explore the XML with those endeavouring to deliver data to try and implement an offline prescribing assessments so that it model but time constraints scuppered can be made this plan. We’d be keen to test this mode again – we did attempt a PDF based version but the file was too big to be easily navigable within the assessment architecture/delivery. This is particularly pertinent for exam delivery – if you cannot download the formulary it means access to the online version is required, compromising exam security. Any facility to avoid this would be greatly appreciated. The BPS/MSC with

[Insert footer here] 13 of 383 Medical Schools have been exploring the use of kiosk modes restricting access and are happy to share our findings.

Digital formats may have a wider reception among medical students than is currently the case for the entire NHS. Familiarity of future health professionals could be improved by making the mobile NICE app available free of charge for the medical schools. MHRA The vision describes a positive Clearly a key element is ensuring Collaboration - The BNF could Thank you for your comments, move to ensure digital technology timely availability of accurate, take a wider look to assess they have been considered along is exploited providing timely, authoritative and relevant information whether other similar operations with the other comments received accurate and relevant information on medicines. The MHRA clearly (such as the British in the consultation, to inform the to healthcare professionals endorses the weight which BNF Pharmacopoeia) could provide development of the enhanced (HCPs). The suggestions further attaches to regulatory decisions and opportunities, for example BNF. go to meet the Government’s communications e.g. via the MHRA's support, skills, information or Digital Strategy. A move to a Drug Safety Update which is technology sharing or joint digitalised BNF will need to accredited by NHS Evidence) working. - Collaboration could ensure that its new format will be Additionally, evolving with advancing present mutually beneficial compatible with the hardware or technology is important, but as initiatives and outcomes or indeed technology available to its main highlighted, will present challenges. opportunities for shared learnings customers eg NHS. Are there These challenges must be explored which could improve the services opportunities for the BNF to learn and addressed. The BNF has actively or product(s). - Engaging with from other similar operations, advanced into new technological wider stakeholders could improve determine whether there are any areas. The BNF should continue its and streamline services, synergies and potentially identify forward look approach and contribute toward the timely opportunities for joint working, explore/exploit opportunities to availability of information and skill/knowledge sharing and improve its services and product build a strong knowledgeable collaboration? A full portfolio. Engagement with the users, network. Data - The BNF could consideration could be given on customers and stakeholders is consider what other data might be what additional data can be linked essential to ensure that the transition available to strengthen its future and/or made available as part of to digital is successful. There should digital product portfolio. For the move towards digital. To be careful consideration on what example, if detailed prescribing include such ideas in the BNF’s effective implementation would look data were available at the BNF vision would also demonstrate like and how it will be measured. The online user interface, the

[Insert footer here] 14 of 383 commitment to investigate and BNF should build on its successes and prescriber could drill down to potentially participate, in the determine where and how it can grow determine the frequency and Government’s Shared Services or contribute to other activities which nature of the medicinal product Strategy and Transparency provide authoritative information and/or prescribed in their area. The BNF Agenda. protect and safeguard public health. should consider all possible data Finally, it is of course important that sets available and see how they the BNF is produced by a streamlined, might be incorporated or linked efficient and cost effective operation. through to the online user interface. - The enhanced digitalised BNF could potentially support other regulatory functions. Product Portfolio - The product portfolio could be increased, for example the introduction of a European NF could be considered. - The BNF could consider different mechanisms to support HCPs and to publish its product on electronic platforms available, for example, the BNF could be fully incorporated and integrated into the NHS prescribing systems. Faculty of The comments herein are The FPM recommends that being We recommend that industry is Thank you for your comments, Pharmaceutica provided on behalf of the Faculty searchable and browsable are the not involved in and responsible for they have been considered along l Medicine of of Pharmaceutical Medicine most vital elements for the enhanced updating the information with the other comments received the Royal (FPM). The FPM is in broad BNF. It should be easy to use and contained within the BNF. in the consultation, to inform the College of agreement and approval of the accessible – especially as IT systems However, we believe that some development of the enhanced Physicians plans outlined in the consultation in the NHS are not coordinated. It consultation with industry be BNF. The uptake of digital document. The plans sound should be rigorously checked for maintained to ensure the usability formats and distribution of print ambitious, and take into account accuracy and completeness of and reliability of information. We formats of the BNF will be subject the changing ways for how people information, and updated regularly – believe that the electronic to ongoing monitoring by the routinely access information and including information on drug medicines compendium is better NICE Board. NICE acknowledges generally reflect the requirements interactions and unwanted effects (this than the BNF in some ways, that digital infrastructure and and needs of users. The is extremely important for all those including; providing specific access to portable devices consultation indicates strong physicians and other health guidance about individual drugs throughout the NHS is not fully support from NICE for the BNF professionals working in the area e.g., excipients, can the tablets be developed. Distribution of print and sets out the advantages of pharmaceutical medicine, especially halved, the sorts of questions that formats will continue in line with

[Insert footer here] 15 of 383 greater use of digital technology. pharmacovigilance). Currently patients ask. We suggest that user requirements, subject to Also, the attention to detail e.g. BNF/BNFC does not fully exploit links could be made from ongoing monitoring and review by utilising national and international advantages offered by digital media: individual drugs in the BNF to the the NICE Board. sources of information, i.e. being searchable in multiple ways, relevant pages of the EMC. We continuously updating the frequent updates, providing links and presume that the new BNF would information and being fully explaining conflicting advice from still include information on searchable and browsable are another authoritative source/s would contraindications, warnings and particularly good points. The BNF be appreciated by users and is likely to precautions for each drug (not just and app is widely available now benefit patients. This change to the the interactions and unwanted but it should be available and guide should use the opportunity to effects). We recommend that the used by non-medical prescribers, link to other sources of information e.g. electronic system should nursing homes, dentists, adverse events, and especially incorporate automatic warnings if optometrists, pharmaceutical genetic/genomic data which affects drug interactions are known for physicians, those working in drug prescribing. One potential concern is combinations with red (do not regulation and all those in training about it allowing quick comparison of prescribe), amber (need to to be health workers. The FPM resource implications, which depend consider alternative medicines or recommends a reduced reliance upon the perspectives (GP, NHS, change dose) and green (no on print but cautions against Society, short term vs. long-term etc). known problems). In the case of concentrating too much on the amber it would also be possible to electronic version, as many collect what the prescriber healthcare professionals may not actually did (e.g. dose changes) have such immediate access to and what the outcome was in computers and mobile terms of efficacy and safety. The technology, so the reduction in system should also build in a the availability of the print version warning for genetic/genomic data. must proceed with care. Continual Finally, it would be excellent if the updating is desirable but should key OTC (over the counter) drugs not be overstated and sometimes could be included within each a short period for digesting new section as appropriate (by active information and allowing time for ingredient). It would also be a critical comment helps. good idea to include commonly prescribed medical devices.

[Insert footer here] 16 of 383 Greater The group has some concern Thank you for your comments, Glasgow and regarding the move towards an they have been considered along Clyde Area entirely digital BNF. As with the other comments received Pharmaceutica mentioned in the consultation the in the consultation, to inform the l Committee success of this is reliant on development of the enhanced access to IT. In community BNF. NICE acknowledges that pharmacy, available computers digital infrastructure and access to are normally continuously in use portable devices throughout the for the process of dispensing and NHS is not fully developed. there is unlikely to be sufficient Distribution of print formats will computer availability to facilitate continue in line with user the necessary frequent access requirements, subject to ongoing required to the BNF. In the monitoring and review by the hospital setting major areas of NICE Board. concern would be times where the healthcare professional cannot leave the patient bedside to check something on a computer, for example when nursing staff are doing medication administration rounds or when medical staff are dealing with a sick patient. In addition, in the primary care setting when healthcare professionals are visiting patients in their homes they may have no facility to access digital based resources. Unless there was available mobile technology i.e. tablet devices or investment in more computers in community pharmacy there is a risk in all these scenarios that out of date paper copies of the BNF are used or healthcare professionals have no facility to check a drug dose, interaction etc. In addition if IT systems fail or are down for a

[Insert footer here] 17 of 383 period of time there would be no paper BNF back up.

While the enhancements and additional information sound interesting and are likely to be beneficial we think it would be important to ensure that the core information for which the BNF is commonly used such as checking the dose or indication for a drug is still easily accessible. If short of time, users may be put off from using the resource if the core information is difficult to find.

The consultation document mentions incorporation of NICE guidance, for users in Scotland will there also be incorporations of SMC advice and SIGN guidance?

Guild of We completely support the vision When the access issues are resolved We have concerns that the Thank you for your comments, Healthcare for an enhanced BNF which will the most important elements of the variable access to IT to view and they have been considered along Pharmacists utilise digital media to provide the enhanced BNF must be: • to become utilise the digital information with the other comments received right information, regularly the single authoritative source of appears to have been overlooked. in the consultation, to inform the updated, in the right format, in the medicines information, integrated with Until access to the proposed development of the enhanced right place, at the right time as guidance from NICE and other NICE digital delivery of this information BNF. NICE acknowledges that well the ability to download to accredited sources to ensure it has the is more widespread, the switch to digital infrastructure and access to local formularies and integration interactivity, mobility and integration the annual provision of the print portable devices throughout the with other clinical systems. with other systems to enable point of version of the BNF should be NHS is not fully developed. care decision making; • continuously postponed. Additionally, in some Distribution of print formats will updated with content updates pushed organisations the use of such continue in line with user out to inform continuing professional mobile technology is prohibited or requirements, subject to ongoing development; • searchable in multiple is prevented by policies in place. monitoring and review by the

[Insert footer here] 18 of 383 ways; • able to link into local Our concerns are that in NICE Board. formularies; • accessible on multiple organisations with less favourable formats and devices. accessibility to the digital version, patients and healthcare professionals will be put at risk by reducing the availability of the print version of the current format of the BNF as they will have reduced access to up to date information. As you state in the consultation ‘digital formats are dependent on the availability and penetration of appropriate technology for users, such as easily accessible computers with internet capability, clinical decision support systems, smart phones and tablet devices. Use of this technology is now widespread, but not yet comprehensive in the NHS’. This is the key issue behind our concerns. Withdrawing the 6 monthly print distribution will not ensure that transition from print to digital format happens in a timely manner, which puts both patients and healthcare professionals at increased risk.

[Insert footer here] 19 of 383 Haringey 1. What are your views on [Ensuring evidence summaries are [Consider options for alternative Thank you for your comments, Clinical the vision for an enhanced BNF updated with latest information.] means of BNF access if a user they have been considered along Commissionin as described? [Ensuring prescribing information are cannot access enhanced BNF with the other comments received g Group [To hope that the ideal for updated with latest information.] e.g. power failure, web browser in the consultation, to inform the “prescribers have timely access to [Changes to existing monographs issue, no smart phone access, development of the enhanced accurate and up to date should be highlighted clearly to enable home visits, travelling outside BNF. NICE acknowledges that information on medicines” is user to pick up without overlooking.] home/office etc….] digital infrastructure and access to achievable and sustainable.] [Ensuring web links are up to date and [Recycling of BNFs (hardcopies) portable devices throughout the are provided only where necessary.] to other countries will no longer NHS is not fully developed. [Would be very helpful if indeed [Ensuring quick connectivity and ease occur. This is recognised as a Distribution of print formats will the enhanced BNF will: Be a of access to eBNF. Sometimes it is a positive social, educational and continue in line with user single authoritative source of struggle to access eBNF which can be environmental use of being able requirements, subject to ongoing medicines information, providing off putting to use as a resource or to benefit others] monitoring and review by the information from a wide variety of reference source.] [Some professional entrance NICE Board. nationally and internationally [Ensure positive features of BNF exams (e.g. GPhC) require use of recognised sources, integrated (hardcopy and eBNF) are maintained BNF for open book exams. with guidance from NICE and such as ease to navigate between Students are informed in other NICE accredited sources.] monographs. In the BNF app this is not advanced which version of BNF to apparent]. use for exam preparation, this [We hope that the full benefits of then enables them to tag, digest digital delivery of medicines and familiarize with that version information such as interactivity, ready for the exam. Removing the mobility and integration with other hardcopy will mean another way systems is such so that of approaching this under both prescribers can make point of exam preparation and exam room care decisions which is conditions.] sustainable also.]

[This is a positive move embracing technology with functionality. Whilst this is a move forward the principles and content of the BNF in its current form i.e. independent evidence summaries must be maintained. This is why the BNF has stood on good ground with healthcare professionals over the years as a

[Insert footer here] 20 of 383 trusted source of prescribing information.]

[The user’s experience of navigation through enhanced BNF must be logical in layout with ease of use. If the platform is full of links and extended file paths the user may disengage.]

[Whilst links to original sources of evidence is welcome, the summaries of the evidence (as per current BNF monographs) are important to maintain an independent and impartial stance.]

Merck Serono MSD is in agreement with the MSD is in agreement with the ABPI MSD believes that a consultation Thank you for your comments, ABPI response. response. with stakeholders to discuss the they have been considered along sources of evidence to be with the other comments received considered for inclusion in the in the consultation, to inform the enhanced BNF and the methods development of the enhanced by which any conflicting guidance BNF. will be aggregated is essential to ensure that the BNF remains a robust source of information.

[Insert footer here] 21 of 383 Medicines The Medicines Management The Medicines Management team The processes used to inform the Thank you for your comments, Management Team supports the vision set out believes that the most important continual development of the BNF they have been considered along Team of the in the consultation. The BNF is a elements of an enhanced BNF are it's must be clear and transparent with the other comments received Cambridgeshir reputable source of medicines accessibility to all healthcare and available to scrutiny. Where in the consultation, to inform the e and information and despite the professionals wherever they are there are concerns or questions development of the enhanced Peterborough developments planned must not working. This is dependent on IT raised about the content there BNF. NICE acknowledges that Clinical lose its core purpose which is to infrastructure within the NHS but must be a clear process for digital infrastructure and access to Commissionin aid the safe, effective and optimal access should be whenever and raising these. These portable devices throughout the g Group prescribing of medicines. wherever it is needed by the individual. comments/questions must be NHS is not fully developed. The BNF must be easily searchable responded to in a timely way by Distribution of print formats will linking to authorised sources of the BNF. continue in line with user medicines information. requirements, subject to ongoing monitoring and review by the NICE Board. Pharmacy We support the need to improve The ability to find information quickly is We believe the way community Thank you for your comments, Voice the BNF and BNFC and to be of paramount importance. Pharmacists pharmacy operates and the usage they have been considered along able to keep it up to date and as and their teams are familiar with the requirements for the BNF in with the other comments received accessible as possible. Our layout of the hard copy of the BNF and community pharmacy have been in the consultation, to inform the comments are made from the can find and interpret the information largely overlooked. The electronic development of the enhanced perspective of community they require quickly and easily. The BNF and BNF Apps have limited BNF. The uptake of digital pharmacy; for reasons covered in current electronic BNF is more use in community pharmacy formats and distribution of print detail in this response, we support cumbersome to use, with many clicks currently. Community pharmacies formats of the BNF will be subject the continued provision of hard required to reach the required should continue to receive, free of to ongoing monitoring by the copy versions of this vital information. Each click can also take charge, hard copies of the BNF NICE Board. NICE acknowledges resource; we hope our views will several seconds to refresh. twice a year in March and that digital infrastructure and be fully considered. September as was the case access to portable devices In a typical pharmacy, the ability to before the changes in distribution throughout the NHS is not fully For community pharmacists and access required, up to date information were announced last December, developed. Annual distribution of their staff the BNF/BNFC is the in a timely manner is essential to its without any consultation. We print formats will continue in line reference source they refer to smooth and efficient running. believe that community with user requirements, subject to first, typically many times a day: Unfortunately, for many patients speed pharmacists will continue to use ongoing monitoring and review by  When dispensing is of the essence, whether it is the time the most recent hard copy version the NICE Board. prescriptions – to check waiting for a prescription to be they have, while other versions dose, indications, dispensed or the time a pharmacist gradually replace them as All pre-registration pharmacists contra‐indications, side takes to find information to answer a technology facilitates the who are registered with the Royal effects, formulations, query or support a patient to self-care. transition, and as the speed to Pharmaceutical Society are brand name, The enhanced BNF needs to offer information of electronic versions supplied with free editions of BNF clear improvements in speed to improves. and BNFC.

[Insert footer here] 22 of 383 manufacturer information and meet the access Pre‐registration pharmacists are requirements of community pharmacy another group who need access The move to annual distribution  When responding to if it is to supplant the hard copy of the to the BNF; they need the current was supported by extensive user queries from patients, BNF as the version pharmacists use in BNF for both study and for the research undertaken by NICE. when supporting self-care accessing the information they need to open element of the We recommend users access or during service delivery provide effective patient facing care. pre‐registration assessment. All digital formats where possible and e.g. medicines use students should use the same user the print format as a backup. It is essential that the new enhanced reviews or the new format of the BNF, which should electronic BNF functionality is road medicine service for the remain the hard copy. They The spring editions of BNF are tested with groups of all practitioners same reasons should be supplied with two hard available to purchase here: who might use it before the system copies of the BNF, free of charge, goes live. We would suggest tester in September and March, during http://www.pharmpress.com/bnf  When discussing a groups of sufficient size to make the their training year. medicine with a prescriber results meaningful. or another healthcare professional, typically A move to wholly electronic would away from their record leave a gap in outages of system whether face to computer networks. Investment in face or by telephone the infrastructure necessary to support the widespread use of the  When responding to electronic BNF (twenty four hours requests for information a day seven days a week) does from another healthcare not appear to have been professional either on the considered as part of this telephone or face to face consultation and is necessary to support the electronic solutions  As independent or proposed.

supplementary In short, we believe that a paper

prescribers, when copy of the BNF is the easiest

checking information and quickest reference source to

before prescribing use and is still fundamental to the

day to day running of a

 When undertaking community pharmacy. domiciliary visits or visiting care homes, prisons or other residential settings. In some instances, hard copy information is

[Insert footer here] 23 of 383 essential: electronic communication devices are not allowed into prisons

 For study. Pre-registration pharmacy graduates use the BNF for study, and for the open question part of the pre-registration assessment.

The average community pharmacy dispenses over six thousand prescription items per month1. Community pharmacies work to standard operating procedures to ensure that the supply of medicines is as safe as possible. No other part of the health service manages as many transactions with so few errors and incidents. Community pharmacies use a computer programme to record all patient information regarding prescribed and dispensing medicine and service delivery – the patient medication record (PMR). The PMR may also include other pertinent information where available such as a patient’s allergy status. Some PMR systems allow access to the BNF through the user interface, although this is not the case for all systems on the market. If the PMR system doesn’t allow direct access to the BNF, then it may

[Insert footer here] 24 of 383 still be accessed online, although that may involve closing the PMR system first, depending on the set up of the local IT solution. Community pharmacy owners may ensure that information governance and, where appropriate, corporate IT security requirements are complied with before enabling pharmacy computers to access external websites.

Many pharmacies currently operate a single PMR terminal, which can restrict access to the electronic BNF when processes – dispensing, performing the pharmaceutical check, running a medicines use review – are happening simultaneously. Dispensaries are designed for the safe dispensing of medicines and to make the most efficient use of space. There may not be space to install extra terminals, while safety may be compromised if the dispensing process is interrupted, for example if a member of the pharmacy team needs access to the computer to refer to the BNF.

The consultation document refers to the BNF Apps. Current use of Apps in the community pharmacy setting is extremely limited and for the majority of pharmacies will not replace a hard copy BNF any time soon. The reasons for their limited

[Insert footer here] 25 of 383 use are:

 Community pharmacy staff members are not routinely supplied with smart phones (or other suitable electronic devices) by their employers.

 Some pharmacy companies have a policy of not allowing the use of mobile phones, tablets

 and other electronic devices in the dispensary in order to limit the opportunity for Information Governance breaches or risks to system security. The use of such devices is also discouraged since they can disrupt work flows and increase the risk of errors.

 Users may need an Athens password to download. As registered healthcare professionals, community pharmacists and registered pharmacy technicians are eligible for Athens passwords, but most are not aware of this. Those that have tried

[Insert footer here] 26 of 383 to obtain an Athens password have told us that as pharmacists and registered technicians working in community pharmacies they are not classed as NHS employees and have been deemed ineligible.

 It is not clear from the eligibility criteria whether Community Pharmacists who are other pharmacy staff who employed by a Pharmacy which may use the BNF from has an NHS contract to supply time to time are eligible medicines to answer FP10 for an Athens password. prescriptions are eligible for an Athens password. Information on how to register for Athens can be The consultation states that the found here: BNF Apps will only be available free of charge to NHS employees. We believe that free access http://www.evidence.nhs.uk/about should be available, explicitly, to -evidence-services/journals-and- those contracted to provide NHS databases/openathens services, not just those employed by the NHS. Currently hard copies of the BNF are provided free of charge, with one per registered pharmacy. We believe that the BNF (hard copies and electronic versions) should remain available free to all those providing NHS services; at present both the electronic and Apps versions have limited use in community pharmacy. Public Health Public Health England (PHE) The most important elements of an From a vaccination point of view, Thank you for your comments, England endorses the proposed vision for enhanced BNF would include the links to the Green Book would be they have been considered along

[Insert footer here] 27 of 383 an enhanced BNF as described, following: helpful. Although this is the with the other comments received which would be the most efficient definitive guide on the use of in the consultation, to inform the way to ensure that clinicians are  Medicines information going vaccines it is not on the list of development of the enhanced referring to the most up-to-date beyond what is in the NICE accredited guidance and BNF. The uptake of digital information However, the manufacturer's datasheet. does not appear to be referred to formats and distribution of print organisation recognises the in the links provided by the formats of the BNF will be subject challenges presented, particularly  Integration with NICE current online BNF. to ongoing monitoring by the in ensuring users have adequate NICE Board. NICE acknowledges guidance where available, internet access. In many Trusts and/or an explanation of that digital infrastructure and this may be a considerable important omissions e.g. why a access to portable devices challenge with a single available drug is not licensed for use in throughout the NHS is not fully terminal on a ward. Clinicians pregnancy which may be developed. Distribution of print working in the community may because the evidence is not formats will continue in line with also not have readily available available or it is too expensive user requirements, subject to internet access when in patients’ to license rather than the ongoing monitoring and review by homes or working in schools and reason being that it is the NICE Board. currently are often reliant on print dangerous. versions. By supporting this, Since they work offline, a prescribing clinicians would  Key references would be connection to the internet is not benefit from having a useful. required once the BNF and BNFC Smartphone, iPad or similar apps are downloaded onto a device, which will have resource  Users being able to sign up for mobile device. implications. changes and side effect alerts for drugs of interest. When changes happen this is the best way to keep up-to-date. Having an efficient alert system is endorsed.

 Good search facilities - the Smartphone app is quite cumbersome at present.

 The Smartphone app being more widely and easily available.

 Data presented by individual

[Insert footer here] 28 of 383 drug e.g. penicillin and by disease for common conditions, which the BNF already does to some extent.

 Ensuring the information is quick to download.

 Any digital format obviously needs to be easy and intuitive to use.

 It would be helpful if there are links from specific sections to broader sections or for all the material to be contained on one page for each drug, e.g. if the drug has interactions or renal/liver/pregnancy cautions then this should all be linked or listed in one place rather than having to look up each section individually as is apparently the case at the moment. Royal College Members of the Royal College of Thank you for your comments, of Anaesthetists are generally in they have been considered along Anaesthetists favour of an on line version of with the other comments received BNF and indeed some of our in the consultation, to inform the members already use this facility. development of the enhanced However our members advise BNF. The uptake of digital caution in doing away completely formats and distribution of print with the hard copy version of the formats of the BNF will be subject BNF, as there have been to ongoing monitoring by the instances where the online NICE Board.NICE acknowledges version has not been accessible, that digital infrastructure and due to poor internet connection in access to portable devices some hospitals/departments and throughout the NHS is not fully limited access by NHS staff to developed. Distribution of print

[Insert footer here] 29 of 383 OpenAthens for NHS, where the formats will continue in line with app for the BNF is available user requirements, subject to ongoing monitoring and review by the NICE Board.

Since they work offline, a connection to the internet is not required once the BNF and BNFC apps are downloaded onto a mobile device.

All NHS staff are eligible for an OpenAthens password, information on how to register can be found here:

https://www.evidence.nhs.uk/abo ut-evidence-services/journals- and- databases/openathens/registratio n-process

Royal College We are broadly supportive of the We agree that it will be useful for Careful thought should be given Thank you for your comments, of Nursing proposals to enhance the medication information to be linked to how healthcare staff are able to they have been considered along information offered by the BNF with “easy to read” patient information. access this resource as not with the other comments received publications. It would be This will be helpful when, talking with everyone has good access to IT in the consultation, to inform the particularly helpful for those who patients about their medication and when prescribing. development of the enhanced have access to effective IT ensuring that they leave the If this is not addressed there is a BNF. The uptake of digital resources. Access to a digital or consultation with accurate and risk that out of date print versions formats and distribution of print mobile application based version evidence based literature about their will remain in circulation because formats of the BNF will be subject could be useful. treatment that is accessible for them. staff do not have access to online to ongoing monitoring by the resources. NICE Board.NICE acknowledges The idea of having access to We agree that any instances of that digital infrastructure and multiple functions such as conflicting advice need to be We would also urge NICE to access to portable devices interactivity, mobility and addressed through open, transparent explore how the proposed throughout the NHS is not fully integration with other systems to processes of guidance development. It system will connect to related developed. Distribution of print enable point of care decision is helpful to note that users of an software systems such as formats will continue in line with making makes sense, and would enhanced BNF would be able to see ‘SystmOne’ and any other user requirements, subject to make the BNF more user friendly. the reasoning for any differences from relevant clinical information ongoing monitoring and review by

[Insert footer here] 30 of 383 NICE guidance, which they currently system. the NICE Board. The idea of linking high quality are unable to do. This will help information for patients, is an healthcare professionals make a more NICE will need to ensure that the excellent one, and means that informed judgement. proposed system is integrated there is a higher chance of with existing platforms to concordance during prescribing maximise accessibility for

sessions with patients. healthcare staff.

We agree that it will be important for the enhanced BNF to explain any points where BNF guidance conflicts with NICE guidance. This should be presented in a clear and unambiguous way to enable practitioners to make safe and evidence based decisions in practice settings.

We are however, concerned that a situation where a digital version of the BNF publications is the only option available, as the vision proposes, will not meet the needs of those nurses who do not have the luxury or access to digital technology.

We would be concerned that staff working in remote settings or areas without adequate Internet access would be prevented from accessing this resource. Print versions should be made available and updated within specified timelines for those who cannot rely in access to the internet. Royal College  The concept – of moving  The ability to one accessed on  Small point, but important Thank you for your comments, of Paediatrics from ‘BNF’ to a drug- multiple electronic interfaces for BNF for Children – they have been considered along

[Insert footer here] 31 of 383 and Child reference linked to e.g. iPhone app, pc etc. need more specialist with the other comments received Health guidance and evidence – Electronic so always kept as paediatric input into the in the consultation, to inform the is excellent. up to date as possible. organ-specific drugs. To development of the enhanced give an example, some of BNF. The uptake of digital  The challenges in  A user friendly index that is the doses used of drugs formats and distribution of print undertaking this transition easily searched online. in the GI section are out formats of the BNF will be subject will be in making sure that of keeping with evidence to ongoing monitoring by the access really is  A drug calculator. and international NICE Board.NICE acknowledges maintained. This will consensus. that digital infrastructure and require excellent search  The most important elements access to portable devices facilities, multiple user are that it should be  We believe chemotherapy throughout the NHS is not fully approaches and clear accessible, easily downloaded is currently not ‘in’ the developed. Distribution of print signposting of ‘how to’. from a normal aging practice BNF – but is in some formats will continue in line with computer system which has a NICE guidance – and will user requirements, subject to  Good that the BNF is lot of memory heavy software be outlined in specific ongoing monitoring and review by moving to a digital format and on a network so little standards set by local the NICE Board. as this will ensure it is as spare capacity. It's a computer networks and national up to date as possible problem and investment in steering groups. Will such Since they work offline, a and much easier to General Practice problem as processes remain outside connection to the internet is not search. However some much as anything? the system or be drawn required once the BNF and BNFC print copies need to be in? apps are downloaded onto a made available, albeit in  It must be easily accessible to mobile device. lower volumes in case of all relevant people without  Inclusion of medical technology failure. complicated log in devices is helpful, but arrangements. what is a ‘medicine’ and  Challenges will arise from what is a food product. the extremely uneven  It must work on all platforms / The difference is nature of IT provision in devices easily, and be reliable becoming increasingly the NHS, and a continued – i.e. low chance of “down blurred – what about use of paper references time”. borderline substances by many clinicians. At e.g. milk formula – should present, the paper based  The paper version must still be there be more BNF is very efficient to available freely and easy to advice/clarity on use and the electronic read / use. indications – their versions in my view is economic costs are high; less accessible.  Good search function, probiotics; vitamin including “sounds like”, and preparations etc. What  Is in-NHS access to be search by description of tablet about parenteral nutrition products?

[Insert footer here] 32 of 383 password free? (for history taking and possible Remembering multiple poisoning / overdose).  The capacity of many GP logins is a practical computers and challenge for many staff.  Regular, easily readable interactivity is poor and summaries of updates / they would not be able to  We think that this is an changes – available via email, use the enhanced BNF excellent goal. A “paper- but also on the site. These even from work. When lite” solution is clearly the must also come in printable accessing through remote preferred option, form for sharing with access via NHS websites recognising that “paper- colleagues. the problem is even more less” is not currently difficult. It would be much achievable in all settings.  2.1 and 2.2, especially being a safer being able to access ‘single authoritative source of the paper version and  We agree that the current medicines information etc. there is a risk that even electronic system which is more old copies would be based on the paper  Had the EU Clinical Trials used if the paper version version is very user- Directive and the EU is thought to be unfriendly. Layout and paediatric legislation been “obsolete”. search functions are not effective in driving new clinical helpful. trials and producing new  There is not specific information, there might be a comment about which  We think the usability for great deal more evidence- operating systems will be the end user is therefore based (clinical trial based) supported. Some a bigger issue than is information to refer to. companies are following a currently acknowledged in Unfortunately, this is not the single route – e.g. this vision and should be case. Will NICE have the windows, or iOS the central issue in any power to commission studies exclusively. We think that redesign. when information is lacking? that would be a mistake, and maintaining flexibility  We have concerns on  The BNFs should be to use browser based how much content will be straightforward books for solutions on a PC/laptop, available to the public as professionals to use simply, must be available as well the list of drug side effects knowing their limitations, and as apps for Windows, iOS is often lengthy and lists not try to be all things to all and Android. even very rare men and women. Each complications. Could this professional will use it  Downloading to ‘local cause problems? differently. formularies’ is also very important to achieve.

[Insert footer here] 33 of 383  This sounds really good  Some mobile signals are poor ‘Addressing conflicting and we hope it will be on the wards and so not a advice’. This may include made user friendly and reliable access and it would be 2 further challenges; interactive, e.g. smart more time consuming ‘fitting in’ with established phone and ipad apps etc. electonically in A & E and local protocols for an we think it would be great outpatients. Also are hospitals increasing number of if it also included drug going to provide mobile common acute Paediatric infusions that are devices capable of this? illnesses and recognising commonly used on the differences in Health paediatric intensive care  Does every prescribing, Policies in all the 4 parts (e.g. dopamine, morphine dispensing and administering of the UK. etc. as it is very easy to health professional carry a write these up incorrectly fully charged, Internet  Are there plans for NICE The proposed enhanced BNF with potentially very connected device which can to place cost-benefit would link to NICE guidance, serious consequences). be readily used and shared analyses including Technology Appraisals. One of the feebacks we with no risk (or at least very (pharmacoeconomic received was from the minimal risk) of theft or loss, information) alongside the author of the “Drug guide loss of signal, loss of service? medicines? to cardiac intensive care No, they do not. If so, this is a at Great Ormond Street” good way to go. A phased  Some comments have in 2008 (which they are transition will be necessary. reported that they always still using – both have the mobile device electronic and paper  Concise, most used/needed apps available and versions). She is happy to information at the top level, no electronic access most advise on this matter if multiple clicks or foraging to definitely has its place but that would be of any help. find essential commonly not entirely at the required information. expense of the printed  In theory great. However word. smartphone access on wards is not always  Unless someone actually encouraged. There are looks at whether and how child protection issues in the paper copy is used paediatrics. Issues in and by whom, we are at PICU’S and cardiac units. risk of creating a culture Hospitals do not have where checking doubts widespread wifi access, and uncertainties with and 3G access can be respect to drug use is problematic due to the made so difficult as to no nature of the buildings, or

[Insert footer here] 34 of 383 surroundings (ie MRI longer be a feasible part units). Smartphone of routine immediate care. access may not be suitable for nursing  The idea of looking at checking doses in the how it is utilised sounds BNF or administration good, although BNF may guidelines whilst have done this recently? preparing iv or other sterile medicines.  We risk removing the most reliable source of  It would be really useful if reference from those least you could type in a likely to have access to a patient’s date of birth, computer at the point of weight and gestational care. age (if relevant) and the recommended dose could  Paper copy transition – be calculated. Many risks of adopting digitally intensive care retrieval appropriate format systems work on this increases risk of problems basis currently (CATS, using paper copy safely STRS and SORT retrieval and in a timely manner – services to name but a etc. few) and this works really well for paediatricians in DGHs trying to manage acutely unwell patients with unfamiliar drugs etc and also for the retrieval registrars.

 Many intensivists also still use the Guys formulary and the Melbourne drug book written by Frank Shann as reference texts as they contain information that the cBNF sometimes does not. It would be useful for there

[Insert footer here] 35 of 383 to be just one reference guide which encompassed all this information (i.e. the cBNF)

 Visionary in one sense. If only we could keep everything (including computers and training) updated all the time.

 Computer access is useful on wards, however there is still a long way to go in ICT infrastructure until there are enough computes available.

 Blue sky thinking. GPs are often aware of possible conflicts in evidence and information as they are already signposted in BNF. Not sure that added expense justified.

 Concerns over what is a very focused, useful and usable publication (BNF) will become diluted and less useful in this vision. While the issue of reducing reliance on print and conflicting advice are seen as two key challenges we think the

[Insert footer here] 36 of 383 issue of ease of use is the biggest challenge. It is often the case that the electronic systems that are being introduced to us in health care are often much less easy to use than the paper based systems they replace. The end result is the clinician at the sharp end is made less efficient by digital design.

 Much needed and long over-due. Challenge will be ensuring the process are transparent, getting buy in from busy clinicians to develop the product, and conflict resolution

 We think it will give added opportunity to build on the BNF's valued position in prescribing and enhance its potential, and reduce the risks

 The BNF is a great resource, used throughout the English speaking world. Hardcopies are a necessity. ICT access and smartphone access is to be encouraged,

[Insert footer here] 37 of 383 however we are far from dropping the hardcopy access.

 The BNFc must remain as a separate entity to keep it workable. Would like to see more of a standardisation of the BNFc doses and those that appear in the adult version also.

 We like the brief concise proposals. Including the view of patients etc. (1.5) is difficult but essential.

 Childrens BNF is great. We would like it to be able to validate / calculate doses based on entered weight, height, age etc

 We would like to be able to see life size pictures of tablets. This is really important for communicating with parents and children and making appropriate choices with them

 Direct links to patient info sheets would be good.

 The ability to link directly from other websites to a

[Insert footer here] 38 of 383 selected pages would be good

 Remove the need for login etc. this should just be in public domain

 Comment from an NMP: have always found the BNF and BNFc to be an essential tool in prescribing. It is probably one of the most used references in our office. Although based at the hospital, being a community worker, and have the BNFc with me at all times. Lucky to have access to an Ipad and have the electronic version downloaded. However using the electronic version when prescribing at a patient’s home is usually impossible and totally dependent on how good the 3G signal is. It is not therefore a reliable method. Whilst they can see the advantages of regular and up to date changes to the BNF electronically as appose to the paper version, It is not reliable when prescribing in the community. Many of my

[Insert footer here] 39 of 383 community colleagues don’t have access to an electronic device to have the BNF down loaded onto and they think that unless individual Trusts and NHS institutions drastically update there IT systems, this is always going to be a problem for community based prescribers.

 Comments from a Lay Representative

- Use the BNFc a lot in assessing new uses for paediatric drugs/safety issues on PM EAG at MHRA. We use the paper version. I had not appreciated that it is on-line. The PM EAG is made up of a variety of paediatric specialists and it is not uncommon that when we come to look at the BNFc for whatever drug we are considering that someone will say "well, that's not how we use it in practice" or "that's not really the scope of the use".

[Insert footer here] 40 of 383

- Often quite surprised how loose the BNFc is regarding indications/dosage in light of the subtle distinctions clinicians will make. For example, a drug may be licensed from 1 yr but the dosage details are only given from 5yrs, or the bands are much wider for some drugs than for others (e.g. 2-12 years) when there is clearly a big difference between the physiology of a 2 year old and a 12 year old.

- Do wonder how up to date BNFc is in relation to high rates of childhood obesity?

- Read what the consultation said about moving towards online rather than paper-based use and in light of the many updates that seems very sensible. We weren’t sure whether the

[Insert footer here] 41 of 383 paper version is planned to be phased out?

- Really pleased to see that medical devices will be included. There seems to be so much crossover now, with drug delivery devices for example, between the two.

- As a patient/parent it is admirable that they want to make the BNFc as patient/parent friendly as possible and as an on-line resource I imagine it will become more so. At the same time, as regards joint decision making I have seen better tools for doing this (e.g. NHS decision making aids e.g. Glue Ear http://sdm.rightcare. nhs.uk/pda/glue- ear/) but not sure if these are for conditions that require pharmacological as

[Insert footer here] 42 of 383 opposed to surgery/therapy interventions?

 Other Council members were positive about the proposal. “I think the proposals made are on the changes to a digital enhanced BNF/c are clearly very positive and open up the possibility of links to so much material currently not there in the hard copy version. In order to make the whole project work the search facilities within the site need to be really excellent. Access does need to be very simple so that all health professionals can get there without passwords etc. I would not see why this site should not be open to the public too”.

 Points also made were:

- Currently paediatric pain (acute and chronic) is not adequately covered and there need to be links to e.g. epidural guidance which NICE may not support/review...how

[Insert footer here] 43 of 383 will this be addressed? Analgesic drugs are within a chapter called "anaesthesia" I think and is such an important subject that I feel it should have its own (general) chapter.

- Some of what is written around meds in the BNFc is still currently based on age. Not sure if this will change but we ought to make the point that this is a problem

- Is there an opportunity to embed calculators into the website to try and prevent drug errors?

 The printed edition provides the only way for rapid cross-referencing and searching. The search can be done in "three dimensions" whilst an on-line search is more "two dimensional”. We would be against doing away with the printed edition.

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 We suggest that the NICE vision seems decidedly clouded and an entirely electronic version would most definitely not reflect the requirements and needs of this particular user. Parts of the vision strike me as gadgetry and "correctness" just for the sake of it and with seemingly little understanding of what actually happens on a real ward.

 Paper copy is still the most used and most accessible. Need to ensure transition reflects this. Royal College The RCP is grateful for the Thank you for your comments, of Physicians opportunity to respond to the they have been considered along above consultation. Our members with the other comments received and fellows believe that the BNF in the consultation, to inform the is one of the greatest development of the enhanced achievements of medical practice BNF. The uptake of digital worldwide. As such, we have formats and distribution of print encouraged them to respond as formats of the BNF will be subject individuals to the NICE to ongoing monitoring by the consultation survey. However, NICE Board.NICE acknowledges from feedback received the RCP that digital infrastructure and remains extremely concerned with access to portable devices regard to some of the proposed throughout the NHS is not fully changes being put forward by developed. Distribution of print NICE. The attached letter from formats will continue in line with the chair of the RCP Joint user requirements, subject to

[Insert footer here] 45 of 383 Specialty Committee on Clinical ongoing monitoring and review by Pharmacology and Therapeutics the NICE Board. to Professor David Haslem, NICE Chairman regarding the earlier Since they work offline, a NICE accreditation report connection to the internet is not illustrates these areas well. We required once the BNF and BNFC also wish to make the following apps are downloaded onto a comments. mobile device.

 The BNF has a tiny budget compared to pharmaceutical companies, yet provides an incomparable counterbalance to the multi-billion pound advertising budgets of the pharmaceutical industry.

 The paper format must be maintained. It is not currently possible to count on expensive hand held devices in a busy casualty or ward in the middle of the night when the internet might go down, or a device goes missing. We believe there should be even greater dissemination of the paper copies.

 The electronic version is an excellent addition, but should not be viewed as a replacement for the paper version, at least until ease

[Insert footer here] 46 of 383 and stability of electronic access is possible across the whole of the NHS.

 The electronic version would benefit by cross referencing the following databases; NICE, Cochrane Database, Electronic Medicines Compendium (an excellent database currently underused by prescribers and medical students which lists all the SPCs for medicinal products: https://www.medicines.or g.uk), MHRA website (now also valuable resource for looking up SPCs).

 Care must be taken when referencing existing databases not to make the BNF unwieldy and a repetition of other sites. The Imperial The Imperial Healthcare NHS Thank you for your comments,

Healthcare Trust Pharmacy Executive they have been considered along NHS Trust acknowledges the drivers for with the other comments received Pharmacy increased use of technology to in the consultation, to inform the Executive deliver prescribing information, development of the enhanced such as increased availability of BNF. NICE acknowledges that mobile devices and the digital infrastructure and access introduction of electronic to portable devices throughout the prescribing. We would support the NHS is not fully developed. ongoing development of Distribution of print formats will

[Insert footer here] 47 of 383 electronic platforms for key continue in line with user reference sources such as the requirements, subject to ongoing BNF. However, we believe that monitoring and review by the there is still currently a significant NICE Board. and important place for paper copies of the BNF in hospitals and would be concerned if the production and distribution of these were to be withdrawn.

The reasons are as follows:

• Not all staff have access to PCs or smartphones at the point of care.

• Pharmacists and nurses frequently find obtaining access to PCs on hospital wards problematic.

• Using electronic information resources at the same time as carrying out complex tasks which also require PC or mobile software such as electronic prescribing or dispensing usually requires switching screens, which makes tasks more complex and increases the chance of errors. It is therefore important to be able to use a paper BNF to support other computer-based tasks

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[Insert footer here] 49 of 383 Comments received from individual commentators

Role Consultation question 1: Consultation question 2: Consultation question 3: NICE’s Response What are your views on the What do you think are the Do you think we have vision for an enhanced BNF as most important elements of overlooked anything? described? an enhanced BNF?

Pharmaceutical The idea is fine but the BNF Keep the current chapter We need clear guidance on Thank you for your comments, they Adviser, NHS content needs improving. There structure but include rankings of monitoring, especially for side- have been considered along with Kernow is no advantage in simply listing medicines in line with NICE effects. Simply saying that a the other comments received in the medicines without a clear guidance. drug may have eg visual side- consultation, to inform the ranking of their value to the NHS. effects leaves us to deduce development of the enhanced BNF. With the exception of the items what sort of test should be less suitable for prescribing, this performed and how often. That valuable information is not should be made clear. currently in the BNF.

Managing It is fine. I would put it slightly The most important element is There is an important Thank you for your comments, they Director, EBN differently. I would say that BNF the separation of the core discussion to be had with the have been considered along with should remain a rich and knowledge base and its current owners about what the other comments received in the definitive source of evidence- published forms. By separating constitutes a sustainable consultation, to inform the based guidance, or agreed best the two, a whole range of BNF funding arrangement. The development of the enhanced BNF. practice where evidence is weak. instances, to suit very many involvement of clinical experts It should be made available at different use cases, can flourish. and professionals is essential every point in the workflow In five years it would be good to to make sure development where it can contribute to good see a wide range of products continues to meet clinical decision making. Where possible incorporating appropriate parts needs, and to command the this means integrating into of BNF, accredited via the full support of the professions. existing work practices so a expert licensing panel described professional can use BNF above to make sure they reflect without "looking up". To do this I correctly the intention of the core believe that BNF needs to be knowledge base. transformed into a knowledge base, curated using the best editorial tools and processes. However its subsequent use should not be limited to particular

[Insert footer here] 50 of 383 instances such as "books", "apps" and so on. Instead an open licence is required to allow third parties to use the knowledge base (as many NHS Trusts and others already do, but on an informal basis). A new team must be created to verify that BNF is rendered correctly by third parties - a quality assurance panel; this team could also be tasked with creating APIs or other simple tools to make BNF available in very many environments. For example, a simple downloadable spreadsheet of cautionary and advisory label wording linked to dm+d codes could feed any dispensing system and contribute to patient safety. The new open licence for reuse of the BNF knowledge base should be part of the core IP arrangements for the BNF and could be funded using the money saved from reducing central orders for books.

[Insert footer here] 51 of 383 Patient (former Overall is good and makes It is important to have a live As a patient my only concern Thank you for your comments, they CCG board sense. central reference point knowing would be that I would like to have been considered along with member) content is as up to date as know of any the other comments received in the possible. Re 2.2 it is good that emerging/experimental consultation, to inform the international sources are treatments not yet fully development of the enhanced BNF. included. 3.3 I would like to see clinically tested for conditions conflicting advice left in ( with a to really encompass the spirit disclaimer pointing out the of a comprehensive reference conflict to the prescriber/patient ) point. ( e g I understand that so that the patient can make an elsewhere in parts Europe it is informed choice re treatment, routine to have scans in pending development of detecting lung cancer, guidance to resolve conflict. compared with the U K where an X-ray is used - which is much less reliable in detecting the cancer in early stages. )

Procurement I can see all the advantages of Authorative information which is Could it undertake complex Thank you for your comments, they Specialist an electronic version. In terms of UP TO DATE. Ability to search dose calcuilations (if given have been considered along with Pharmacist keeping it up to date, not having Could it undertake complex patient parameters). Could it the other comments received in the back copies lying around etc. It dose calcuilations (if given prompt for interactions if consultation, to inform the would also be easier to find stuff patient parameters). Could it patients history typed in? development of the enhanced BNF. etc. BUT the paper copy is so prompt for interactions if patients NICE acknowledges that digital very convenient and accessible. history typed in? infrastructure and access to Especially when on the move portable devices throughout the and when there is no access to NHS is not fully developed. Wi Fi etc. If I could download a Distribution of print formats will copy onto a laptop that woule be continue in line with user ideal but then there is the issue requirements, subject to ongoing of keeping the laterst version etc. monitoring and review by the NICE Board.

[Insert footer here] 52 of 383 Consultant There needs to be three bnf. The Patient friendly screen- photo of Dont try and be the be all and Thank you for your comments, they Psychiatrist paper copy must exist because tablets, big text Drug interaction end all. Encourage people to have been considered along with community workers cannot from (click two or more drugs quote BNF as a range of the other comments received in the always use (or afford) tech and and press display) The option to sources and compete on consultation, to inform the its harder to include clients by overlay local formularies so accessibility encouraging development of the enhanced BNF. showing them a screen. Mobile which drugs are in and which people to look more widely and NICE acknowledges that digital bnf should not require a data are out are clearly defined highlight areas where infrastructure and access to connection should include differences are appearing. portable devices throughout the keyword searches and should Then acknowledge or amend NHS is not fully developed. include an automated drug as appropriate. Distribution of print formats will interaction flagger. The continue in line with user enhanced part can use data for requirements, subject to ongoing updates at intervals and storage monitoring and review by the NICE of personalised stuff securely Board. offline. Nothing identifiable must Since they work offline, a remain on a stealable mobile connection to the internet is not device. The web based ebnf required once the BNF and BNFC should include nice guidance apps are downloaded onto a mobile and other guidance, without device. feeling the need to only issue one message. The advantage of saying there are three guidances on this matter are a) informed choice b) supporting professionalism c)underlining that only StarTrek find the correct answer every time.

Semi retired A good idea, however must be As mentioned above, the size The new BNF must be trialed Thank you for your comments, they pharmacist evolved to allow users to and use in the field are the and show to work before any have been considered along with consultant become familiar with the new strength of the BNF. The changes are made to the the other comments received in the systems and for developers to independence of the source of availability of the paper consultation, to inform the ensure thay can handle the information and the quality of version. development of the enhanced BNF. changes. The paper version is staff producing the output NICE acknowledges that digital useful for two reasons, it is a ensures that it is used as a infrastructure and access to suitable size to fit in the pocket reference source not only in the portable devices throughout the and does not require technology UK but in many other parts of NHS is not fully developed. so can be used in the field. the world. Distribution of print formats will

[Insert footer here] 53 of 383 continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. Extensive user testing will be undertaken to support the release of any enhancements to the BNF,

Domain Lead Sounds marvellous! Quicker access and lower costs Paper should still be available Thank you for your comments, they Information as a back-up have been considered along with Standards the other comments received in the Board consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 54 of 383 Advanced anything which improves access They most useful will be the NOT AT THIS POINT Thank you for your comments, they Nurse to authoritative information has ability to have up to date have been considered along with practitioner to be a good thing. integrated information. it is the other comments received in the INTEGRATED nICE INFO IS important that the information I consultation, to inform the ESSENTIAL use on my I pad is as development of the enhanced BNF. comprehensive as the books, NICE acknowledges that digital which as I work for the OOH infrastructure and access to service in Cornwall which is portable devices throughout the commissioned by Serco ,I NHS is not fully developed. understand have not been made Distribution of print formats will available to the organisation, continue in line with user despite being commissioned by requirements, subject to ongoing the nhs. It is important that we monitoring and review by the NICE do not have too download info Board. Print copies of the BNF and regularly as we are often out of BNFC are available free of charge signal and this is our only asset to eligible staff working for OOH in terms of prescribing which is services, please contact why , when you are in the [email protected] to arrange for middle of a farm in the early provision of copies. hours a book was always helpful.

Medicines Seems to be appropriate to That the information is no, its reasonable Thank you for your comments, they Information expand the information and links authoritative and evidence comprehensive. Theres a risk have been considered along with Pharmacist beyond the current BNF content, based; where approrpiate it of information overload. The the other comments received in the but it is unclear how the should also express a view on current web based format of consultation, to inform the information could be extended cost effectiveness. The the BNF could be more user development of the enhanced BNF. into areas where the information aspiration of including devices is friendly, it has a look as if the available is of poor quality, good, but often the trials of paper content has been lifted controversial or simply does not efficacy for these are poor or and simply pasted into a exist (eg long term use of some lacking altogether. webpage. medicines).

[Insert footer here] 55 of 383 Chief I think the idea of buiding on the being searchable and browsable yes the availability and Thank you for your comments, they Pharmacist excellent data already available in numerous ways practicality of using a digital have been considered along with in the BNF is admirable, however version of the BNF in the the other comments received in the I do have concerns that the workplace, especially places consultation, to inform the dependence on access to it via like mental health low secure development of the enhanced BNF. digital media may cause where mobile devices and NICE acknowledges that digital problems where access to digital internet access are prohibited infrastructure and access to media is limited or limited portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Development The vision seems fine. I would want to be able to link to No Thank you for your comments, they manager a specific drug from another have been considered along with systems, e.g. eprescribing, the other comments received in the without having to search for the consultation, to inform the drug. So I need to be able to development of the enhanced BNF. reference a drug and bring up the information on it using the DMD VTM code for the drug. This is possible via medicines complete but will also need to be possible via NHS evidence. This allows system to system retreival of information. This idea could be extended to allow specific parts of the information about a drug to be reteived.

[Insert footer here] 56 of 383 Pharmacist A good idea as long as it is easy Easy use. The current one is no Thank you for your comments, they to use and search. difficult to search and does not have been considered along with present the most likely result the other comments received in the first. It would also be good to consultation, to inform the have an alphabetical index for development of the enhanced BNF. when we only know a partial drug name or are uncertain of the spelling. I would access this via pc or tablet, but the availablility of suitable devices and speed of search is sometimes limiting when on a ward in the hospital

Head of The vision is admirable, I'm not I'm not sure GPs and NMPs are I'm not sure the Health service Thank you for your comments, they Medicines sure we are ready or if it is in a position to routinely use an in the UK is ready for an have been considered along with Management necessary to the majority of enhanced BNF. Accessibility to enhanced digital BNF in terms the other comments received in the healthcare workers at the enhanced information will of practicalities. Health care consultation, to inform the moment probably only be useful in small professionals providing care in development of the enhanced BNF. number of cases a week. Its the peoples homes, care homes, NICE acknowledges that digital routine clarifications and roving GPs, community infrastructure and access to checking that is the bread and nursing etc do not have access portable devices throughout the butter of the BNF in my to phones and tablets that NHS is not fully developed. experience. would make a digital version Distribution of print formats will user-friendly, and what about continue in line with user where signal strength is patchy requirements, subject to ongoing or non-existent. Also some IT monitoring and review by the NICE systems using patient data Board. platforms make it very difficult to access internet based information at the same time as using a patient database.

[Insert footer here] 57 of 383 Advanced The plans to move to a digitised I would like to use this at the no Thank you for your comments, they Nurse version of BNF makes alot of point of care when making have been considered along with Practitioner sense , being able to access prescribing decisions . the other comments received in the more integrated infomation Integration of infomation eg consultation, to inform the would be helpful . The issue for NICE, CKS, and BNF would be development of the enhanced BNF. those working out of hospital is helpful , as would access to access to appropaite technology easily printable infomation for to enable us to utilise this at the patients . point of care which is often in patients homes .

Academic GP This is a really good concept I Providing links to number Electronic devices and internet Thank you for your comments, they Trainee rarely use the paper BNF as I needed to treat and number facilities are definitely not have been considered along with always have the online one open needed to harm data (broken universal and access and the other comments received in the when I am in consultation down, where known to quality is variable PLEASE consultation, to inform the HOWEVER, my practice does subgroups of patients) Providing make sure there is some sort development of the enhanced BNF. not have wifi nor any tablet links to information next to of offline option - even if only NICE acknowledges that digital computers - therefore we are dosing regarding evidence for dated PDF version that can be infrastructure and access to reliant on own mobile internet that indication downloaded or app with offline portable devices throughout the contracts. I do not have an i- capability which is updated via NHS is not fully developed. phone but a windows phone - internet if e.g. going on home Distribution of print formats will apps often are not made for this. visits to prevent problems at continue in line with user Therefore I am keen to the time of patient contact if requirements, subject to ongoing emphasize the need for the internet cannot be monitoring and review by the NICE comprehensive 'off-line' access accessed PLEASE PLEASE Board. even if this is temporary - e.g. dont make this just for i-phone download a dated PDF version - i have a windows phone and onto personal phone so can this is often overlooked by app access it while on home visits or devlopers apps that can be used off line but update as soon as they are reconnected - rather than having to rely on internet connection while out and about.

[Insert footer here] 58 of 383 eBusiness I think this is a brilliant For use when clerking in The functionality of the BNF Thank you for your comments, they Pharmacist opportunity to harmonise these patients, choosing treatments App needs quite a bit more have been considered along with resources and improve dataflows as an inpatient or outpatient work. It does not mimic the the other comments received in the with minimal hurdles to choosing discharge medication way the book works. Dose and consultation, to inform the overcome a BNF/dm+d for discharge summaries. An additional information is often development of the enhanced BNF. collaboration would be a unambiguous way of describing difficult to find as the pages do fundamental shift but provide a medicines which provides not flow from one another well huge and beneficial impact on confidence that the medicine patient safety, intended will always be the medicine dispensed and so ,administered. Unambiguous recording of medicines in Summary Care Record and Electronic Patient Record

Chief I agree entirely with the vision for The most important element of In the broad terms of the Thank you for your comments, they Pharmacist a fully integrated digitally based an enhanced BNF will be its consultation document, I think have been considered along with enhanced BNF. However, in ability to operate as a "one-stop- the key aspects of what is the other comments received in the making that transition, it is shop" for prescribing decision needed have been captured. consultation, to inform the important not to lose the support and as an aid to support development of the enhanced BNF. informative suporting information patient advice and consultation. that the paper version has - it Clearly it may perform this role should be absorbed in an partly by acting as a portal to enhanced way into the digital information held on other version systems, but it needs to ensure that any links are limited to sources of information that meet the quality criteria of the BNF itself.

[Insert footer here] 59 of 383 Acting Chief I agree with the proposal and Rapid and intuitive searching No Thank you for your comments, they Pharmacist support the development of an and browsing functions Ability to have been considered along with enhanced BNF with a more search by Brand but then link to the other comments received in the response user interface, the full monograph for the consultation, to inform the however I am concerned that generic medicine-generic and development of the enhanced BNF. staff (particularly ward-based brand names used NICE acknowledges that digital nursing staff) are still heavily interchangably in hospital infrastructure and access to reliant on a paper copy of the practice Ability to customise for portable devices throughout the BNF and I do not see this local use e.g. provide embedded NHS is not fully developed. changing rapidly, particularly for links between BNF and local Distribution of print formats will areas that do not use electronic information e.g. local formularies continue in line with user prescribing. Access to IT at ward or other info sources e.g. requirements, subject to ongoing level is currently insuffient to Medusa IV administration guide monitoring and review by the NICE support electronic-only access to Board. the BNF. Where we have tried to use electronic-only access to other information sources e.g. Medusa IV infusion guide this has not proved successful.

GP Prescribing "Be produced to rigorous, open 1) Comparing effectiveness, It's a huge challenge and I Thank you for your comments, they Adviser and transparent processes that safety, cost-effectiveness, hope it hasn't been have been considered along with (Pharmacist) meet the NICE Accreditation quality etc of all medicines and underestimated in terms of the other comments received in the standards, and provide clarity devices listed 2) Making it easier staff willing to change. It will consultation, to inform the about how recommendations are for shared decision making 3) require major re-training of the development of the enhanced BNF. made" - This is key to the making the BNF more way all healthcare NICE acknowledges that digital enhanced vision. Although the transparent in it's professionals access BNF infrastructure and access to BNF is excellent and trustworthy recommendations information. I am quite a new portable devices throughout the I do not believe their decision graduate (2008) and frequent NHS is not fully developed. making is currently as user of BNFonline however I Distribution of print formats will transparent as it should be. am still adjusting to accessing continue in line with user "Include commonly prescribed the BNF online...... if it's requirements, subject to ongoing medical devices as well as something I am unfamiliar monitoring and review by the NICE medicines" - This would be a with/quite complex I still resort Board. vital component of any enhanced to the paper version as I am BNF. While a lot of devices are more comfortable with that listed in the current BNF there is format. I can't imagine how no rationale or "prescribing hard it would be fora more

[Insert footer here] 60 of 383 information" available meaning a experienced healthcare lot of time prescribers are just professional to adapt to prescribing based on accessing info from an recommendations. I also believe enhanced BNF. listing in the BNF for devices should mean that these devices should be subjected to the same rigorous study as medicinal products. This unfortunately is not the case presently and many devices of dubious quality are listed in my opinion. "Include links to high quality information for patients, including information to help healthcare professionals and patients reach decisions together " - a great opportunity to tackle shared decision making in a practical way "Allow quick comparisons of key information on effectiveness, safety, patient factors and resource implications" - The BNF is currently a great list of drugs without any real comparison of treatments within it

President RSM Very important. The old style 1) Indicating which products You assume that NICE should Thank you for your comments, they BNF is a dinosaur and should be are endorsed with a positive stay withthe BNF. If the BNF have been considered along with revitalised along the lines appraisal by NICE 2) is unwilling or unable to adapt the other comments received in the described. Stop the print version Reconciling conflicts between to the modern age, then NICE consultation, to inform the and rely exclusively on the online the BNF and other sources of should abandon the contract development of the enhanced BNF. one guidance (especially NICE and start developing the "NICE guidance) 3) Providing Formulary". It wouldn't nearly immedicate access to drug as much fuss as you might safey warnings issued by imagine! MHRA/EMA

[Insert footer here] 61 of 383 Honorary I fully support a move to digital Retention of clarity and ability to The ability to key in 2 (or more) Thank you for your comments, they Consultant format and phasing out print. I refer to it quickly Be searchable drugs and have potential drug have been considered along with Psychiatrist almost exclusively use the BNF and browsable in multiple way interactions automatically the other comments received in the app on smart phone due to the Frequency of update flagged up, stratified by consultation, to inform the frequency of updates and severity (e.g. colour-coded) development of the enhanced BNF. portability. One concern that I and frequency It would be have is that the BNF as it is good to contain currently formatted is a superb downloadable/printable example of clarity of purpose and medicine information sheets presentation. If its purpose is for each drug that could be expanded to include the given to patients when evidence base for choice of discussing or initiating medication, patient factors and medications. Potential resource implications etc it risks integration with computerised becoming cumbersome to find prescribing systems You what one is looking for. If its could use it to deliver usefulness could be expanded intermittent national while retaining its simplicity and medication alerts e.g from DoH clarity of use it would be ideal. or MHRA

GP am happy to have digital would be great to be able to how would things like the Thank you for your comments, they providing our software provider search on treatment areas as tables of supplementary have been considered along with (EMIS) is up to speed with this well as individual drugs substances work? it is the one the other comments received in the but also there is a clear way of time I refer to the book as they consultation, to inform the accessing the whole BNF when are easy to see in the book. development of the enhanced BNF. want more general info not necessarily about a given drug

Dermatology Excellent idea, however may not Ease of use. That there be little I would still like to have BNFs Thank you for your comments, they Specialist always be accessible if it is web- or no 'down-time'. Would like in hard copy format available. have been considered along with Nurse based if there are glitches with 'links' to patient information the other comments received in the P.C.s, connection/internet leaflets, possibly also product consultation, to inform the problems and on home visits. leaflets as included in the development of the enhanced BNF. packaging. Possibly link in to NICE acknowledges that digital guidelines and, or something infrastructure and access to like 'Up to date'. portable devices throughout the NHS is not fully developed. Distribution of print formats will

[Insert footer here] 62 of 383 continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Clinical A good logical way forward for Highlighting Nice/BNF Although technology has Thank you for your comments, they Research the BNF.Information clearly and diffrerences and bringing more moved swiftly since the BNF have been considered along with Pharmacist concisely available at one's information to help in decision introduction,the availability of the other comments received in the fingertips is the ideal way for making. computers/devices still is a consultation, to inform the reducing risks and promoting major issue in most Hospitals development of the enhanced BNF. good medical practice.Bringing and Health Centres. NICE acknowledges that digital Nice and the BNF together would infrastructure and access to lead to an up to date information portable devices throughout the source that would widely NHS is not fully developed. referenced. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Pharmacist no comment no comment Its so handy to have a book. I Thank you for your comments, they dont think that the online have been considered along with version should replace the the other comments received in the book, but just an additional consultation, to inform the option to have alongside. You development of the enhanced BNF. need to make the app more NICE acknowledges that digital accessible. I have tried to use infrastructure and access to it before, but had difficulty portable devices throughout the getting access through the NHS is not fully developed. athens password. Our hospital Distribution of print formats will doesnt have wifi at the continue in line with user moment and cannot yet requirements, subject to ongoing provide handheld devices to all monitoring and review by the NICE users. So users have to use Board. their own personal mobiles to Since they work offline, a access this on the wards using connection to the internet is not their own data allowance required once the BNF and BNFC through personal phones. For apps are downloaded onto a mobile

[Insert footer here] 63 of 383 this reason we need access to device. the book until our hospital infrastructure has the ability to support this ie. wifi.

SpR Medical Great idea - I use the BNF app Accessible and searchable. Try and make the update Thank you for your comments, they Oncology on my iPhone, but it could be Ensure it can be downloaded downloads faster? Or have been considered along with improved significantly. onto phones/tablets, as internet incorporate a function that the other comments received in the Sometimes I can't find the connectivity not always allows downloads to happen at consultation, to inform the information I am looking for in available. Keep it free, and free a certain time every day, or development of the enhanced BNF. the app, but I know where it is in of advertising. week? Sometimes I go to look NICE acknowledges that digital the paper copy, so resort to at the app for info when I am infrastructure and access to looking in that. pressed for time, and am portable devices throughout the offered a download update. I NHS is not fully developed. mean to press 'later', but end Distribution of print formats will up pressing 'now' instead, and continue in line with user as the wi-fi connection at work requirements, subject to ongoing is slow, I then have to wait for monitoring and review by the NICE the download to finish rather Board. than addressing the question in hand.

GP Vision enables computerised Rapid searching with all no Thank you for your comments, they access of BNF - no need for information to hand have been considered along with paper the other comments received in the consultation, to inform the development of the enhanced BNF.

[Insert footer here] 64 of 383 Consultant Well overdue. We use electronic See above Detail is necessarily scanty but Thank you for your comments, they Nephrologist & prescribing in our clinical area all the elements are mentioned have been considered along with Medical but not in the whole Trust, this is the other comments received in the Director hopefully coming. Updating our consultation, to inform the local e system is very time development of the enhanced BNF. consuming. I'd like to see all secondary care prescribing systems interfacing with an electronic BNF and also with primary care (through summary care record or similar). The possibilities for improved safety, audit, research etc once all these are properly joined up are huge

Pharmacy It will be a huge improvement on Integration with other systems is If it is only available in digital Thank you for your comments, they Technician IT what we currently have, the key to realising all the benefits, format, this may cause issues have been considered along with Specialist current electronic version is very logging into a separate app or if it is inaccessible - for the other comments received in the difficult to use compared with the webpage is something that example we have recently had consultation, to inform the paper version. Access to NICE users complain about. Being up an incident where we lost all development of the enhanced BNF. guidance will be very useful, to date and accurate is electronic systems in the NICE acknowledges that digital although we will need to ensure obviously critical, if it's hospital - we have paper infrastructure and access to there is a method for providing integrated with other backups for this eventuality but portable devices throughout the local guidance where this differs applications though this needs if we have no paper BNF we NHS is not fully developed. due to specialist to be a seamless process, have no access to any of this Distribution of print formats will funding/guidance currently applications such as information (we can't rely on continue in line with user FDB require a shutdown of the phone access as some areas requirements, subject to ongoing system to update. eithe have no phone signal, or monitoring and review by the NICE mobile use is not allowed due Board. to equipment). Since they work offline, a connection to the internet is not required once the BNF and BNFC apps are downloaded onto a mobile device.

[Insert footer here] 65 of 383 Quality Positive step to ensure that Access to computers and Could it be linked to NPSA Thank you for your comments, they Improvement information is up to date, like the technology, although most reports on patient safety have been considered along with Lead Nurse idea of including links to other medics tend to have smart incidents and errors providing the other comments received in the sources and particularly like the phones, nurses may not have a direct opportunity to learn consultation, to inform the interactions section them or carry them around from incidient reporting Will development of the enhanced BNF. whilst on duty, yet a significant you be looking for pilot sites? NICE acknowledges that digital number of errors occur during infrastructure and access to the administration phase I portable devices throughout the particularly like the idea of NHS is not fully developed. highlighting the high risk drugs Distribution of print formats will or those that have the most continue in line with user commonly reported errors, requirements, subject to ongoing which may raise awareness monitoring and review by the NICE during prescription and Board. administration. Extensive user testing will be undertaken to support the release of any enhancements to the BNF,

Team No comment No comment I wanted to point out that one Thank you for your comments, they Administrator of the assumptions in the have been considered along with consultation is wrong. The the other comments received in the print version of the BNF is consultation, to inform the probably not distributed to all development of the enhanced BNF. NHS staff that need it. What Please note that Chief happens at least in the Sussex Pharmacists/Heads of Medicines Partnership Foundation Trust Management are provided with a list is that a number are delivered of all staff who are eligible to to one particular office, and are receive copies of the BNF. They are picked up on a first come first responsible for ensuring all these served basis. There is no list of staff are able to access copies. The people who must have it. This list will include all doctors, means not only that some pharmacists and some NMPs. practitioners don't have the up to date BNF, but doctors in Staff who are unable to access outlying units who might not copies, but should receive one, necessarily go to Mill View - for should request one directly from instance, the consultant in my their Chief Pharmacist/Head of

[Insert footer here] 66 of 383 unit, never gets one either. Medicines Management.

Senior Content ideas sound excellent Making it more current in light of The main thing is this sounds Thank you for your comments, they Lecturer, NMP amendments/changes within very London Centric. You need have been considered along with Programme time frame of bi annual BNF. to recognise the poor IT the other comments received in the Lead and V300 Layout sounds better as it can infrastructure for those working consultation, to inform the & V100 be difficult to navigate through outside of the M25 wher development of the enhanced BNF. prescriber internet access is non existent NICE acknowledges that digital or patchy. This affects those infrastructure and access to working with patients in their portable devices throughout the homes/visits to people in their NHS is not fully developed. homes where SystmOne is Distribution of print formats will unusuable and equally the continue in line with user BNF on line will also be. They requirements, subject to ongoing must have the hard copy for monitoring and review by the NICE patient safety otherwise we go Board. backwards from the NMP perspective where drugs cannot be checked and the patient/carer has to pick up a prescription from the surgery. It could also increase risk where some might chose to prescribe because of patient pressure withiout being able to double check the drug details and rely on memory.

Clinical Defintiely the right direction - With childrens BNF don't paper versions still useful Thank you for your comments, they Director Gwent overlap age groups eg 0- OOHome home visits in have been considered along with OOH , Aneurin 3months 3-6 months - parents regions where mobile signals the other comments received in the Bevan get confused re dosing links to still dont work so dont get rid of consultation, to inform the University NICE guidance and other them all together. development of the enhanced BNF. Health Board national sites - toxbase SIGN NICE acknowledges that digital palliaitve care sites. links to infrastructure and access to SPCs especially re frequency of portable devices throughout the side effectd NHS is not fully developed. Distribution of print formats will

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Consultant in A better on line searchable having good search facilities and I think alimited supply of a print Thank you for your comments, they anasthetics version with good links to comments on possible version may still be needed have been considered along with and intensive interactions ond side effects interactions, needs to be the other comments received in the care would be useful. Beingable to available on all hand held consultation, to inform the look at a list of drugs relevant to devices development of the enhanced BNF. a patient and then be given NICE acknowledges that digital possible interactions would be infrastructure and access to usful as would some decision portable devices throughout the support when interactions are NHS is not fully developed. flagged up. Easier access to Distribution of print formats will dosages relevent to renal or liver continue in line with user failure would be useful requirements, subject to ongoing monitoring and review by the NICE Board.

QIPP In principle yes to a digital format portable on phone and ipad The BNF as it stands is not Thank you for your comments, they Pharmacist but would expect this to be reflective of all the prescribing have been considered along with updated more frequently. that occurs in the UK. There is the other comments received in the Currently updated every month a lot of unlicensed prescribing consultation, to inform the on the apps but need to be (off label medicines and development of the enhanced BNF. explicit on what has changed unlicensed medicines)- refer to NICE acknowledges that digital every month and keep the Epact Data which we need infrastructure and access to changes for the next 6 months information on, preferably portable devices throughout the so that users can reference. I evidence based, where the NHS is not fully developed. use the BNF as a reference for medicines come from, brand Distribution of print formats will my specials guide and expect names etc. It is a document in continue in line with user the BNF to be a live resource. it's own right but would be requirements, subject to ongoing useful to link this to GP monitoring and review by the NICE prescribing systems from the Board. Please note that the BNF moment that a gp types a and BNFC online are openly

[Insert footer here] 68 of 383 medicine in to issue a accessible at www.evidence.nhs.uk prescription. it is not clear how all NHS users can access BNF on internet on computer. Not everyone has access to Medicines Complete, perhaps via Athens would make this more accessible to users in the NHS

Lead Primary Really like what you are trying to Actually I think all the suggested Would be good to try and link Thank you for your comments, they Care achieve. Sounds even more elements in the vision are BNF entries to patient have been considered along with Pharmacist useful than current format, which important decisions aids where they the other comments received in the is slightly limited by the lack of exist. Are NICE thinking of consultation, to inform the detail in some areas particularly accrediting patient decision development of the enhanced BNF. about relative benefits and aids? NICE is currently exploring its harms approach to developing or endorsing patient decision aids.

Senior A excellent progression in A excellent progression in Mobile apps - our trust uses Thank you for your comments, they Medicines providing up to date quality providing up to date quality Blackberry phones. I cannot have been considered along with Management information. information. find a free app on the phone the other comments received in the Advisor for the BNF. consultation, to inform the development of the enhanced BNF.

[Insert footer here] 69 of 383 Clinical I totally agree with the views set I think the most important No other than the comment Thank you for your comments, they Pharmacist out. element is one of accessibility. above. have been considered along with My experience of the other comments received in the secondary/tertiary care working consultation, to inform the is that the BNF as a paper development of the enhanced BNF. reference is too imbued in the NICE acknowledges that digital mindset of healthcare staff. For infrastructure and access to the vision to be achieved, the portable devices throughout the NHS must invest in IT NHS is not fully developed. infrastructure so that staff have Distribution of print formats will ready access to PCs, laptops, continue in line with user tablets. My biggest barrier to requirements, subject to ongoing accessing electronic resources monitoring and review by the NICE at a ward level is finding access Board. to a computer.

Advanced Although access to more up to It appears a good idea. Wifi/ Internet access. Trusts Thank you for your comments, they practitioner date information is an excellent Especially linking to policies and need for hard have been considered along with idea. This can be very distracting guidelines/research around less copies on wards/units and how the other comments received in the and appear ignorant if completed familiar topics However can be a change will be interpreted. consultation, to inform the whilst client present. Access to seen as rude if accessing whilst The speed at which info can development of the enhanced BNF. WiFi/ Internet can be very client there or don't know what be accessed NICE acknowledges that digital problematic and it is not always your doing Limited access to infrastructure and access to easy to obtain info. It can be technology in community portable devices throughout the more stressful and lead to task locations Can take a lot longer NHS is not fully developed. taking a lot l than looking in a book and lead Distribution of print formats will to frustrations on all sides Would continue in line with user be less weight to carry round As requirements, subject to ongoing a practitioner can become too monitoring and review by the NICE engrossed in related topics/ Board. research not keeping to the Since they work offline, a query thus adding to time spent connection to the internet is not clarifying an issue required once the BNF and BNFC apps are downloaded onto a mobile device.

[Insert footer here] 70 of 383 Lead I completely agree with the vision Further integration with other Nothing that I can think of. Thank you for your comments, they Pharmacist for to shift reliance from paper resources - such as NICE have been considered along with Mental Health, copies to electronic media. guidance, patient information, the other comments received in the Medicines Use However, my concerns are a) patient decision aids. Inclusion consultation, to inform the and Ensuring that the electronic of new information such as development of the enhanced BNF. Procurement versions being accessed are up patient counseling points (similar to date. How will updates be to the Australian Medicines pushed out reliably? b) Handbook). Enhanced and Increased reliance on the use of intuitive interface, with the personal devices (such as smart inclusion of powerful search phones) as the portal to access capabilities. Ensuring that the the BNF - in terms of infection electronic version will function control, patients' perceptions of on a wide variety of devices, and clinical staff accessing function quickly on a variety of information on their devices operating systems. I think it is during consultations. c) Deciding critical that the enhanced BNF on which links to high quality must be able to easily integrate information for patients to or overlay with organisations' include, and being rigorous with formularies in an effective respect to this process. For manner, to save laborious example, will link to patient duplication at Trust-level (such information leaflets on as with BNF Formulary medicines.org.uk be provided Complete or other similar (and how will these be linked to systems). ensure the brand prescribed and dispensed has the correct PIL, and how will they be updated. Will links to patient decision aids be included, and what will the criteria for inclusion be? Can local links to organisation- specific resources be provided? d) Ensuring that the BNF remains the authoritative source on medicines information.

[Insert footer here] 71 of 383 Paediatrics Could be useful for more Ease of usage: needs to be Essential to keep books Thank you for your comments, they Consultant complex situations. drug intuitive and user friendly. available. Tend to be faster to have been considered along with interactions, and unusual side Needs to make it very easy and use, and don't crash, freeze, the other comments received in the effects. Need to ensure that quick to ask easy and quick and generally play up in the consultation, to inform the double checking the dose of a questions, whilst offering routes way that hospital development of the enhanced BNF. commonly used/familiar drug onwards to more complex computers/trust IT systems NICE acknowledges that digital (which is the main use in information, and preferably a often do: important to be able infrastructure and access to paediatric pratice) is not made very visible alert to any really to access in event of IT portable devices throughout the more difficult. important information (eg problem. NHS is not fully developed. lamotrigine highlighting watch Distribution of print formats will for rash. Would be usefeul if continue in line with user main info page included link to requirements, subject to ongoing printable parent information monitoring and review by the NICE leaflet (note parent - need paed Board. specific info) senior nurse sounds like a great idea to info that is cross referenced with Sometimes it is good to have Thank you for your comments, they paediatrics amalgamate the two and have all other important info eg contra abook or paper version In have been considered along with the info in one place. indications etc good that it will rural areas the internet signal the other comments received in the be searchable through different is not always available Talking consultation, to inform the key ways but will all the info as from the south West. development of the enhanced BNF. hazards etc be linked to each Community nurses may well other? be prescribers and so this electronic version may not always be available to them.

Consultant digital on-line would be the best potential to link sections to apart from evidence links, no. Thank you for your comments, they option independent evidence sites, e.g. have been considered along with linking analgesics to the the other comments received in the Bandolier site from the Oxford consultation, to inform the Pain unit or to relevant development of the enhanced BNF. Cochrane reviews

Clinical Sounds good Drug-drug No Thank you for your comments, they Research interaction/conraindication alerts have been considered along with Fellow the other comments received in the consultation, to inform the

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Production It is a good vision, I think the Clear search functions I don't think commonly Thank you for your comments, they Pharmacist NHS and associated Recognisable format Relevant prescribed medical devices have been considered along with organisations around it are Information (giving pricing is should be in the BNF, it should the other comments received in the usually really slow to embrace pretty useless as I don't think be for medicines that are consultation, to inform the change and technological anywhere pays BNF prices for licensed in the UK only. Unless development of the enhanced BNF. advancement. any medication) Different login the MHRA changes its stance credentials for the apps to on licencing medical devices of athens More deail in specialist course. The same should also sections (the term "consult apply to borderline product literature" just substances. These can be encourages us to do that in the adressed in other first place and makes the BNF sources/publications seem redundant in some areas)

Director of Sounds the right way forward. It has got to be as easy to use It would be useful to have a Thank you for your comments, they Pharmacy as possible with a logical layout calculator included so that you have been considered along with or users will find other sources can work out doses based on the other comments received in the of information which are easier body weight / renal function consultation, to inform the to use. etc. development of the enhanced BNF. associate Good. the opportunity to provide ditto no Thank you for your comments, they medical links is very helpful have been considered along with director+ the other comments received in the consultation, to inform the development of the enhanced BNF.

[Insert footer here] 73 of 383 Clinical In my opinion this can only have From my perspective this would No, I believe that this type of Thank you for your comments, they Pharmacy a positive outcome. As a clinical mainly include dosing and side- action is a step in the right have been considered along with Technician technician i spend most of my effects. When i am unfamiliar direction both for the staff the other comments received in the working day on the words with a drug I use the BNF to using such facilities and also consultation, to inform the supporting the pharmacist, Drs ensure that the dose is the patient. At the end of the development of the enhanced BNF. and nurses with regards to appropriate for the patient. Also, day, their care is always our pharmaceutical care for out as my role involves a large priority and any effort to patients. The BNF book still amount of counselling of improve this is beneficial. plays a role in my general day patients with regards to their but i am quickly chosing the medication, I use the BNF to online version over its paper look up potential side-effects so counterpart as i know this is the that should the patient have any most up to date information questions regarding their (sometimes the book is out of medication, i am already aware date or simply nowhere to be of potetial side-effects and any seen). In current practice there specific administration are now generally more requirements. computers available on the ward thanks to electronic prescribing. This means that they are also available to other staff working on the ward to access other various software and relevent information. By providing an enhanced BNF it will allow the ward staff better access to pharmaceutical information inorder to aid clinical screening, administration and prescribing.

[Insert footer here] 74 of 383 Chief A digital format of the BNF/cBNF Healthcare staff could be Care staff in social care Thank you for your comments, they Pharmacist, would provide a mobile first provided with a very useful tool. settings have medicines have been considered along with Kingston solution as medicines reference, This would be a complete waste information requirements in a the other comments received in the Hospital NHS but would need enhancement for unless adequate training is moch more lay language as do consultation, to inform the Foundation further detail often required by available on how to use it. family carers. Let's not also development of the enhanced BNF. Trust practitioners. The immediate remember patient cross reference to product SPC requirements for information and an IV administration guide (such as Medusa) would be essentials as would cross reference to local formalaries. Access through the BNF to on- line reference material on interactions/side effects/pregnancy as are basic requirements of DGH pharmacy Medicines Information services would greatly inhance the use Hyperlinks to journal articles would be of use, but not essential.

Lead There are distinct advantages in Better side effect definition and Unlicensed medicines are Thank you for your comments, they Pharmacist - using a mor regularly updated more specific ranking would be loosely referred to in the BNF - have been considered along with Medicines digital resource than a paper a viable and useful development this component could be more the other comments received in the Information document which is out of date as would a more expansive details and integrated consultation, to inform the and before it is published and printed. explanation of drug/drug particularly when licensed development of the enhanced BNF. Management Pulling together the NICE interactions an the clinical products are discontinued or guidance and BNF prescribing significance thereof. Links to unavailable which is a advice and structure has already Map of Medicine management common hurdled in providing proven its value. Further of disease states would be ongoing care. Unlicensed or devolopment and integration of extremely useful as a reference off-license uses of medicines this progress can only be source and a means to put the that have some evidence base beneficial IF the format is not medication therapies in a clinical would be a useful inclusion changed too radically. The BNF perspective. already includes rudimentary side effect and interaction detail - development of these areas in

[Insert footer here] 75 of 383 particular would be of enormous value to prescribers and other healthcare professions.

Head of I think the vision is very clear but Frequent up-dates compared to Users would need a smart Thank you for your comments, they Medicines will require a change of culture to annual paper version More in phone or access to a have been considered along with Management make use of electronic format. line with concept of "paperless" computer. the other comments received in the offices Useful as an APP for consultation, to inform the community staff on the move to development of the enhanced BNF. talk to patients about their NICE acknowledges that digital medicines Links to local infrastructure and access to formularies Multiple search portable devices throughout the strategies Evidence base links NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Deputy Chief I think the move to an enhanced searchable, I would want to see I haev a huge number of Thank you for your comments, they Medical Officer cBNF is a good one (I don't do more decision support both for thoughts nd ideas but I can't have been considered along with adult prescribing but everything I the prescriber and the come to any of the workshops the other comments received in the say for children applies to adults) administrator - if you want to talk tot eh consultation, to inform the I think we need to cover Birmingham team who are development of the enhanced BNF. gestation base, weight based developing the drug dictionary Thank you for your offer to contact and age based prescribing and for PICS please do get in the team in Birmingham. It has been simply it so that the advice is touch with me kept on record. clear as to which piece of info takes priority if we are goign to to age based prescribing we are going to need to do some simplification of age groups - between cBNF and Guys and THommy's we haev found over 400 different age ranges

[Insert footer here] 76 of 383 Medical Heavy on the content, light on Links to guidance at multiple not enough detail, but perhaps Thank you for your comments, they Director the technology Important to be levels, i.e. Product and Chapter that will follow seperately have been considered along with fully integrated with and supporting elements like the other comments received in the Prescribing/Dispensing systems precautions in Renal and Liver consultation, to inform the and not clear from the document disease, Pregancy etc development of the enhanced BNF. how that will be achieved

Senior I agree with the vision. Be a single authoritative source Enhanced information on renal Thank you for your comments, they Pharmacist - of medicines information Be + liver disease. Include have been considered along with Medical continuously updated Available information, where available, the other comments received in the as electronic formats Include to guide dosing in extremes of consultation, to inform the information on drug interactions body weight (becoming more development of the enhanced BNF. and unwanted effects including common). SMC status if All pre-registration pharmacists who rating of their frequency and restricted / non-accepted. are registered with the Royal seriousness, to minimise the risk Make paper copy of Spring Pharmaceutical Society are of harm (April - August) BNF available supplied with free editions of BNF for pre-registration trainee and BNFC. pharmacists (core text for GPhC exam). Consideration to be given to other academic / examination settings where BNF is a core reference text used in exams.

Consultant Happy for an enhanced BNF but Easy and Speedy Access. NO Thank you for your comments, they Paediatrician still would like to have access to have been considered along with print version particularly if asked the other comments received in the about a medicine when on call consultation, to inform the from home or to have in the car. development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE

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clinical nurse I like the idea of it and can see That it is updated - so a 'live' The difficuly in accessing Thank you for your comments, they specialist the reasoning behind it but I document and can reflect up to computers in some areas have been considered along with worry about the access to date findings and research the other comments received in the technologies in ward areas in consultation, to inform the hospital> I use the BNFs on the development of the enhanced BNF. wards a lot and would be unable NICE acknowledges that digital to get access to a ward computer infrastructure and access to as there are not enough portable devices throughout the computers for all the staff NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 78 of 383 Consultant I think that the idea is a good Personally, I would not take a See outline above Thank you for your comments, they Pharmacist one, but there needs to be handheld device onto the ward. have been considered along with considerable thought around i would access the information the other comments received in the continuing with a handheld book via a desktop computer. it consultation, to inform the for some time to come for those would have to be adaptable to development of the enhanced BNF. individuals that are in the local guidance too e.g. our NICE acknowledges that digital community and that do not have formulary choices are infrastructure and access to access to electronic prescribing highlightable for example and it portable devices throughout the support. Also, there is a lack of would also have to be quick i.e. NHS is not fully developed. computer access to those not take 5 minutes to access Distribution of print formats will working in secondary care from and load up. continue in line with user the point of view of number of requirements, subject to ongoing computers. Also, technical monitoring and review by the NICE support needs to ensure that Board. NHS computers will be able to easily access the electronic versions by installing the appropriate software to support it's application. The information must be accessible in multiple formats as websites and apps for mobiles and tablets and be linked to the other major sources of information eg NICE, Stockley, Martindale etc

Consultnat in I think it will be a good integrated Enhanced up to date information TOXBASE should be included. Thank you for your comments, they AMU and way of accessing up to date in one place easily accessible. have been considered along with clinical information with benefit of NICE the other comments received in the Pharmacology consultation, to inform the and Therputics development of the enhanced BNF.

[Insert footer here] 79 of 383 Hospital Agree that the online versions Being able to follow the Integrating systems to enable Thank you for your comments, they Pharmacist need improved functionality; I information with a single click, prevention of poor prescribing have been considered along with have found that my personal having all different information as above the other comments received in the preference and most effective relating to a drug (different uses, consultation, to inform the version are the apps. Limit its notes sections, guidance etc) development of the enhanced BNF. availability i.e do not allow Integrating formulary into the numerous online version via BNF Integrating the BNF AND different platforms, limit to one formulary with prescribing and online format that is fully dispensing systems to prevent functional (for example via non-formualry prescribing FormularyComplete it is really not user friendly). MedicinesComplete format is quite good but as the consultation says, very much a copy of the paper book.

Head of Care The enhanced BNF as described Consider how the information No I think this is a practical Thank you for your comments, they Standards & would widen the way in which could safely be made available solution which will give access have been considered along with Review practitioners could browse for to non clinical support workers. to all clinical support workers the other comments received in the information. A digital electronic Currently the mobile apps are to ensure the appropriate consultation, to inform the format can be accessed in only available to NHS advice and support is available development of the enhanced BNF. serveral ways and therefore it employees but most patients thereby ensuring we are would be possible for the who require support with their safeguarding those people in practitioner to have the medication management have the community who require information with them at all this delivered by home carers support with medication times. As is described it would who are emplyed by Home Care management. be possible to log many types of Agencies or Local Authorities. medical devices and equipment The question is who should which are unavailable in the have the information available, current format. I would request what kind of supports can be put that a limited edition be available in place to benefit not just to non clinical support workers healthcare professionals but all are not clinically trained but professionals who are involved medication management and in medication management and support for the service user is support. part of their caring role. Because these workers are not clinically

[Insert footer here] 80 of 383 trained they do not have the same access to supporting documention and are not trained to the same level as clinicians it is imperative therefore that they receive up to date information and advice in a timely and accessible manner. I think the changes described would enable the information currently available in the BNF to be delivered in a format that could be supportive for instance when describing a drug this could be accompanied by pictures of what the drug might look like, in practice linking complex clinical information with practical information for non clinical support workers.

Consultant in I think this is a long overdue and Comprehensive and easy to use Please see above comments Thank you for your comments, they Palliative essential step in providing timely and search I work in palliative on the Palliative Care have been considered along with Medicine access to accurate and medicine and whilst the BNF is Formulary. the other comments received in the consistent prescribing useful it has limitations in that consultation, to inform the information for clinicians. the section on prescribing in development of the enhanced BNF. palliative care is very basic and does not support clinicians in some of the more complex palliative and end of life prescribing decisions and dilemmas. The Palliative Care Formulary (PCF) print and online versions are the definitive resource for practising palliative care clinicians and the enhanced BNF would not be complete without inclusion of

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Care Home It is useful to have access to Needs to be able to find drugs Please don't take away our Thank you for your comments, they Support digital methods such as the app with similar spellings, like google paper copies, we use it all the have been considered along with Pharmacist and the website for getting the can predict and give you time as pharmacists. Some the other comments received in the most recent information and for choices. Needs to be much professionals, maybe the consultation, to inform the use when out and about. easier to find the relevant doctors may be happy to use development of the enhanced BNF. However, I still rely very heavily information - too many pages to only on-line. I have seen the NICE acknowledges that digital on the paper copy. It is quicker click through at the moment. junior doctors on wards using infrastructure and access to and easier to use after 20 years mobile apps frequently and not portable devices throughout the as a pharmacist. Sometimes I the paper copy, but NHS is not fully developed. am not sure of a drug spelling pharmacists still rely very Distribution of print formats will and it can be very difficult to find heavily on their books! continue in line with user via an on-line method which requirements, subject to ongoing relies on you knowing the monitoring and review by the NICE spelling. With the index of the Board. BNF I can scan to find the appropriate drug. Also I can find the correct information much faster via the book - often you have to click through several pages to find what you are looking for either on-line or via the app.

Lead The aspirations all seem entirely Intuitive navigation, providing Continue and enhance links Thank you for your comments, they Pharmacist - appropriate, but arguably much information in context - currently with CPPE to produce learning have been considered along with Electronic of the NHS is still not adequately easy to miss key information materials, inclusion of the other comments received in the Prescribing equipped to provide reliable that sits above specific drugs in prescribing safety guidance eg consultation, to inform the access to a digital format eg too the tree structure, redesign of NPSA/NHS England or development of the enhanced BNF. few PCs in clinical areas and log the standard monograph layout equivalent, search by ADR, NICE acknowledges that digital ins too slow, inadequate wireless eg using interaction to open up contraindication, caution. infrastructure and access to access for handheld devices. specific elements, search using portable devices throughout the Even the switch to free annual soundex - prescribers often can't NHS is not fully developed. paper distribution is premature in spell drug names correctly Distribution of print formats will my opinion, and will potentially continue in line with user compromise patient safety. requirements, subject to ongoing monitoring and review by the NICE

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CAMHS/Neuro I think the paper copy of the BNF Having it more up to date. My No Thank you for your comments, they Practitioner has been out of date for some colleagues who prescribe need have been considered along with (RNMH) time in this digital age. Anything it to be as up to date as the other comments received in the which makes things more possible. It would be good if the consultation, to inform the immediate/up to date can only be NICE guidelines were, in development of the enhanced BNF. a good thing. addition, required reading for our GP colleagues as they often appear to struggle to know about their responsibility in terms of physical health checks re eating disorders and other issues (which we then have to quote at them).

[Insert footer here] 83 of 383 Principal I like the idea of an enhanced The most important aspect of a I can't think of anything. Thank you for your comments, they Pharmacist BNF so long as it runs in parallel enhanced BNF is that it is user have been considered along with Critical Care with a paper BNF. I think part of friendly and readily available. It the other comments received in the Epsom & St the sucess of the BNF is that it should still be free for everyone consultation, to inform the Helier provides information in a concise involved with prescribing, development of the enhanced BNF. University NHS way so that you can find out for dispensing or delivering NICE acknowledges that digital Trust example a dose or side effect of medicines. The format should infrastructure and access to a drug quickly without having to remain the same ie 15 chapters portable devices throughout the wade through a lot of data. etc. NHS is not fully developed. Hospital wards and departments Distribution of print formats will still have limited access to continue in line with user computers/ electronic format and requirements, subject to ongoing until this is addressed people will monitoring and review by the NICE not be able to check things as Board. quickly and easily at the bedside as they can with a book. I am always concerned with risk and I think one of the ways we reduce risk is by having quick and easily accessed information on the basics.

[Insert footer here] 84 of 383 Strategic Lead A couple of initial thoughts as to It has to be user friendly and I don't think so. Thank you for your comments, they for Medicines & whether this is in addition to the responsive otherwise it won't get have been considered along with Decision current format or an additional used. I suspect the key the other comments received in the Support resource. I'd suggest that the elements will be different for consultation, to inform the priority is to support the safe and various users, but as above development of the enhanced BNF. cost-effectuive use of medicines interactability with other NICE acknowledges that digital and therefore anything that took prescribing software packages infrastructure and access to away a well respected and well would be useful. The worskhop portable devices throughout the used resource before any new will be useful to see the vision in NHS is not fully developed. system was embedded would be action- the other issue is Distribution of print formats will a risk. The vision however is whether there will be a cost, and continue in line with user sound, but the question is not if so how much? Clearly the requirements, subject to ongoing only what it would look like but universal value of the current monitoring and review by the NICE how it might best be used to arrangement is that the end user Board. support improvements in quality doesn't pay. and safety, and moving the latest evidence into practice. The current book is used as a handy reference- and there is still a need for this, but making the enhanced version integral to other software packages could have a major benefit, in avoiding the need to go in and out of web- resources.

Resuscitation Seems a poitive move but not all links to other sources of Would be good if the Thank you for your comments, they Officer areas have easy technology information expecially critical BNF/BNFc could be combined have been considered along with based access i.e my trust care informaition again the other comments received in the encourages use of the BNF apps consultation, to inform the (although disouraging personal development of the enhanced BNF. use of mobile phones) but does NICE acknowledges that digital not provide tablets etc, online infrastructure and access to access requires finding a free portable devices throughout the PC, loggin on etc in which case a NHS is not fully developed. paper version is MUCH quicker Distribution of print formats will continue in line with user requirements, subject to ongoing

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Lead Search functionality needs to Usability. Users will frequently - Closer integration with Thank you for your comments, they Pharmacist - include partial names, sounds be under time pressure and will electronic prescribing and have been considered along with ePrescribing & like, do you mean..... functions to need to find and review electronic patient record the other comments received in the Medicines account for mis-spellings, faster information in very short period systems - drug catalogues, consultation, to inform the Administration searching etc. of time. This brings with it the drug alerts (interactions, development of the enhanced BNF. risk of mis-reading information patient specific dose range Thank you for the offer of support it hypo / hyper etc. Get design checking, therapeutic has been kept on record. NICE will advice from User Interface duplication), IV guidance undertake extensive user testing on specialists such as those from (stability, carrier solutions, any enhancements made to the Micorosoft who worked on the infusion rates BNF. Common User Interface projects for connecting for health. Contact details can be provided if needed.

Pharmacist Wonderful vision. Difficult to Being as up to date as possible Practicality of life in a busy Thank you for your comments, they Manager achieve in community pharmacy, Quick and easy to find pharmacy with poor IT/ have been considered along with with multiple computer systems. information connectivity the other comments received in the Sometimes access on my consultation, to inform the personal mobile devices at development of the enhanced BNF. personal cost NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 86 of 383 ENT advanced I think it is very sensible to push Extra addons can be made with Another enhacement that Thank you for your comments, they nurse BNF into the e format almost ease as well as URLs to could be considered is an alert have been considered along with practitioner exclusively. The Apps on the evidence based sites and for interactions that would be the other comments received in the andriod system is excellent and I clinical alerts. Links to more more detailed than the current consultation, to inform the find drugs very quickly. There is detailed pharmacology eg drug list format given in the paper development of the enhanced BNF. some info missing that the paper 1/2 lifes. copy. In the e-version of BNF BNF has (some of the detailed you could pick off all the drugs preamble to a chapter and that the patient is on add in the pharacology/dynamics) new drug to be prescribed and Currently in practice there are detailed report of possilbe different versions of paper copies interactions generated. link to being consulted and often no the yellow clinical alert Links to most up to date one being used. the patient information leaflets Many trusts now have wifi that come with the drugs access for staff and most clinical staff have smart phones or tablets. I would be very happy only to access BNF though phone or tablet

Pharmacist My experience of electronic Linking information and able to Often local systems are not up Thank you for your comments, they information sources has showen see relevant information is to quick easy electronic have been considered along with that it is not usually easy to see available when looking at a access. IT access on the the other comments received in the information around the subject drug. Quick and easy to find wards in my hospital is poor - consultation, to inform the as they tend to lead to specifics what you are looking for. desk top computers usually in development of the enhanced BNF. e.g. on opening paper BNF you use and old, WiFi access NICE acknowledges that digital can easily see information at the patchy and mobile access infrastructure and access to start of the section on a group of patchy so getting online to portable devices throughout the drugs, boxed info from NICE or access electronic sources not NHS is not fully developed. MHRA etc. which you may not easy on the wards. Any Distribution of print formats will see online, especially on a electronic system needs to be continue in line with user mobile app. The inclusions are supported with basic systems requirements, subject to ongoing good if it works well in practice. and out dated servers or it will monitoring and review by the NICE become useless to some users Board. and they will have no choice but to use the out-dated paper sources which are easier to access.

[Insert footer here] 87 of 383 SENIOR Great to have more information more evidence based availability of digital technology Thank you for your comments, they CLINICAL but it needs to be easily statements would be very in the NHS. Is it possible to have been considered along with PHARMACIST accessible in a hrad copy as useful. have a hardcopy abridged the other comments received in the there is not enough version for ready access and consultation, to inform the computer/digital access in the an electronic version with the development of the enhanced BNF. NHS to allow ready access. new information? NICE acknowledges that digital Ready access is essential for infrastructure and access to good prescribing. If only a digital portable devices throughout the form is possible due to the NHS is not fully developed. increased size of the proposed Distribution of print formats will document I woul rather remain continue in line with user with the current format as I need requirements, subject to ongoing that for frequent daily reference. monitoring and review by the NICE As a Scottish practitioner we Board. would need reference to SMC and SIGN publications also for ti to be relevant.

Outcomes Easy access to this information I think it needs to be clear what Links to clinical trial Thank you for your comments, they Research is indeed empirical. However, the recommended dose is based information may be made have been considered along with Associate this gives us the chance to also on patient composition and available Links to licence the other comments received in the shape the information made adverse events experienced. information Links to in practice consultation, to inform the available by this source. Which, I e.g. key contraindications use, e.g. news stories development of the enhanced BNF. feel has been also made clear in (experienced in clinical practice) highlighting best practice/ the vision of this consultation. where a lower dose may be adverse events considered

Practice Based Excellent idea but do not want to Links to evidence and guidance Not sure Thank you for your comments, they Pharmacists, loose the printed version from NICE have been considered along with Prescribing the other comments received in the Advisor consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user

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Medicines I understand accessing online The information would always Maybe some serivces still Thank you for your comments, they Management BNF would ensure health be updated. require paper copy BNFs have been considered along with Pharmacist professionals have up-to-date which need to be considered. the other comments received in the information, however sometimes consultation, to inform the the online version is not always development of the enhanced BNF. easy to navigate and I may not NICE acknowledges that digital have access to a computer all infrastructure and access to the time, therefore carrying a portable devices throughout the paper copy of the BNF ensures I NHS is not fully developed. have a BNF with me at all times. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Deputy Chief Sounds reasonable Quick access, simple format, You forget how people actually Thank you for your comments, they Pharmacist authoritive, accurate work. In busy Depts where a have been considered along with clinican needs info NOW, the other comments received in the cannot wait for a computer to consultation, to inform the decide to display the internet development of the enhanced BNF. and serach for the info. The NICE acknowledges that digital book format is key and an infrastructure and access to imortant safety tool. how about portable devices throughout the some development of that to NHS is not fully developed. refine and reduce it to a format Distribution of print formats will that is furture proof. continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. NICE will undertake extensive user testing on any enhancements made

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Consultant Entirely supportive. With the Allow user to quickly reference Integration with local formulary Thank you for your comments, they Rheumatologis complexity of prescription now it the minimum text provided in the information (at least a 'tag' to have been considered along with t is essential that the latest standard BNF, but allow them to highlight whether or not the the other comments received in the information is at our fingertips. expand and quickly get further drug is approved or restricted). consultation, to inform the information about relevant NICE development of the enhanced BNF. guidelines etc. Ideally there NICE acknowledges that digital should be also an option to link infrastructure and access to up with local formulary portable devices throughout the information (this was possible in NHS is not fully developed. Epocrates, for example) This Distribution of print formats will information should be easily continue in line with user accessible from mobile apps or requirements, subject to ongoing from the electronic prescribing monitoring and review by the NICE interface (which we don't have Board. at this stage). Note that in NICE is working with Queens N.Ireland we still do not have University Belfast to make the NICE access to the BNFapp for mobile BNF and BNFC apps available in devices. It is very difficult to get Northern Ireland. to a PC on ward rounds.

Pharmacist I think it is a good idea as the Faster updates. combining data No Thank you for your comments, they paper versions are bulky to carry from other pulications to have been considered along with and can go out of date quickly. produce a more informative tool the other comments received in the consultation, to inform the development of the enhanced BNF.

[Insert footer here] 90 of 383 antibiotic agree that print version quickly easy, fast access from many links to references of your Thank you for your comments, they pharmacist out of date, especially with points. intuitive system (i.e. if entries would be useful have been considered along with people relying on old copies. spelt slightly wrong, to bring up the other comments received in the medical devices would be useful options and to be able to search consultation, to inform the inclusion. no print copies at all without inputting the whole development of the enhanced BNF. throws up problems for areas word) NICE acknowledges that digital with no mobile signal (patient infrastructure and access to houses etc), if the system goes portable devices throughout the down, and also for students in NHS is not fully developed. exams. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant I think the idea of an enhanced Easy access to the information The process for reporting Thank you for your comments, they Nurse BNF is a great idea. The you require. Sensitive search digitally? have been considered along with proposal seeks to improve the process to enable this. Ability to the other comments received in the information available to use the information to guide consultation, to inform the prescribers within clinical policy & protocol at local level. development of the enhanced BNF. settings. Electronic format is Patient information. great as I am not always able to locate a print copy of the BNF. Easy access to drug interaction and side effects information will be very useful. I also like the idea of being able to collaborate with the patients about the medications to assess if it is righ tfor them.

[Insert footer here] 91 of 383 gp partner seems reasonable with a strong It needs to interface easily with integration /links from a drug to Thank you for your comments, they emphasis on digital first. GP clinical systems and be patient information leaflets have been considered along with easily accessible via web and would be helpful. the ability to the other comments received in the phone download in wi fi areas and consultation, to inform the then use off line in wi fi poor development of the enhanced BNF. areas and update when back NICE acknowledges that digital in rnage would be good. infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. Since they work offline, a connection to the internet is not required once the BNF and BNFC apps are downloaded onto a mobile device.

Senior I think it is a good idea to use I think upto date information No, I have read the document Thank you for your comments, they Pharmacy digital technology to deliver safe should be easily accessible for and fully support the have been considered along with Technician (IT) and effective infromation to staff people who need it at the time of proposals. the other comments received in the would would need it in a click of the need. This would improve consultation, to inform the a button patient safety and increase development of the enhanced BNF. confidence for the patient.

Locality Lead Great! Would be helpful to have Ability to link to inhouse Please make sure that back Thank you for your comments, they Pharmacist more advice on when NOT to formularies is essential. copies are still available if have been considered along with West prescribe certain drugs and going over to digital copies the other comments received in the Hampshire when DRUG HOLIDAYS are only. As part of my expert consultation, to inform the CCG indicated (e.g. bisphosphonates, witness work, it is important to development of the enhanced BNF. antimuscarinics, quinine for leg consult BNF advice that was NICE acknowledges that digital cramps etc) with a view to driving available at the time of the infrastructure and access to down inappropriate legal case under investigation. portable devices throughout the polypharmacy in elderly patients For this reason I have kept all NHS is not fully developed. with multiple co-morbidities. my old print copies. Distribution of print formats will

[Insert footer here] 92 of 383 Prescribers often feel they need continue in line with user a justification for stopping requirements, subject to ongoing something which has previously monitoring and review by the NICE been started. Board.

Pharmacist Generally happy with the I think additional links to help Don't overlook the usefulness Thank you for your comments, they principles - but don't patients understand medicines of a qucik reference to check have been considered along with underestimate the usefulness of better would be useful, as well an interaction or dose etc. It the other comments received in the a quick-reference paper as links to better information may be that the print version consultation, to inform the resource, a role the BNF has about could become a slimed down development of the enhanced BNF. performed well for many years. pharmacology/pharmacokinetics version of the full on line NICE acknowledges that digital Also, whilst it needs to be of the medicines so that resource providing key info infrastructure and access to evidenced based the BNF has professionals can easily access about indication, doses and portable devices throughout the always been a pragmatic more in depth knowledge if interactions. NHS is not fully developed. document that included required. Distribution of print formats will information relating to real world continue in line with user use of medicines and common requirements, subject to ongoing usage even if this was outside monitoring and review by the NICE the product licence or evidence Board. base.

Consultant Timely and relevant Design and Clarity Simplicity of use Intuitive Just because its electronic Thank you for your comments, they Physician 'usabilty' will be key ward based format Accessible does not mean it is accessible have been considered along with technology needs to be available I am 55 and thus in firm luddite the other comments received in the to optimise potential Side territory but I found the QRGs consultation, to inform the effect/harm important BUT hard (even online ones) for CGs development of the enhanced BNF. to define as many common very useful - you could skim NICE acknowledges that digital appropraite usages are captured through in one go. They were infrastructure and access to within potential S/fx so needs abolished and I now have to portable devices throughout the real clarity - as an example AKI go online to access a NHS is not fully developed. guidance is laeding to a lot of pathways which I find less Distribution of print formats will cessation of HF meds with intuitive. It takes a few steps continue in line with user

[Insert footer here] 93 of 383 adverse consequences. as does getting a list of quality requirements, subject to ongoing standards so with each step monitoring and review by the NICE needed my enthusiasm flags. Board. Maybe my problem but electronic access seems to drive one size fits all thinking?

Optometrist Its really important that the BNF I need access to a BNF which is Optometry! Thank you for your comments, they is available to all prescribers - up to date, accurate and ideally have been considered along with you didnt even list optometry as also gives dose regimes the other comments received in the a profession on this consultation consultation, to inform the document for example development of the enhanced BNF.

Clinical Seems totally logical in this day More timely updqates and 1. Notification of significant Thank you for your comments, they Adviser and age evidence base. Also the updates when they happen - I have been considered along with (Pharmacy) transparent reasoning where would like to see this the other comments received in the NHS England recommendations are different incorporated into all dispensing consultation, to inform the Area Team & and prescribing systems and development of the enhanced BNF. Community related to the drug e.g. If Pharmacist guidance significantly changes for a particular drug then a mesage should show on the system next time it is being prescribed or dispensed. This would facilitate more timely reviews. 2. A requirement through NHS contracts (&CQC) that this new version is the option of choice and that links to IT systems are implemented by a particular date (IT companies will only implement changes in a timely fashion when they have no

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Senior I think the vision is to be Available via a number of No Thank you for your comments, they Medicines welcomed and provide sources and updated regularly have been considered along with Management prescribers and others a range of the other comments received in the advisor options to view what they consultation, to inform the require. development of the enhanced BNF.

Palliative Care I am very encouraged to see The Palliative Care Formulary The Palliative Care Formulary Thank you for your comments, they Specialist this. It is essential to have (PCF) print and online versions (PCF) print and online versions have been considered along with Pharmacist access to accurate and are the definitive resource for are the definitive resource for the other comments received in the consistent prescribing practising palliative care health practising palliative care health consultation, to inform the information, relevant to the professionals and the enhanced professionals and the development of the enhanced BNF. specific area of medicine. BNF would not be complete enhanced BNF would not be without inclusion of this complete without inclusion of resource. this resource.

Senior Lecturer Plans for enhancement of Clearer & more quantified Difficulties in electronic access Thank you for your comments, they in Pharmacy content appear helpful. Plans for information e.g. re effectiveness in some settings (see above). have been considered along with Practice digital-only access are & adverse effects. Links to other the other comments received in the (registered concerning - such access is not key guidance. consultation, to inform the pharmacist) yet universal in the NHS (e.g. development of the enhanced BNF. during home visits to patients) NICE acknowledges that digital and access to digital formats is infrastructure and access to more difficult for users outside of portable devices throughout the NHS settings. NHS is not fully developed. Distribution of print formats will

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Joint I think those aims are very good. Accessibility and being able to No Thank you for your comments, they Formularies I would highlight the 'right format, rely on the fact that the most up have been considered along with Technician right place right time'. With the to date and accurate information the other comments received in the hope that the book format does is included consultation, to inform the not vanish completely. development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Pharmacist A really good idea, i think the The addition of unlicensed I think it would be very useful Thank you for your comments, they knowledge base for unlicensed medicines and more up to date to include citations throughout have been considered along with medicines and unlicensed information the BNF in order that we can the other comments received in the indications would be very useful immediately access treatment consultation, to inform the and improve patient safety guidance as well as useful development of the enhanced BNF. literature to aid our prescribing recommendations. Obviously you are already reviewing this information alongside team BNF and so to add primary sources I think would add significant value and transparency

[Insert footer here] 96 of 383 specialist While the move to a digital forma acknowledgement of prescribing Inclusion of optometrists Thank you for your comments, they optometrist may provide a rapid and simple healthcare professionals other formulary and prsecibing have been considered along with method of delivering completely than doctors, dentists and nure guidelines for IP optometrists the other comments received in the up to date information, this does practitioner consultation, to inform the rely on the user having access to development of the enhanced BNF. an internet-linked device which, NICE acknowledges that digital in some situations like home infrastructure and access to visits may not be available. In portable devices throughout the addition it also removes the use NHS is not fully developed. some healthcare professionals Distribution of print formats will who work outside the NHS get continue in line with user form the use of previous editions requirements, subject to ongoing with out the need for a monitoring and review by the NICE subscription (yes this does Board. happen)

Principal Having a BNF via an electronic That it is updated more Could drug recalls be added to Thank you for your comments, they Medicines device would be the best option. frequently, and further advice the list of items sent out, as have been considered along with Management But apaper copies would still can be supplied using this this would facilitate more the other comments received in the technician need to be available as method. people being aware earlier? consultation, to inform the internet/wifi access is often development of the enhanced BNF. limited.

Director, the I agree that we need the That the information is UKMI was and under NICE still Thank you for your comments, they academic unit information in the BNF and the authoritative and current are the is an excellent 'gatekeeper' to have been considered along with of pharmacy, BNFc to be authoritative and a most important aspects to me. I other sources, journals, texts the other comments received in the radiography link to NICE and CKS and or teach nurses, medical students, etc. The BNF remains to me a consultation, to inform the and healthcare other medical information pharmacists and radiographers. simple to use source of development of the enhanced BNF. science systems would be excellent. A All have slightly different needs prescribing information. NICE acknowledges that digital single source is a good idea but, for using the BNF. I also teach Personally a link from the infrastructure and access to when I use NICE as a any aspect on non-medical UKMI page to the BNF and portable devices throughout the ‘gatekeeper’, I'm happy to have prescribing. I do want the BNFc is the most appropriate. NHS is not fully developed. compartments with the various enhanced system but not if it Yes improve the content where Distribution of print formats will sources such as CKS, EMC and means losing the BNF print necessary but not at the continue in line with user the BNF. However I would not copy. expense of the print copy. requirements, subject to ongoing support a complete removal of Teaching 300 nurses how to monitoring and review by the NICE the BNF print copy as it has its use and show what is in the Board. place and while talking to BNF is currently easier with

[Insert footer here] 97 of 383 individuals its handy just to have the print copy as we buy The BNF is published biannually. it there next to the telephone or multiple copies. Don’t get rid of NICE distributes copies of the in a pocket. I don’t always have it just for the sake of it. Many September edition free of charge, access to the computer or iPad. students still do not have copies of the March edition are I agree we must ensure internet access particularly in available to purchase from the prescribers have timely access some class rooms. I also have publisher here: to accurate and up to date difficulty accessing the BNF http://www.pharmpress.com/bnf information on medicines. To online in certain parts of the ensure that information is University. presented in the most appropriate way to all those in health and social care involved in handling, prescribing, commissioning and making decisions about medicines, is essential so although I want an online version I also want a print copy. If all the suggestions for example including devices as well as drugs are to be realised, there couldn’t be a single print copy and that I therefore consider unacceptable. I am also uncomfortable about teh print copy bneing annual - or is that just the free to NHS copies?

[Insert footer here] 98 of 383 pharmacist Agree with most of the positive Including medical devices, as More about the management Thank you for your comments, they aspects of the vision, but really well as medicines, links for of critical conditions such as have been considered along with concerned about the decision to patients and healthcare hypomagnesaemia and the other comments received in the promote online BNF access professionals to make decisions hypophosphataemia, to consultation, to inform the rather than using the book, together. Producing quick complement the existing development of the enhanced BNF. particularly in secondary care, on comparison tables of key guidance on the management NICE acknowledges that digital wards and in departments as information on effectiveness, of low calcium and potassium infrastructure and access to they rely on the book as the most safety, patient factors and etc. portable devices throughout the up to date version of the BNF, resource implications. NHS is not fully developed. and struggle for online access at Distribution of print formats will the best of times due to limited continue in line with user computers on wards and in requirements, subject to ongoing departments. In addition, not all monitoring and review by the NICE nurses, doctors, pharmacists and Board. other HCP have access to smart phones on wards or clinics, and if they do, most struggle to connect to wifi server/internet due to high demand on server and poor signal within the hospital grounds.

Consultant Cautious about exclusively Quick easy search to confirm Potential to have one's own Thank you for your comments, they urologist online as Trust firewalls are so function and type of drug with personal formulary of common have been considered along with strong. Otherwise keen to have appropriate dosages. I currently medicines. the other comments received in the online access as could be easier use paper copy to check doses consultation, to inform the to search and find interactions of many drugs. development of the enhanced BNF. etc. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 99 of 383 Inpatient Pain I agree that a more user friendly Easier access information in a Hard to tell without seeing a Thank you for your comments, they service electronic version would be portable format that doesn't version of the propsed new have been considered along with manager better than the current online require carrying the 2 paper formats the other comments received in the versions of the printed copy. copies consultation, to inform the Realtime information is also development of the enhanced BNF. useful so the user can access up NICE is working with Queens to date information without having to wait for mail shots or University Belfast to make the NICE paper updates. Accessibility in BNF and BNFC apps available in Northern Ireland within the NHS Northern Ireland. needs to be addressed as we cannot access the apps for Ipad etc

Paediatric The proposals seem fair though I'd say added functionality in Marketing of the new digital Thank you for your comments, they Pharmacist I'd hope this extends to BNFC as searching for relevant formats would be useful - I've have been considered along with it is not clear whether or not the information is the most important met many a member of staff the other comments received in the intention is to enhance both element - providing multiple that doesn't know they exist or consultation, to inform the BNFs or just the non-children's ways in which to search for the how to access them and I don't development of the enhanced BNF. one. Though if BNFC is to be same information. The electronic think I've met anyone that Please note that any enhancements included, I'd say there is far less availability of both references is doesn't have a capable phone will affect the BNF and BNFC. NICE guidance to link with the useful to have but the fact it they could use failing the BNFC for more complicated doesn't provide a more user availability of facilities in the disease states. Though I do friendly search function is hospital. You might consider wonder how concise this annoying. providing calculation functions information is likely to be and for complicated monographs therefore how well it is likely to so prescribers can choose e.g. be used in a clinical setting when Age, weight, indication, route differences between guidances and have the dose calculated and explanations are included. and capped for them. Entries such as aciclovir in the BNFC are poorly prescribed as prescribers often only read half the entry and miss things like dose capping and other indications. I think you've overlooked the lack of NICE guidance for many paediatric

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Consultant Good to have a unified Must be easily available to Don'y know Thank you for your comments, they Anaesthetist concensus on prescription access the information At have been considered along with advice present we are not allowed to the other comments received in the use mobile phones in theatres consultation, to inform the because of medical equipment development of the enhanced BNF. interference - so cannot use NICE acknowledges that digital apps. Also not enough computer infrastructure and access to terminals in theatre to access an portable devices throughout the e - verson as readily available NHS is not fully developed. as a book. Also need backup Distribution of print formats will hard copies if IT failure occurs. continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Reader Ambitious Internet access is not always The BNF is an excellent Thank you for your comments, they availble. There are areas of rural resource. There is no have been considered along with Wales & Shropshire which do equivalent in many other the other comments received in the not have broadband. This would countries. consultation, to inform the be a problem when doing house development of the enhanced BNF. calls (nurses or GPs). On many NICE acknowledges that digital wards doctors have hand-held infrastructure and access to devices to access the BNF etc. portable devices throughout the However, these are not usually NHS is not fully developed. available to nurses, who have to Distribution of print formats will rely on paper copies on the continue in line with user 'drug trolley'. Nurses must have requirements, subject to ongoing full access to the full BNF as monitoring and review by the NICE they need to check all medicines Board. before administration. Resrouce allocation should continue to prioritise the paper version of the BNF.

[Insert footer here] 101 of 383 Clinical The vision is good, enable great Such an Enhanced BNF must In delivering this enhanced Thank you for your comments, they Pharmacist access via more means to more be visually appealing and yet BNF it must remain portable, it have been considered along with content can only be good for the intuitive to use and search. The needs to be accessible in as the other comments received in the delivery of safe medicine based ability to bookmark frequently complete a form as possible in consultation, to inform the interventions. used sections and add remote locations (such as development of the enhanced BNF. annotations would be a powerful where there is not internet NICE acknowledges that digital additional also. connectivity) infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Deputy I think the aspiration is I personally have never been Accessibility - having to Thank you for your comments, they Director of appropriate and needed but it able to use the online BNF very register to have passwords to have been considered along with Pharmacy should not be with the objective effectively. In previous jobs I access the reference source is the other comments received in the of having no print version. A have been a Medicines a major barrier to access, consultation, to inform the provision of a print version twice Information Pharmacist so it is people have too many development of the enhanced BNF. a year is still required in my view not that I am not familiar with passwords/usernames to NICE acknowledges that digital but the volume supplied could be using on line resources and I remember. Healthcare infrastructure and access to less (half) what it is now. IT is actively support there use (and workers who have to go into portable devices throughout the not always quick enough or developed and ran a paperless patient's homes or travel to NHS is not fully developed. available and during "downtimes" Medicines Information Service different site may prefer a Distribution of print formats will hospitals that are operating 24/7 several years ago). However, paper source or not have continue in line with user with acutely ill patients will still when using it I find it very access to mobile technology. requirements, subject to ongoing need to have this important back difficult to see the drug I am User ability - ensuring monitoring and review by the NICE up reference source. The print looking at in context and read healthcare professionals who Board. version always carries the caveat the surrounding information are working in very busy NICE will undertake extensive user that once it has gone to print it is about that class of drugs. Don't environments can use the testing on any enhancements made effectively out of date as things over complicate the reference resource is key. It needs to be to the BNF. are changing all the time but for source - this is something that usable without any training the large part of what it is used needs to be accessible to all other than what they will for in an acute setting I feel it is people involved in receive to become that not a high risk. You at least handling/using medicines for healthcare professional, ie it need to have launched the new them to be able to look things up needs to be straightforward. enhanced version of the BNF and easily and get simple facts Fancy links and matrices etc

[Insert footer here] 102 of 383 with it being tested in situ before back without having to are great but better for more you withdraw the print version understand too much to be able complex level of resource than and also the provision of the to use the reference source, the basic go to handbook. I twice a year free copies (and as I NVQ level 2 staff upwards and have been very surprised by have already fed back to NICE patients need to be able to use the lack of IT expertise of staff previously send half the volume this as it is what we term a "level I have had to work with, twice a year to save money 1" resource and the basic first predominantly in the nursing rather than making it the same line resource anyone should profession, whereas with volume annually). use. medical practitioners and pharmacists pick up how to use IT resources pretty easily.

Advanced An electronic format is the way A search element is essential. Would be useful to have Thank you for your comments, they Practitioner forward but it must be as To be honest I fully agree with printable information links to have been considered along with Intermediate complete as paper copy all the points in 2.2 however it is give to patients the other comments received in the Care including devices information. An vital that the enhanced BNF consultation, to inform the electronic format must allow for remains as a mobile version as development of the enhanced BNF. continuous updates and could well. include new alerts rather than accessing these via MHRA. Access to NICE guidance would be very helpful and act as a reminder for those of us who's prescribing emit is wide.

Senior no comments see below I fully understand digital device Thank you for your comments, they Pharmacist in has been widespread in our have been considered along with Elderly Care society in general and BNFs the other comments received in the can be easier to be carried in consultation, to inform the portable device, however. development of the enhanced BNF. Some/most NHS hospitals NICE acknowledges that digital including ours do have neither infrastructure and access to WIFI nor tablet devices portable devices throughout the provided. It is also hard to find NHS is not fully developed. available computers at wards. Distribution of print formats will Therefore, I have to use my continue in line with user own smart phone at work to requirements, subject to ongoing look up information including monitoring and review by the NICE

[Insert footer here] 103 of 383 BNF if paper BNF is not Board. around. I still prefer to use a paper BNF during ward round because eBNF (via smart phone) dose show only one item by one item. It does not show a whole page; it is difficult to compare or to consider alternative options in the same group/chapter of medicine. (Probably, my own smart phone screen is not large enough to use for eBNF.) I am sure that NICE/BNF goes to the right direction in digital area; please think about some/most NHS hospitals situations and work together how to implement the e- system widely in NHS. I wonder if some/most NHS hospitals could spend more budget to provide or maintain the IT system e.g. WIFI, tablet device and enough numbers of computer at wards (including speed up of computer).

[Insert footer here] 104 of 383 TB Nurse If the enhanced on line version is Easy access Direct information - See above Thank you for your comments, they Specialist as described it will be better not having to click through have been considered along with when seated at a desk. several pages to find what you the other comments received in the Currently the online BNF which I actually want Succint, useable consultation, to inform the rarely access is not as easy to info in the first instance that is development of the enhanced BNF. navigate as it could be and takes expandable if appropriate for the longer in my opinion to get particular circumstances Easily information from than the paper accessible appendices - ie version. I, and others are not interractions, Not sure why it always at a desk - and therefore only neds to be free to NHS staff a computer - so it will not be as - are we not supposed to be convenient to have to go and find adopting an open honest policy a computer rather than do the with informative decision making reading at the bedside/in the - can't think there is anything to patients home. I guess the app hide in the BNF that can't be would cover the home accessed by the public elsewhere on the internet. Free to all would make it more user friendly from the outset because staff wouldn't need an Athens account for example to access it

Lead CNS My main concern would be that NICE guidance and devices No Thank you for your comments, they Respiratory when visiting patients if I had no would be useful have been considered along with Services BNF to turn to re side effects and the other comments received in the doseage it may delay prescribing consultation, to inform the of the treatment. Would development of the enhanced BNF. welcome the enhanced BNF on line when hospital based

Medicines I beleive it will be good to have To be continuously update, with No Thank you for your comments, they Information infromation from NICE, but will it new updates from NICE and have been considered along with Pharmacist be user friendly??Prescribers, new current recommendations the other comments received in the especially GPS like the BNF on practice. To include consultation, to inform the because it is quick and easy to recommednations off development of the enhanced BNF. use, will they still use it if have to seriosuness of interactions. much information to read. I do like the sound of links to patient,

[Insert footer here] 105 of 383 healthcare professionals information, to help make joint decision.

Specialist Patient decision support will be a Decision aides for both clinicians No Thank you for your comments, they Practitioner valuable tool and the fact that it and patients Good evidence have been considered along with is updated more frequently There base and the link to local the other comments received in the will need to be active support for formularies consultation, to inform the clinicians to utilise an online tool development of the enhanced BNF. and will only be adopted if very user friendly, from experience of trying to facilitate use of info technology it is not easy especially among 40+ age group. Personally I try to embrace online tools and would appreciate this development

[Insert footer here] 106 of 383 Medicines I feel that much of this is positive. Digital access to prescribing That there are both benefits Thank you for your comments, they Information I agree that digital access is the information with intuitive and risks of having a single have been considered along with Pharmacist way forward and this should be decision support and links to authority for medicines the other comments received in the embraced. I also feel it would be guidance and impartial information. consultation, to inform the good to have access to many of evidence. development of the enhanced BNF. the proposed features in one place. My reservation is the notion of this becoming one single authority for medicines information. If this attempts to be too all encompassing, then the risk could be that key information is diluted and hard to find unless the interface and search functions are refined and intuative. I don't find the current NICE evidence website fantastic in this respect so this would be my concern. As a medicines information pharmacist I use multiple specialist information sources when researching an enquiry and there can be a benefit of having smaller, specialised sources that are very focussed and easy to access. If implemented well this could be very good but I feel there is a balance to be struck between the convenience of having everything in one place and the benefits of having focussed and easy to access specialist information. This cannot become "too big to fail".

[Insert footer here] 107 of 383 Liaison Nurse The concept is excellent and If as suggested it will be easy for I would suggest a link to an Thank you for your comments, they Mental Health when electronically attainable will someone like myself in mental online version of the have been considered along with and Brain allow switching between the health to get instant information Maudesley Guidelines for the other comments received in the Injury current BNF and latest gudance regarding the vast lists of mental health as I am aware consultation, to inform the research and guidance easily physical meds and conditions that not many GP's and development of the enhanced BNF. and timely and in the presence of and possible reactions and hospitals, if any, actually sem the patient. However I wonder interactions with Psychotropics, to know that these exist. GP's how quick or slow it will be when this would be invaluable. and clinicians often take over trying to look up appendices Working as I do with Brain injury the responsibility for mental which in the book is quick and and neurological conditions I health matters, either on easy. would find this of great help. discharge or during admission and have no idea about swopping or stopping such medicines in the event of emergency or assumption of care.

Prescribing Very glad to see that BNF is now Being the single operative Unfortunately, not everyone Thank you for your comments, they Advisor available in digital versions on source of medicines and devices has access to digital device have been considered along with different portals but not very well will be very useful and having e.g. ipad or laptop in special the other comments received in the publicised, not aware of the digital versions of both BNF and cases working in care home or consultation, to inform the option that is available on clinical BNFc that are updated patient home for accessing development of the enhanced BNF. prescribing system continually ensure the most up quick prescribing information. NICE acknowledges that digital to date information is available infrastructure and access to for prescribers portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 108 of 383 Paediatric I think this is an excellent idea Enhanced BNF/BNFc from my Just the limitations in the Thank you for your comments, they Registrar with potential for huge understanding gives us access availability of resources in the have been considered along with information sharing and more to more uptodate information NHS is the major issue that the other comments received in the importantly uptodate information and links to evidence base needs addressing. consultation, to inform the as changes happen on a regular which is more reliable and development of the enhanced BNF. basis depending on the available hence more acceptable in terms NICE acknowledges that digital evidences. This is the only cost of accuracy. It is obviously infrastructure and access to effective way to keep up with difficult to have only an portable devices throughout the current practice. However, ease electronic copy due to the NHS is not fully developed. of acceptability and availability in limitations in the NHS as Distribution of print formats will the NHS could be a big problem mentioned earlier. continue in line with user due to LIMITED RESOURCES requirements, subject to ongoing like - 1, Not enough computers monitoring and review by the NICE available for everyone to check Board. on a prescription when needed - this could be a waste of valuable time for some. 2, This can be a potential draw back in time critical situations like in resus scenarios - help is often sort from non-prescribers who might need more training and access to appropriate information ( while in todays situation, the appropriate page is opened and shown to the responsible doctor for checking whilst they're busy in other important clinical work at the same time) 3, Not many have smart phones to access the apps. and prescribers of a different generation may need some training and practice to work online

[Insert footer here] 109 of 383 SpR in clinical It is a good idea to enhance the Make the BNF Open Access The BNF should be available Thank you for your comments, they pharmacology BNF as described, and to (e.g. creative commons non- as a standalone app on have been considered along with and remove the print versions, but it commercial) and remove the smartphones, tablets, PCs the other comments received in the therapeutics is important that the electronic registration requirements, which (Windows, Mac, Linux) etc. consultation, to inform the and general version is available both as a will make it more convenient and which do not require network development of the enhanced BNF. internal networked version and a easier to use. The main user of access. Healthcare workers NICE acknowledges that digital medicine standalone application that does the BNF is the NHS which is should be provided with digital infrastructure and access to not require network access. This funded by the UK taxpayer, and copies free of charge. This is portable devices throughout the is to ensure that it is available at the benefits of making it more to ensure that it is available at NHS is not fully developed. all times in healthcare settings, accessible (potential reduction in all times in healthcare settings, Distribution of print formats will particularly in areas with poor drug errors, no need to spend particularly in areas with poor continue in line with user internet connectivity. money on access controls) internet connectivity. requirements, subject to ongoing outweigh the small amount of monitoring and review by the NICE income generated from Board. commercial sources. The BNF sections on adverse effects should include the frequency of adverse effects of medication, so that it is useful information for healthcare workers to tell to patients. Some key points ("Patients should be warned of ...") will make it easier to practice safe medicine and avoid litigation without overburdening patients with too much information. There should also be links to patient information leaflets and the SPC. Currently the adverse effects of medication are listed in a haphazard way and are meaningless and not useful. For each drug there should be a page on additional information with links to guidelines, meta- analyses, studies etc.

[Insert footer here] 110 of 383 Library I believe that the flexibility of Access via mobile devices will Publicity for everyone and Thank you for your comments, they Information hyperlinks wil be very helpful. be important - we appreciate awareness raising of the have been considered along with Services improved Athens arrangements strength of these resources will the other comments received in the Manager be really important. consultation, to inform the development of the enhanced BNF.

Advanced it seems to be a logical approach The most important area is only area is ensuring electronic Thank you for your comments, they Nurse and more user friendly. as a ensuring a rigourous process devices accessible for staff to have been considered along with Practitioner prescriber reassured that the ensuring all information is upto use to access the BNF. the other comments received in the information would be up to date date and relevant ensuring otherwise nil else consultation, to inform the via electronic version rather than safety is maintained. development of the enhanced BNF. paper copy. concerns are: NICE acknowledges that digital currently do not have access to infrastructure and access to work electronic gadgets out of portable devices throughout the the office as review patients in NHS is not fully developed. their homes. need to ensure that Distribution of print formats will organisations are on board with continue in line with user this from governance and safety requirements, subject to ongoing aspect. will only recieve paper monitoring and review by the NICE copies yearly. if do not have Board. access to electronic gagdets at the same time could be unsafe practice.

[Insert footer here] 111 of 383 Medicines Great vision but we need to take Access to up to date evidence Need to ensure that the new Thank you for your comments, they Information & care not to overwhelm users with based guidance. Ideally the new database links with a wide have been considered along with Formulary information. In my experience version for the BNF should be range of electronic prescribing the other comments received in the Pharmacist some users already have able to be integrated into systems. Clinicians need this consultation, to inform the difficulty accessing some of the electronic prescribing systems information/information development of the enhanced BNF. BNF content even when they with local formulary content prompts at the point of know it is there. Could consider available to the clinician at the prescribing. a basic version backed up by a point of prescribing. full version behind (similar to the methods used in Drugdex) so that users can access this additional information only when they choose to. I edit a local hospital formulary hosted on the BNF on FormularyComplete. As a user I was actively involved in the development of this database and the transition from the WeBNF. Despite this the transition was by no means smooth, extremely time consuming and fraught with bugs. Please ensure that users such as myself are involved from an early stage to ensure a smooth transition to the new version.

[Insert footer here] 112 of 383 ePrescribing The vision to access the 'book' Patient and front line focussed. The information contained Thank you for your comments, they Lead, NHS via electronic means is sound. Information available in ways within the book can be used to have been considered along with England However there is little to identify that meet todays needs i.e. the far better support clinical the other comments received in the how the core information is ability to drill down quickly and practice - with the addition of consultation, to inform the intended to be used to support to find high level summaries or patient specific information it development of the enhanced BNF. clinical decision support. If information with the option to dig will be possible to derive far NICE acknowledges that digital current mechanisms for support deeper if required. consistency more patient focussed support infrastructure and access to i.e. those available via other third of dosing and the inclusion of that is not currently available portable devices throughout the parties, are duplicated there is practical support that is not elsewhere. CDS in the future NHS is not fully developed. little benefit and they will be currently available. Multiple will not just be about a+b but Distribution of print formats will widely turned off. There is an options in terms of how the links rather a+b+patient info - the continue in line with user opportunity to deliver CDS that can be utilised and whilst BNF has the knowledge requirements, subject to ongoing meets clinical needs and lead theoretical information is helpful embedded to support this monitoring and review by the NICE the way in delivering support that there is also a need to be reducing the current incidence Board. is innovative and useful. I would pragmatic and identify where of over-alerting with third party suggest that more thought is this is the case. There are a suppliers. given to this area and how it number of gaps in the content might be developed that need to be plugged.

GP The reason the current BNF Keep guidance separate from Please trial carefully any Thank you for your comments, they system works is its simplicity. fact. Forcing clinicians to forage suggested changes with have been considered along with NICE is Guidance mainly. BNF through 'guidance' sections to ordinary clinicians in ordinary the other comments received in the is factual. The two should be get at facts might meet an work situations. It is not in our consultation, to inform the clearly separated. BNF has organization's agenda but miss population's interest to have a development of the enhanced BNF. stood the test of time in its the outcome agenda on patient super-dooper-enhanced BNF NICE acknowledges that digital current format. To change it is care. that nobody uses. infrastructure and access to not without risk. I am concerned portable devices throughout the that NICE's sees its problem as NHS is not fully developed. struggling to be widely adopted. Distribution of print formats will I wonder if it might be better to continue in line with user address its own issues rather requirements, subject to ongoing than piggybacking on BNF. monitoring and review by the NICE Naturally I am concerned that Board. changing the BNF to meet a NICE will undertake extensive user different agenda would testing on any enhancements made undermine its greatest appeal - to the BNF. ease of access to factual information.

[Insert footer here] 113 of 383 Palliative Care Seems like a good development, Making sure the most up to date Link to other national Thank you for your comments, they Pharmacist to utilise the technology options information is used. All too often specialities such as the have been considered along with available I see out of date BNF's being Palliative Care Formulary. the other comments received in the used to inform prescribing Scarity of funding means our consultation, to inform the decisions. organisations hospices do not development of the enhanced BNF. have electronic access to this NICE acknowledges that digital incredibly useful resourse. infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant in Please do it Hyperlink to evidence/ dosage An interactive bulletin board/ Thank you for your comments, they Adult Critical calculations etc forum linked in..? have been considered along with Care Medicine, the other comments received in the Clinical consultation, to inform the Director of development of the enhanced BNF. Diagnostics and Clinical Support

Macmillan Looks good - great to be able to Most imprtant that it is up to date As a palliative care specialist I Thank you for your comments, they Specialist search by various terms rather and that all nationally accredited use the Palliative Care have been considered along with Palliative Care than just look up a drug. advice is cross referenced and Formulary (PCF) online more the other comments received in the Pharmacist vailable alongside. often than any other resource consultation, to inform the in suppprting parcatice. Free development of the enhanced BNF. and linked availability of this would be ideal - particilurly when advising GPs and district nurses who would have the assurance of being able to access detailed specialist information to support their patient managment.

[Insert footer here] 114 of 383 Senior Some good ideas, (others are I like the idea of comparisons of Where there is a new Thank you for your comments, they Pharmacist harder to visualise without efficacy and safety. development, warning or news have been considered along with Medicines seeing an example). Where item about a drug, will there be the other comments received in the Information international resources are used link to this in the BNF? consultation, to inform the it would need to be essential that development of the enhanced BNF. the origin of the resource is referenced clearly so readers are aware of differences in UK and non-uk uses (especially doses). Not sure what 'continuously' updated will entail - will this include reactions to news items. Where side effects will be rated for frequency - will this match the system used in manufacturers' Summaries of Product Characteristics to ensure consistency across different resources.

Senior Sounds a very goood idea. Being able to search by No Thank you for your comments, they Pharmacist - Being able to search by condition condition or in maps similar to have been considered along with Medicines is very useful. NICE guidance pathways e.g. the other comments received in the Information pick the pathway that your consultation, to inform the patient is on and then pick the development of the enhanced BNF. stage and being able to see a drug comparison for the drugs recommended. Including links into other resources such as palliative care formulary.

Section Head Reducing reliance on print - very Quick easy access, correct Not sure, only recent user of Thank you for your comments, they good idea, most people access information, easy to interact BNF have been considered along with online nowadays and if the data the other comments received in the is more up to date then are more consultation, to inform the likely to - as long as development of the enhanced BNF. communicated effectively. Digital format would be easier to read,

[Insert footer here] 115 of 383 more interactive etc.

Medicines Currently the paper edition has Up to date, easy to search. Links to other resources e.g., Thank you for your comments, they Information the advantage of being able to Links to guidelines/national Palliative Care Formulary. have been considered along with Pharmacist flick between drugs within a protocols. Easier set-up with local the other comments received in the section. The current electronic formularies (ie Formulary consultation, to inform the version does not allow this. An complete). development of the enhanced BNF. enhanced version would hopfully make this easier (currently you hvae to go back and forth several times o swap between drugs). Allowing more than one drug on screen at a time would be useful.

Pharmacist Working in a hospital internet Link to other reliable sources for Intravenous administration Thank you for your comments, they access is not always available. differet specialities e.g. palliative chapter is very useful and will have been considered along with We rely on the printed version. care formulary hopefully stay. the other comments received in the Until the rest of the NHS catch consultation, to inform the up I doubt we can rely on an development of the enhanced BNF. electronic version alone. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Deputy Chief Clearly the way to progress. I find the current version difficult Enable direct links to other Thank you for your comments, they Pharmacist - Hardware is still a big issue for to use compared to the hard "free" resources E.g. Palliative have been considered along with Medicines the NHS (availability of tablet copy. Too many clicks to drill Care Formulary? the other comments received in the

[Insert footer here] 116 of 383 Management & PCs, good wireless connections down to what you want, and consultation, to inform the Governance etc) Being able to browse by then back out to look at another development of the enhanced BNF. clinical condition / disease state drug. The ability to view three or is definitely a good move. four monographs at the same time as when viewing a double page of the book can be very helpful at times. The electronic version should be able to handle multiple "windows" on the data so it is easy to view side by side data or flip between items with a short-cut key. (CTRL+Tab etc.) Get away from links like "See xxxx " for cautions and contraindications and "See notes" - an electronic version should be able to insert the data into the monograph in situ.

[Insert footer here] 117 of 383 Clinical Agree for more accessible digital I would want it immediately It may be helpful to include, as Thank you for your comments, they Pharmacist document for variety of devices available for prescribers in well as free to view information have been considered along with or embedding in other primary/secondary care when e- and free links, suggested links the other comments received in the documents/sites. I don't find the prescribing. I would want it to be to subscriber sites and data consultation, to inform the eBNF very easy to navigate. The integrated with NICE/SIGN bases if further information development of the enhanced BNF. pages feel clumsy and guidance and links to NPSA (but not necessarily frequently information not as immediately guidance, rather than a blue needed) is available. Users identifiable as the print version. panel in the general information could then, depending on their (as in present BNF), a link from specialty, decide whether every monograph of drugs subscription for themselves or affected by that guidance. I their organisation was a would also want it to include priority. eg Drugs in either as text, or free link to Pregnancy/Lactation, Renal specialist websites offering Drugs, Stockley's drug information: BAPEN for enteral interactions, Medicines feeds and medicines with feeds, Complete, etc. and to palliative care formulary (PCF) (information in BNF for paliative care is currently patchy) where there is specialist information which prescribers, pharmacists and other HCPs can obtain information via an online link to the PCF.

Core Trainee in All sounds good to me. Making Easy to search by drug generic Not that I can see Thank you for your comments, they psychiatry access easier and the searching name or proprietary name. Up have been considered along with of the information more easy to date information on available the other comments received in the would improve upon the existing preparations. consultation, to inform the formats. development of the enhanced BNF.

[Insert footer here] 118 of 383 Clinical Extremely concerned. The BNF It is important the quick practical Yes - the chance to keep the Thank you for your comments, they Pharmacologis is one of the greatest nature of the current BNF is not paper copy the chance to have been considered along with t achievments of medical practice lost as an invaluable aid to reference existing databases the other comments received in the worldwide. The BNF has a prescribing. There are plenty of without making the BNF consultation, to inform the minute budget compared to academic and other references. unwieldy and a repitition of development of the enhanced BNF. pharmaceutical companies, yet Much could be made of cross other sites Please do not spoil NICE acknowledges that digital provides an incomparable referencing the following a world renowned gem. infrastructure and access to counterbalance to the multi- databases: NICE Cochrane portable devices throughout the £billion advertising budgets of Database Electronic Medicines NHS is not fully developed. the pharmaceutical industry. The Compendium - this excellent Distribution of print formats will paper format should be database is grossly underused continue in line with user maintained. It is not possible to by prescribers and unknown to requirements, subject to ongoing count on expensive hand held medicial students, yet lists all monitoring and review by the NICE devices in a busy casualty or the SPCs for medicinal Board. ward in the middle of the night products: when the internet might go down https://www.medicines.org.uk or your device goes missing. MHRA website - now also There should be even greater valuable resource for looking up dissemination of the paper SPCs copies. The electronic version is an excellent addtion, but is not a replacement for the paper version.

[Insert footer here] 119 of 383 clinical site Good aspiration limited by poor Easier to navigate and find Lack of reliable access to pc Thank you for your comments, they lead access to computers in nhs and information reliably. Wider free etc in NHS and lack of have been considered along with pharmacist especially at patient bed when access to specialist resources. resource to provide sufficient the other comments received in the prescribing and administering Offline access and support for a pc, tablets, purchase of consultation, to inform the medicines in a predominantly wide range of platforms i.e. No additional paper copies means development of the enhanced BNF. paper based environment. current app for windows phones! that a significant number of NICE acknowledges that digital Additional concerns around prescribers, pharmacists and infrastructure and access to community services delivered at nurses will now only access an portable devices throughout the patients home where lack of annually updated copy of bnf NHS is not fully developed. mobile signal etc could prevent when prescribing for and Distribution of print formats will access to digital resource (what administering drugs to patient continue in line with user happens if mobile device has flat with associated increased risk. requirements, subject to ongoing battery and no charger?). Wider monitoring and review by the NICE free nhs access to resources Board. such as palliative care formulary and specialist resources(neonatal, oncology, icu etc.) also essential. Would accept inconvenience of no paper copy if had free access to resources which currently require additional subscription.

Clinical Nurse In this digital age a paper version I would want it to contain the How much prescribing is done Thank you for your comments, they Specialist in is soon outdated and it is difficult PCF Formulary but in a more for palliative care patients and have been considered along with palliative care. to maintain all updates which user friendly manner. I need to how the BNF does not always the other comments received in the Independent compromises safety access the BNF in patients help consultation, to inform the prescriber. homes and my employer does development of the enhanced BNF. not provide me with the equipment to do this online.

[Insert footer here] 120 of 383 Consultant in I agree wholeheartedly that we Keeping BNF up to date and Adding additional useful Thank you for your comments, they palliative should encourage access online. widely accessible. I do worry information online e.g. have been considered along with medicine I think that apps are the easiest that if print books removed Palliative care formulary. the other comments received in the way to view information for me, completely, this May consultation, to inform the but when we look at electronic disadvantage certain people development of the enhanced BNF. prescribing as an organisation I who are less technology savvy. NICE acknowledges that digital would hope to look at online infrastructure and access to access too. I would like to see portable devices throughout the other access for example, to NHS is not fully developed. palliative care formulary- Distribution of print formats will essential in my work, come with continue in line with user BNF and be centrally funded for requirements, subject to ongoing all practitioners as I think this will monitoring and review by the NICE improve quality of palliation. Board.

Pharmacist The ideas are great and will Linked guidance to reduce Links to Summary of Product Thank you for your comments, they definitely help improve patient costs. Monthly updates rather Characteristics and Patient have been considered along with care. It will be much easier to link than 6 monthly paperback Information Leaflets beside the other comments received in the current and local guidance on updates. Digital links. Multiple each medicine/product. consultation, to inform the the best medicine(s) for a search methods. Comparison Access to the NICE BNF app development of the enhanced BNF. particular patient. function. for community pharmacists.

Medical I suspect that it is not so much a Accessibility via various devices Nothing overlooked. Thank you for your comments, they Director, matter of whether or not the and the constant updating would have been considered along with Hospice outlined changes will take place, be important. Links to relate the other comments received in the but more one of when they will. resources like PCF would be consultation, to inform the Personally, I am a book- essential, also. development of the enhanced BNF. orientated person but I can see the advantages of electronic versions which can be readily updated. Links to other resources will be very valuable. I would say that the PCF would be an essential link. This invaluable resource is one I refer to on a daily basis and I believe it would be valuable to colleagues

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Palliative CNS more palliative care related as above No Thank you for your comments, they prescribing would be beneficial. have been considered along with The PCF charges for its books, the other comments received in the internet access. consultation, to inform the development of the enhanced BNF.

Consultant I agree with these views Easy to use with up to date Links to key references would Thank you for your comments, they evidence and guidelines. Needs be useful have been considered along with to be free to access and useful the other comments received in the to link other resources such as consultation, to inform the renal drug formulary and development of the enhanced BNF. palliative care formulary.

Dentist All sounds very positive. One of One of the big things for me is No Thank you for your comments, they the big things for me is knowing knowing the drug interactions. A have been considered along with the dru section that allowed you to list a the other comments received in the patients meds and then type in consultation, to inform the what you wanted to prescribe development of the enhanced BNF. that highlighted any serious interactions would be most useful.

General Dental seems like a long overdue idea! No need to search for the book, Search facility is essential for Thank you for your comments, they Practitioner instantly kept up to date, dentists trying to work out what have been considered along with viewable on any browser their patients have been the other comments received in the prescribed by the GP, etc. - consultation, to inform the often the patient can't spell the development of the enhanced BNF. name of the drug, or aren't sure of the name, so something that allows for misspellings, and intelligent searches would be useful. Reporting adverse reactions would be a nice addition.

[Insert footer here] 122 of 383 Dentist and Good, but must be downloadable Common Conflicts between Our medical Colleagues need Thank you for your comments, they Teacher of off-line when internet connection medications when more than to be aware of DENTAL have been considered along with Dentists poor. TWO items taken complications before the other comments received in the (postgrads) prescribing certain things, such consultation, to inform the as Biphosphonates, Insulin, development of the enhanced BNF. Steroids, immuno-suppressive Since they work offline, a therapy etc, to ensure full dental health exists or these connection to the internet is not prescriptions could required once the BNF and BNFC hospitalise/disable patients if apps are downloaded onto a mobile they need a tooth (or teeth) out device. later, gum diseases worsened etc, etc. Can't this be flagged as a warning on GPs computers when entering such prescriptions?

Locum Seems sensible. Need to Up to date; easy to Should consider other sources Thank you for your comments, they Consultant in consider other sources too. read/navigate. of information eg Palliative have been considered along with Palliative Care Formulary (available the other comments received in the Medicine online via consultation, to inform the www.palliativedrugs.com. development of the enhanced BNF.

Locum As I work in rural community with Easily accessible and ? coordination with other Thank you for your comments, they consultant poor internet coverage cannot be searchable. Links with and does specialist resources eg in have been considered along with palliative solely reliant on internet app. not conflict with other specialist palliative care a major the other comments received in the medicine Print BNF is useful for carrying in resources eg Palliative care specialist resource is consultation, to inform the car and very quick reference of formulary. Portable app that palliativedrugs.com. This is development of the enhanced BNF. items in other locations eg does not require complex currently free to access in NICE acknowledges that digital hospital wards. password and time consuming Scotland but not England. infrastructure and access to to access from multiple places. portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 123 of 383 Since they work offline, a connection to the internet is not required once the BNF and BNFC apps are downloaded onto a mobile device.

dentist / / Bring back the dental section Thank you for your comments, they in the BNF have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF.

Dentist Should link into dental clinical The early version of the eBNF Yes, your marketing. I receive Thank you for your comments, they software as a bolt-on module put me off using it. When I do a a new hardcopy of the BNF have been considered along with Should report all potential prescribe and need to check up every year approximately. I the other comments received in the interactions All products should on a product in the BNF it is an would would like to see a card consultation, to inform the have a short code which can be irritating process Another point with a login code and url stuck development of the enhanced BNF. entered to ensure accuracy and is that presumably these to the front of it. More speed of recording OR better still versions of the BNF cost a generally you could try pharmicies should load the data considerable amount to produce achieving the ease of access onto a cheap usb / micro sd and maintain (electronic to information which Pubmed card, or alternatively encode it in versions). Surely there should and Google frequently a set of printed QR codes for be a single EU electronic facilitate. In the case of practices to read. version? Google, if one is certain about an address for information provided by a search, it puts in the shade anything else I have ever used if I want to read up on a dental or medical issue.

[Insert footer here] 124 of 383 Specialty Dr It would be extremely helpful to The most important thing is that The consultation document Thank you for your comments, they Palliative have easy access, via an information is up to date and looks comprehensive to me have been considered along with Medicine enhanced BNF, to PCF 4 - from accurate. In addition easy and if the aims are achieved it the other comments received in the palliativedrugs.com (currently access is essential whoever the would be a huge benefit to consultation, to inform the only accessible in Scotland via setting we fine ourselves clinicians. development of the enhanced BNF. Athens Log in) working in.

Dental surgeon I agree that the BNF should be 1. constantly kept up to date 2. No Thank you for your comments, they the authoratative source on all move away from print which have been considered along with medicines and prescribing, quickly becomes out of date 3. the other comments received in the deliver free access by modern ensuring robustness of consultation, to inform the media and ensure that information provided 4. development of the enhanced BNF. recommendations are evidence maintaining independence from based NICE 5.ensuring recommendations are evidence based

Advanced Investment in electronic Ease of use Adequate cross No Thank you for your comments, they Clinical resources is good, however referencing Fit for purpose have been considered along with Pharmacist Trusts must have adequate IT Quick to use - current eBNF is the other comments received in the resources to support this. As a not intuitive and it is easy to consultation, to inform the practising pharmacist working on miss important things as cross development of the enhanced BNF. clinical wards it is sometimes refereing poor NICE acknowledges that digital difficult to access a PC, and I do infrastructure and access to not have a tablet device. portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 125 of 383 Specialist These all sound good. Especially it has to be easily searchable - it No if the key important themes Thank you for your comments, they Pharmacist those in the second half of isn't at the moment are progressed digital have been considered along with Cardiology section 2 would be relevant to electronically. More information information only could be the the other comments received in the me. on adverse effects, side effects useful way forward. consultation, to inform the and their frequency would help. development of the enhanced BNF. It would also help if you could search for conditions and it would find drugs indicated. If it can include more up to date information to help clinicians and patients make informed decisions together that would be good.

Senior Special Sounds like a great idea and an Simple gold standard advice Doesn't look like it! Well done. Thank you for your comments, they Care dentist example of technology at its available all in one place at the have been considered along with best. However as a community touch of a button. the other comments received in the dentist working in residential and consultation, to inform the care homes, I would be development of the enhanced BNF. concerned if the print version NICE acknowledges that digital were to disappear completely as infrastructure and access to I need this backup if for any portable devices throughout the reason the smart phone, tablet or NHS is not fully developed. other device were to fail/be Distribution of print formats will unable to receive a signal etc continue in line with user when working in remote areas requirements, subject to ongoing monitoring and review by the NICE Board.

Optometrist We still need to have a paper . Trust IT systems are not Thank you for your comments, they version. reliable enough to have solely have been considered along with digital BNF. the other comments received in the consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed.

[Insert footer here] 126 of 383 Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Dentist It is difficult and expensive to get To stop drs prescribing No Thank you for your comments, they the app I'm afraid, this puts me antibiotics for dental problems. have been considered along with off very much as I can just This encourages patients to the other comments received in the google things and see what think that antibiotics are the consultation, to inform the comes up. answer because they trust their development of the enhanced BNF. GP more than they trust us. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. The NICE BNF and NICE BNFC apps are available free of charge to NHS staff including dentists. Information on how to access the apps is here; http://www.nice.org.uk/About/What- we-do/NICE-apps-for-smartphones- and-tablets

Reducing prescribing of antibiotics for dental problems by doctors is outside of the scope of the proposed enhancements to the BNF but NICE is developing guidance on

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Dentist I think it is a great idea and It should contain all the I use the mobile app and it is a Thank you for your comments, they should be explored further. associated links directly wonderful resource and used have been considered along with associated with each drug such many times daily to check the other comments received in the as interactions, dosages, dosages and show the safety consultation, to inform the contraindications, warnings etc. aspects to the patients. development of the enhanced BNF. It should be available offline if there is loss of reception.

Consultant in Support the concept Accessibility - I frequently use I use the palliative care Thank you for your comments, they Palliative the book as it is closer to hand formulary more freqently than have been considered along with Medicine on the ward when compared to the BNF - both the book PCF4 the other comments received in the finding a vacant computer and and online consultation, to inform the logging on. I still find reading a www.palliativedrugs.com development of the enhanced BNF. paer document easier than a which I subscribe to. Could the NICE acknowledges that digital computer screen BNF link to the PCF? It is an infrastructure and access to excellent resource for portable devices throughout the prescribing in the context of NHS is not fully developed. palliative care and is written so Distribution of print formats will it is accessible to generalists continue in line with user and palliative medicine requirements, subject to ongoing specialists. The PCF being monitoring and review by the NICE available to all NHS Board. prescribers would support the ongoing need for better end of life care.

[Insert footer here] 128 of 383 Advanced The vision is good but to be Rapid updates, particularly to Nothing crucial Thank you for your comments, they Pharmacist/Tea honest, for a quick reference I saftey of medicines. have been considered along with cher would rather have a relatively up- the other comments received in the Practitioner to-date paper copy in my hands. consultation, to inform the I think there will be too much development of the enhanced BNF. information in the "enhanced" NICE acknowledges that digital version to allow fast assimilation infrastructure and access to of information, it will be great for portable devices throughout the long case discussions or NHS is not fully developed. students writing an essay but Distribution of print formats will could mean that lots of short, continue in line with user quick queries end up taking a lot requirements, subject to ongoing longer to resolve with too much monitoring and review by the NICE irrelevant (to that situation) Board. information getting in the way. I would expect people working in their own specialiistie to be aware of latest NICE guidelines etc anyway and they are not difficult to refer to when necessary in their current format.

[Insert footer here] 129 of 383 Hospital The use of digital media is an Access to the digital version of It will be vital that the new Thank you for your comments, they Pharmacist appropriate vision for the future the BNF. Currently in some NHS version is compatible with the have been considered along with allowing for more up-to-date hospital, access to I.T. is limited. Health Board formulary, the other comments received in the information. Updating the search For example, on my ward there allowing for Health Boards to consultation, to inform the functions will be extremely is one pharmacist, one easily integrate it with their development of the enhanced BNF. important, as I currently find that pharmacy technician, 4 or 5 online formulary to prevent any NICE acknowledges that digital I am unable to find information in qualified nurses, 2 consultants problems at the point of infrastructure and access to the medicines complete online and 5 or 6 junior doctors and a dispensing. portable devices throughout the version, despite knowing exactly ward clerk and we have access NHS is not fully developed. where it is in the paper version. to 5 computers, one of which is Distribution of print formats will Links to NICE guidance will be reserved for use by the ward continue in line with user extremely useful at the point of clerk and only one of which is a requirements, subject to ongoing care, in order to help guide mobile PC on wheels whilst the monitoring and review by the NICE prescribers including junior others are static PCs, making Board. doctors. Links to further the paper BNFs currently more explanation of the evidence useful for accessing the behind NICE guidelines will be information at the point of care extremely valuable for registrar i.e. on the ward round. However, and consultant level doctors who electronic prescribing is wish to base their decisions on currently a priority for our Health this. Board so in the near future we envisage having greater access to mobile devices in which case an enhanced digital version of the BNF will be invaluable.

Macmillan The single access point sounds As said above cros referencing not that I can see Thank you for your comments, they Nurse less confusing than the number information from PCF and BNF have been considered along with of different source I have just is something I do regularly. The the other comments received in the discovered in one of your ability to make use of reliable consultation, to inform the previous questions. I often cross approved pt information and development of the enhanced BNF. reference the BNF with the print it off and give to pt's would palliative care formulary and be of great benefit. would find it convenient to have both from one source. Although you are not specific I would assume you are considering including the PCF in the range of

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F2 Doctor Useful to have more information Intergrating NICE and other No Thank you for your comments, they about evidence and guidelines to guidelines. Being able to cross have been considered along with help decide what to prescribe. reference multiple drug the other comments received in the However, could get confusing if combinations for patients to consultation, to inform the there are constant updates and avoid interactions. development of the enhanced BNF. lots of information. Local protocols may differ from NICE guidelines as well. Although computer use is widespread across the NHS, access to computers can be limited on a busy ward environment. For quick prescribing, a print version of the BNF can be the most useful and easy to find as search engine searches can give complicated results.

Medicines I think it is a valuable, but To have the pertinent At the point of care, the main Thank you for your comments, they Information optimistic vision. To have all that information available from the thing a prescriber / other HCP have been considered along with Pharmacist information in a searchable and initial search, without having to wants is a quick answer. There the other comments received in the accessible format, without wade through numerous pages are many resourse in which consultation, to inform the overwhelming the 'reader' will be of irrelevant information, as is detailed searches can be development of the enhanced BNF. difficult to achieve. People want currently the issue with NICE undertaken. The BNF the electronic format to be quick evidence search. There needs represents a concise but and simple - this sounds to be a function to allow mis- comprehensive resource. It potentially over-complicated. spelt words to be matched. would be a shame to dilute it Provision of sepcialist with vast amounts of additional information (eg: Palliative Care information that is ultimately Formulary) would be valuable. available elsewhere. However, People don't just want links to improving on the intuitivity of other documents (eg: NICE the search function of the guidance, MHRA info) - they current electronic BNF would want concise summaries as be a vast improvement. There included in the print BNF is currently huge amounts of currently. important information

[Insert footer here] 131 of 383 contained in the eBNF, but there is a belief that this often missed due to the current presentation of search results and the restrictive search function. consultant in please include links to nil else nil else Thank you for your comments, they palliative recognised non BNF resources - have been considered along with medicine such as the PCF (palliative care the other comments received in the formulary, both adults and consultation, to inform the children). if practitioners work development of the enhanced BNF. only with the BNF and drug licensing this will severely compromise the care of patients where off label and off licence prescribing are in their best interest

[Insert footer here] 132 of 383 Community A single record with up to date Remote access in patients home Will cost of drugs and cheaper Thank you for your comments, they Matron information on medicines and linked to national care records alternatives be available to have been considered along with their actions and interactions such as Systm one would be access at same time to ensure the other comments received in the which can be accessed in the invaluable from a safety and most cost effective drug is consultation, to inform the patients home would be governance point of view and chosen will it be linked to development of the enhanced BNF. invaluable as a prescriber who is make clinical decisions more schemes such as script called to patients not known to timely and effective. Good switch?? Drug interactions and them with limited access to their network connectivity obviously side effects tailored to patients medical record. This would make paramount. Links to NICE individually would be useful practice in community settings guidance and advice again could we input patients current much safer and less likely to be invaluable particularly when drugs and be made aware of delayed if have to go elsewhere negotiating treatment plans with possible interactions for to access the information. patients can show them the example if in a patients home evidence of why clinical and not in their medical record decisions are made. Being able ? to access patient information readily to print off and give to or email to the patient would be advantageous. Drug interactions and side effects tailored to patients individually would be useful could we input patients current drugs and be made aware of possible interactions for example if in a patients home and not in their medical record ? pharmacist Would expect to see all Enable all healthcare see first comment. Thank you for your comments, they (industry) authoritative data sources professionals to make evidence MHRA/EMA make Market have been considered along with included - Sumary of Product based determinations of Authorisation decisions based the other comments received in the Characteristics, patient appropriate treatment choices, on the balance of evidence consultation, to inform the information leaflets, EPAR, including aspects of available. These data sources development of the enhanced BNF. CHMP positive opinion, polypharmacy not previously should be included. Stockleys drug interactons etc covered.

[Insert footer here] 133 of 383 Consultant Greater access to digital updated Easy access to speciality No Thank you for your comments, they Palliative versions is desirable. The vision resources and up-to-date have been considered along with Medicine to incorporate links to speciality prescribing information the other comments received in the sources again would be (especially with reference to consultation, to inform the essential. In my own speciality drug alerts and changes that development of the enhanced BNF. we refer to the Palliative Care occur between prints). Formulary (PCF) which is available on-line too.

EOLC lead fully agree Easy access Inclusion of Paliative CAre Thank you for your comments, they Formulary - PCF have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF. nurse Would like a mobile device, I would like improved Prescribing profile, could this Thank you for your comments, they practitioner already have access to computer information about interactions individualised and linked to have been considered along with ophthalmology but it is not always speedy. and eye medications, health formulary? the other comments received in the Process of logging on will need conditions that are significant consultation, to inform the to be clear and straight forward. when prescribing eye drops development of the enhanced BNF. Prescribing profile, could this individualised and linked to formulary?

Specialist I think this is a positive move I would benefit from links to Not that I've thought about Thank you for your comments, they clinical other sources eg PCF4, renal have been considered along with pharmacist handbook, maudsley prescribing the other comments received in the palliative care guidelines consultation, to inform the development of the enhanced BNF.

Palliative Care, This should provide an excellent The ability for decision making No Thank you for your comments, they Clinical Nurse resource. My colleague and I based on up to date research have been considered along with Specialist are currently undertaking remote and individualised patient needs. the other comments received in the working in which an on-line consultation, to inform the service would enhance practice development of the enhanced BNF. and reduce the need to carry bulky books

[Insert footer here] 134 of 383 FY1 Sounds good...... Thank you for your comments.

Pharmacist I think linking with other evidence I think it needs to be clear to No Thank you for your comments, they based sites and publications is access and read all information have been considered along with essential. I would particularly around a medication on one the other comments received in the like to see links with the page and not having to keep consultation, to inform the Palliative Care Formulary (PCF) 'clicking' from one page to development of the enhanced BNF. and palliativedrugs.com. I think another. free access to the information they provide is essential

Senior This is a good idea, as it will Most important is to allow easily Involve off license drugs and Thank you for your comments, they Pharmacist, make accessing accurate, robust accesible information, that is up unlicensed indications for have been considered along with Surgery and evidence based medicine in to date and evidence based. licensed medications. the other comments received in the a quick and timely manner. It will consultation, to inform the also mean that all the information development of the enhanced BNF. is in one place, which will save time, aid cost effective and safe prescribing.

[Insert footer here] 135 of 383 CRF Manager Though I agree that electronic The document need to be user Easy access of computers to Thank you for your comments, they Lead Research media is a good way forward it is friendly and intuitive when using all who would access BNF have been considered along with Nurse reliant on there being easy the electronic system and when the other comments received in the access to computer where searching it needs to be able to consultation, to inform the nurses get medication from pick up regardless of word order development of the enhanced BNF. which is not the case in most and if possible give suggestion NICE acknowledges that digital hospitals. We have limited in case people are not sure of infrastructure and access to access to computer terminals the spelling. Worry I have is if portable devices throughout the and there for paper BNF still very the electronic version is going to NHS is not fully developed. useful. Also the use of apps is get updated more frequently Distribution of print formats will making the assumption that than the paper BNF then this continue in line with user nurses can access wifi or use could cause confusion if not requirements, subject to ongoing phone connection. Not all nurses worse errors. Both should be up monitoring and review by the NICE have touch phones and not all dates in same way. Paper Board. have open contract with version could state that it is only unlimited data access which puts valid up to xx date and if there these people at a disadvantage. are up dates then a paper print Also we are not supposed to be out could be made and then encouraging nurses to use their emailed to all so to add to paper phones in the clinical setting. doc if require by that team. Need to make it very easy and clear how to download the app for free for NHS nurses.

[Insert footer here] 136 of 383 Lead Recognise that electronic BNF More information on drug Paper version is my preferred Thank you for your comments, they Prescribing would be more up to date and interactions would be a welcome access method. have been considered along with Advisor reduce costs. But use paper addition. Regular updating. the other comments received in the version of BNF a lot as much Medical devices could be useful. consultation, to inform the easier and quicker to move Unclear on how 'download to development of the enhanced BNF. between pages, chapters and formularies' would work. NICE acknowledges that digital sections etc when looking for infrastructure and access to and comparing information. portable devices throughout the Would still like hard copy BNF NHS is not fully developed. even if anually. Use ePACT Distribution of print formats will which is arranged in similar continue in line with user number format, but assume you requirements, subject to ongoing would keep that. Smart phones monitoring and review by the NICE too small to use regularly to look Board. at information or large amounts of information. Access to computers is not always available outside the office for on-line use. Computer access in GP practices needs to be considered. Reading lots of information from computer screens is stressful visually.

PICU Nurse / Enabling BNFc to be Easily searchable Accessible N/A Thank you for your comments, they Simulation downloadable into local via local formulary (linked) Hard have been considered along with Team formularies or prescribing copies should not be eliminated the other comments received in the Coordinator systems would be beneficial. - sometimes Internet access is consultation, to inform the Currently it can be very difficult not available development of the enhanced BNF. to access BNFC as frequently as necessary due to lack of computers being available at the right time.

[Insert footer here] 137 of 383 GP Amenable to regular updates so I really do value the print BNF. It The implications as above for Thank you for your comments, they it will be consistently accurate. is invaluable when out on home reducing the print copies. have been considered along with Excellent idea to be able to visits. We are not set up for the other comments received in the search it in different ways i.e mobile data in our practice and I consultation, to inform the from condition don't know any in my locality development of the enhanced BNF. that are. Mobile data is very NICE acknowledges that digital patchy where I work. If it was infrastructure and access to already downloaded to a device portable devices throughout the that would be fine but we don't NHS is not fully developed. have tablets in our practice. If Distribution of print formats will we did each doctor would continue in line with user require one and that is a requirements, subject to ongoing significant cost to the practice. monitoring and review by the NICE Board.

PHARMACIST It is a logical development given Ease of use and clarity - it could Would like links to other Thank you for your comments, they PRESCRIBER that the technology and access easily become confused and references eg PCF for have been considered along with is now available almost conflicting if not managed palliative care, which would the other comments received in the everywhere. properly. greatly expand its' usefulness. consultation, to inform the development of the enhanced BNF.

Consultant I think its a good idea. Working in community, apps or The palliative care formulary Thank you for your comments, they pdfs that can be used off line are (PCF4) is an essential have been considered along with very helpful. resource for those working in the other comments received in the palliative care and beyond. In consultation, to inform the germany this is paid for development of the enhanced BNF. nationally and available to all health care professionals. In the UK, individuals or organisations have to buy either the paper book, pdf, or online subscription. It would be fantastic if the PCF could be incorporated into an enhanced BNF.

[Insert footer here] 138 of 383 Lead The BNF should continue to be A carefully managed transition Drug dose calculators could be Thank you for your comments, they Pharmacist - readily accessible and free for all from the paper to the digital in-built e.g. for patient specific have been considered along with Medicines healthcare professionals version is essential as there are mg/kg dosing. the other comments received in the Optimisation involved in any stage of the many areas of the modern NHS consultation, to inform the and medicines use process. The which still do not have reliable development of the enhanced BNF. Information vision is a reasonable goal for access to online resources. NICE acknowledges that digital Service what is needed in the current infrastructure and access to healthcare system. There should portable devices throughout the be more links to relevant NHS is not fully developed. guidelines and more guidance Distribution of print formats will should be provided in the text continue in line with user e.g. management of drug requirements, subject to ongoing interactions/side effects and IV monitoring and review by the NICE administration. Board. matron agree with the principles, consistancy and acuuracy of yes- IT access. I have a 35 Thank you for your comments, they however the scant access to, inforamtion-key, but see above beded ward with 5 terminals have been considered along with and time delay when accessing for lack of reality of this proposal for all staff, no terminal in the the other comments received in the electronic formats mean print is clincial room, non in the 25 consultation, to inform the stil required. Even in a tertiary single rooms, wireless is not development of the enhanced BNF. acute hopsital- so community available throuought the NICE acknowledges that digital prescribres, who often are in pts building. NICE needs to infrastructure and access to home with no e access, wil be acknowledge there are risks in portable devices throughout the left withouht guidence- its not temres of curency with pront NHS is not fully developed. practical or realistic yet. versions, but its the only Distribution of print formats will practical option for a lot of continue in line with user prescribign /administering requirements, subject to ongoing situations monitoring and review by the NICE Board.

Consultant in Overall seems reasonable, but Succinct and up to date No Thank you for your comments, they Paediatrics my experience of online and authoritative medicines advice. have been considered along with apps access is that is it less easy the other comments received in the to use than the printed copy. So consultation, to inform the it would be important to improve development of the enhanced BNF. this if the aim is to move to mainly electronic access.

[Insert footer here] 139 of 383 Midwife/Superv 1. All the proposals are 1. An electronic format must be 1. There is wide evidence that Thank you for your comments, they isor of welcomed. 2. An overall consistent and easily searchable medicines management is have been considered along with Midwives impression is that the vast in the way it provides confusing for midwives. Some the other comments received in the majority of clinically available information for each drug. 2. of this confusion relates to consultation, to inform the medicines information and The idea that it will be Midwives Exemptions. I would development of the enhanced BNF. facilities is aimed specifically downloadable to local welcome inclusion of any towards the needs pharmacists formularies is welcome and I information that would clarify and prescribers. There is would like more information the situation such as a clear generally less consideration of about how this would work. A indication with each drug as to the needs of the nurses and local midwifery formulary is what exemptions and any midwives (and others no doubt) under development and it would conditions that apply. Clearly who are required to administer be a huge advantage to be able this may vary between medicines and the challenges to link directly to up to date different health professionals encountered in doing so in information on individual and as in the case of midwives accordance with professional preparations to be included as the MRHA set conditions and standards. I would urge that any well as to NICE clinical the NMC set further changes take this into guidelines associated with restrictions on the use of the consideration. different uses of the drugs. 3. medicines by midwives. 2. Prescribing information and that The legal status of drugs can aimed at minimising harm vary between preparations and should link to clear guidance on this is not always clear in the the management of pregnant current paper BNF. A specific and breastfeeding women. 4. example is Ferrous Sulphate Information for patients is 200mg tablets: From Sandoz welcome and would like to see they are POM and from this in a clear, meaningful and Actavis they are P(Pharmacy). printable format and in a range Midwives can supply the latter of languages as well as with the but as Ferrous Sulphate is not inclusion of information for on the Midwives exemption list pregnant and breastfeeding they cannot supply the Sandoz women. 5. I would like to see form although it is widely profession specific Continuing assumed that they can. 3. It is Professional Development very difficult for midwives to information (e.g. midwives). explain to women why the NICE recommendation for management of 3rd Stage requires off-label use of Syntocinon. The NMC

[Insert footer here] 140 of 383 demands that women are given an explanation. Perhaps an enhanced BNF could include such explanations to help fulfil professional standards. 4. Inclusion of links to examples of calculations for particular drugs when appropriate would be welcome.

Chief I agree with the point to exploit The most important element is Operational issue in particular Thank you for your comments, they Pharmacist avantages offered by digital that the enhansed BNF is how charities and independent have been considered along with (Third Sector media. I also strongly agree required to interface in some healthcare providers like the other comments received in the NHS Service regarding ensuring that way with the e-Prescribing Addaction will be able to consultation, to inform the Provider) prescribers have timely access systems we use. In this way access or register for the development of the enhanced BNF. to up to date information in the then the information can be enhansed BNF due to limited most appropriate way to ALL referenced within the patient current access with the lack of HEALTH AND SOCIAL CARE notes, can be used for to an NHS email. PRESCRIBERS as currently the support prescribing decision or charity I work for has had limited to enhanse the quality of history access to medicines information taking and in the safer resourses due to the lack of an identification of adverse drug NHS email address. interactions/interactions particularly in complex patients. In addition a degree of interface will support the implemention of the Addaction national formulary with the respective links to the complete NICE guidance for education and update of prescribers.

[Insert footer here] 141 of 383 consultant in link with palliative medicine to allow generalists to gain link with palliative care Thank you for your comments, they palliative care formulary. great resource for advice that is suggested by formulary resource have been considered along with indications and doses of specialists and provide evidence the other comments received in the medications for symptom control. to support prescribing. consultation, to inform the these are often used off licence development of the enhanced BNF. and would not be quoted in the BNF for their specific palliative care use.

Head Sounds great but am concerned I think the best part of the I would be concerned that Thank you for your comments, they Pharmacist that it is not always possible to enhanced BNF will be the link to when I am on call it is not have been considered along with access a computer to be able to the NICE guidance so it will always practical/ possible to the other comments received in the use this as it is intended. On the always be up to date. In the have access to a computer so consultation, to inform the wards I work on there are pharmacy setting this will be am relying on the paper BNF. development of the enhanced BNF. insufficient terminals for the very useful although on the Perhaps there needs to be a NICE acknowledges that digital people to check an online BNF wards the reality is that wards check whether the enhanced infrastructure and access to and there will always be a need to have sufficient computer BNF is accessable when portable devices throughout the reliance on a paper BNF when terminals for this to work in visiting patients in their homes NHS is not fully developed. nurses are administering practice. etc Distribution of print formats will medication at the bedside and continue in line with user electronic prescribing is still not requirements, subject to ongoing up and running. Same with the monitoring and review by the NICE Drs and ward rounds, drugs are Board. prescribed on the ward round and the Dr cannot keep running to find a terminal to check doses so they still rely on paper BNFs.

[Insert footer here] 142 of 383 ST5, Ease of access in the clinical Reference: interactions, No Thank you for your comments, they Psychiatrist setting, eg in ward rounds is frequency of side effects, have been considered along with important. It is also good that cautions and contraindications the other comments received in the you are considering improving and the reasons for these. consultation, to inform the the drug interactions area, this is Needs to be accessible in a development of the enhanced BNF. really important as doctors variety of settings, so use of working in specialties will never mobile devices would be ideal. keep abreast of new Needs to be updated regularly. pharmacology in other specialties, being able to see more easily the particular interactions and delineation of the risks of each would be helpful, currently we have to seek this information elsewhere. Generally we are well informed about our own medications.

SHO In theory this is a good idea as it An easier way to know if the What to do in the event of Thank you for your comments, they can be very frustrating trying to drug will cause interactions with technology failure. have been considered along with find a BNFc on the ward so other medications the patient is the other comments received in the having online access that is on or needs dose reductions in consultation, to inform the more readily available and more patients with, for example, renal development of the enhanced BNF. user friendly would be a good failure. A feature whereby you NICE acknowledges that digital idea. The current online version could enter in all the other infrastructure and access to of the BNFc is difficult to search medications a patient is on and portable devices throughout the and not very user friendly. it flagged up any interactions NHS is not fully developed. However, technology frequently would be useful. Distribution of print formats will fails, we recently had a 2 day continue in line with user period of being unable to access requirements, subject to ongoing the internet in our hospital. To monitoring and review by the NICE not be able to access the BNF Board. due to technology failure would be dangerous.

[Insert footer here] 143 of 383 Lead Nurse I think this is the way forward as Clear dosing, simple to search, No Thank you for your comments, they Pain Services, long as prescribers can get ability to put a number of have been considered along with Nurse computerised access either via medicines in to a form and get the other comments received in the Independednt PCs or to be enabled to use advice about interactions from consultation, to inform the Prescriber mobile devices than, ability to link into e- development of the enhanced BNF. prescribing systems NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Medical I think it would be excellent. We Working in palliative care, the See above re palliative Thank you for your comments, they Director of St need to be using electronic section in the BNF is woefully prescribing have been considered along with Mary's Hospice systems as default methods brief. There is an excellent the other comments received in the of Furness soon as paper based systems opportunity here to have strong consultation, to inform the are too soon out of date and links to our Palliative Care development of the enhanced BNF. costly in many ways. The Formulary and perhaps to distinction between what is expand the basic advice that is available and what is given currently. recommended would have to be very clear. There would be more opportunity to make this obvious if this is done electronically.

ST6 Old-Age Great idea, the most up-to-date Easy navigation to drug No. Thank you for your comments, they Psychiatry advice is always welcome. information and the ability to have been considered along with Access to e-versions can be compare different drugs within a the other comments received in the difficult at times though, either class, without having to consultation, to inform the through poor signal to a smart scroll/click back and forth development of the enhanced BNF. phone in the community or lack through different pages. NICE acknowledges that digital of readily available computers at infrastructure and access to work. If a version could be portable devices throughout the downloaded onto a smart phone NHS is not fully developed. and automatically updated say Distribution of print formats will

[Insert footer here] 144 of 383 weekly with new information, this continue in line with user would make it extremely useful. requirements, subject to ongoing monitoring and review by the NICE Board.

health and It is prudent to change from The obvious advantage is in It might be advisable to Thank you for your comments, they social care making this essential reference prescribing, to have live updates canvass for information on the have been considered along with manager work an online resource rather as new information becomes extent of secondary use that is the other comments received in the than publishing it as a book. The available, and therefore the made of the BNF, particularly consultation, to inform the availability of the book is still ability to advise clients in community based social development of the enhanced BNF. important in a variety of health accurately. However, the ability care settings, in case IT NICE acknowledges that digital and social care settings, but in of the enhanced BNF to be access issues become a infrastructure and access to those settings in general one is searchable by a variety of critical factor. portable devices throughout the referring to the book as a general parameters such as the client's NHS is not fully developed. guide, for example in supporting medical conditions means that in Distribution of print formats will individuals to manage their its wider use the online BNF continue in line with user various medications and any could be used to take more requirements, subject to ongoing interactions they may have with accurate histories, complete monitoring and review by the NICE self-administered drugs, information which the client only Board. particularly alcohol. In substance vaguely remembers and use services it is important to therefore be able to support the have the reference work client with more accurate available to explain to clients information regarding their regarding important information health, the symptoms they are about the drugs they are taking, experiencing or what to expect. particularly in reducing harms. The enhancements may therefore contribute to more holistic treatment

Macmillan I only use the BNF occasionally Linking with NICE. Having direct Links to more specialist Thank you for your comments, they Palliative Care because working in specialist information about adverse sources of prescribing have been considered along with Lead Nurse palliaitve care I use the Palliaitve effects, contraindications etc guidance eg Palliative Care the other comments received in the

[Insert footer here] 145 of 383 care formulary mostly. Twice with the drug listing sounds Formulary. consultation, to inform the yearly publication seems very worthwhile. development of the enhanced BNF. expensive. I see lots of junior doctors using their smart phones to access the BNF but I don't carry my personal phone about on the wards. Logging into a computer can be time consuming on the ward areas to check the online BNF. If the online BNF was user-friendly and the paper copies less avaialble clinicians would quickly get used to using it.

Formulary They are not currently Linkning with national Guidance Possibility to include a lot more Thank you for your comments, they Pharmacist particularly specific (which is OK and therapeutics - i.e. not just therapeutics. Overall the have been considered along with at this stage). Not particularly drug infomation, but disease vision is not partcularly the other comments received in the interested in the inclusion of information, and treatment specific, so there is not a lot consultation, to inform the medical devices - but that is choices and algorithms as per overlooked. development of the enhanced BNF. likely due to my specific role as a national guidance. pharmacist.

Non medical An online app would be very Easy access to interactions and I can't think of enything. Thank you for your comments, they prescriber in useful, especially if it could be anything else related to the drug have been considered along with mental health downloaded and used where you are searching. the other comments received in the there is no internet cover consultation, to inform the development of the enhanced BNF.

[Insert footer here] 146 of 383 GP prescribing with evidence base up to date information book form to continue to be Thank you for your comments, they would be helpful; keep it user availability available or not? have been considered along with friendly and not cumbersome. the other comments received in the good idea. consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Palliative Care The current BNF is more a indexing and evidence Please include the PCF Thank you for your comments, they Clinical Nurse catalogue of medicines but the have been considered along with Specialist and most useful tool that we have to the other comments received in the Independent inform prescribing. However consultation, to inform the prescriber there is continued research and development of the enhanced BNF. evidence occurring and this could be available from selected validated sources eg Cochrane. The most useful tool as a Palliative Care team is the PCF (Palliative Care Formulary) however this website has recently had to charge members in order to keep going. Using the PCF to add to information in the enhanced BNF would be amazing nd of huge benefit to patients and prescribers.

[Insert footer here] 147 of 383 GP Agree move towards digital Ease of access, improve search Lack of access to digital Thank you for your comments, they version would be most up to facility - especially a "sounds version in some working have been considered along with date. like" search - often either I or the environments - eg: home the other comments received in the patient can only remember the visits, especially with out of consultation, to inform the first few letters of the name of a hours services development of the enhanced BNF. drug. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Lead Looks like a good initiative in Easy access and navigation. Incorporating expert advice Thank you for your comments, they Pharmacist for keeping up with the times. Completeness of information. obtained from specialist have been considered along with Care of Keeping it up to day with current resources such as the renal the other comments received in the Complex practice. drug handbook, palliative care consultation, to inform the Needs formulary and Infection development of the enhanced BNF. management / antimicrobial specialists, as the current information available in the BNF is quite outdates or vague in such respects. If an enhanced version is going to be made available, the information inside it should be enhanced too.

Data & Please have a relatively flat Background clinical coding and Clincial coding in the Thank you for your comments, they Professional information hierarchy. When making that data available for background (those side have been considered along with Services making a point of care decision, integration in other systems. effects, contra-indications, the other comments received in the Manager drilling down through eight levels This could put clinical decision cautions and indications consultation, to inform the (Leyland and of links isn't the ideal way to find support on an enhanced level. should be SnomedCT coded). development of the enhanced BNF. Chertsey the information you need. Where This will improve decision DM+D coding for drugs and respectively) the paper BNF has 'see also', support and enhance patient appliances. Rationalise there should be some way not to grouping of appliances -

[Insert footer here] 148 of 383 require clicking to 'see also'. safety. currently Drug Tariff, DM+D There is no mention of how and BNF don't agree with each drugs that are in the DM+D but other. Look at groupings for not in the BNF will be dealt with - enteral and parenteral feeds they can't just be ignored. and food products (inc ACBS). NICE guidance is good - what about other guidance (SIGN etc)? MHRA drug safety updates/appliance safety updates? Making the data available for use (website is nice, but integration into the user system is better). Summary of all changes that have been made to the data available for use.

Consultant in The BNF is already an excellent Comprehensive information on Linking the BNF to the Thank you for your comments, they Palliaitve source of information on drugs. drugs Palliative Care Formulary I have been considered along with Medicine Furhter enhancements also think would be very helpful. It the other comments received in the helpful. would complement whats consultation, to inform the already available. development of the enhanced BNF.

Medicines Sounds very comprehensive Searchablle Downloadable to Hard to say at this stage Thank you for your comments, they Management local formularies have been considered along with Pharmacist the other comments received in the consultation, to inform the development of the enhanced BNF.

[Insert footer here] 149 of 383 Clinical Nurse It would be good to have all Easy to update - so you know The search engine would need Thank you for your comments, they Manager versions compliled together. I you have the latest version. to be able to cope with part of have been considered along with currently find the paper version a keyword or be able to cross the other comments received in the better for my work as a Nurse reference with a drug genre consultation, to inform the Practioner in a walk-in facility as and not just a name (spelt development of the enhanced BNF. without access to patients own correctly!) NICE acknowledges that digital GP records I have to rely on the infrastructure and access to patients memory of their portable devices throughout the medication. This is often scant or NHS is not fully developed. they can remember only partial Distribution of print formats will spelling or often just the first few continue in line with user letters. Using the paper version I requirements, subject to ongoing can always find out what the monitoring and review by the NICE mediactioin is they are on. I Board. cannot do this with an electronic version. When patients can remember their drugs the electronic version is better for contraindications. Not all my Community based colleagues have access to electronic devises that would support an electronic versin of the BNF. palliative care i find the app extremely useful The immediacy of updates and If NICE or BNF e-versions Thank you for your comments, they pharmacist and easier to keep up to date knowledge at your fingertips. could include a link to the have been considered along with with Palliative Care Fromulary from the other comments received in the palliativedrugs.com with a consultation, to inform the national subscription as development of the enhanced BNF. already acheived in Scotland this would be extremely useful and reduce the reliance on the print version

[Insert footer here] 150 of 383 Consultant I am concerned by desire for Easy to find dosing information. Not really Thank you for your comments, they Physician meeting NICE accredsitation Single click link from drug info to have been considered along with standards. These standards are relevant interactions. Easy the other comments received in the good and desirable, but not search of interactions (eg list consultation, to inform the always possible (eg due to lack drug patient is on, any development of the enhanced BNF. of published RCTs), and interactions with new drug being NICE Accreditation assesses sometimes misleading (eg RCTs added. Single click link to advice processes used to develop show no inhaler device "better" re dose changes in renal / liver guidance such as the BNF, rather than cheap meterd dose inhaler disease. Want to keep it simple than appraising specific medicines. aerosols - but that is because - so link to relevant NICE RCTs of inhaler devices only guidance etc might be helpful, recruit patients who can use the but if I want to know the dose of devices being compared omeprazole, I do not weant to adequately - a small minority of have to read the whole NICE patients in the case of MDIs). I guidance on the managment of would not want information about peptic ulcers before I can find drugs / devices to be unavailable the dose! / limited because of lack of NICE criteria. clinical I believe that a paperless system The enhanced BNF should be No, my only concern is Thank you for your comments, they pharmacist- is the way forward, as easily searchable, with good use computer access is not always have been considered along with GI/Palliative information in healthcare of filters for searching. It is also available at a given time in a the other comments received in the care changes on a daily basis. It is important that the BNF clinical area. Ideally Trusts will consultation, to inform the also important that BNF users continues to include clinical continue to invest in their IT development of the enhanced BNF. can link to other guidelines, particularly for systems so BNF users have NICE acknowledges that digital resources/specialists texts such common conditions. It would be timely access to the BNF in infrastructure and access to as Martindale and Stockley's useful to include information on electronic format. portable devices throughout the Drug Interactions. There are also unlicensed use of licensed NHS is not fully developed. opportunties to link the BNF in drugs, and unlicensed Distribution of print formats will with prescribing systems and medicines. At present this continue in line with user formularies which is critical to information is only available in requirements, subject to ongoing good practice. more specialist text books, monitoring and review by the NICE which many clinical staff do not Board. have access to, or are unaware of their existence.

[Insert footer here] 151 of 383 Consultant in These suggestions seem It needs to be simple and There is opportunity to improve Thank you for your comments, they Emergency positive and realistic based upon intuitive. clinical practice with this. You have been considered along with Medicine modern developments in IT. look up, say, Ramipril. The the other comments received in the Most of my junior colleagues website could ask you; "Do consultation, to inform the tend to use BNF online - (they you know the patient's eGFR?" development of the enhanced BNF. have never really known the before letting you read the book version) - and we have information. You could have an links to it from the trust and option to answer with the departmental websites. I have number, or to say No. But found the printed BNF to be a either way, the prescriber has valuable tome over the years, already been forced to think but nowadays, the only reason I about renal function. The would ever pick up the book is if Emergency Department isn't it was right in front of me, or if really the place for electronic the computers were all busy. In prescribing, but I am sure that fact the main reason I ever use it primary care and other fields of is to remind me how to complete medicine would benefit greatly a CD prescription without it being from this. sent back from pharmacy. The one on my desk here is from 2010, and this email has just encouraged me to recycle the ones on the shelf from 2006-9. I would appreciate a website that was able to cross reference various important points with NICE and perhaps other trusted sources (Toxbase?).

[Insert footer here] 152 of 383 Consultant It would have to be much more All wonderful - if we could be no Thank you for your comments, they Physician user-friendly than the current sure that they would work for have been considered along with eBNF, which contains multiple ordinary staff in ordinary the other comments received in the circular entries for the same drug hospitals consultation, to inform the and which is therefore much development of the enhanced BNF. harder and slower to use. A NICE acknowledges that digital primarily electrone BNF also infrastructure and access to requires that people have instant portable devices throughout the access to a computer and teh NHS is not fully developed. internet, a far cry from many Distribution of print formats will hospital IT systems - the only continue in line with user realistic method is a personal requirements, subject to ongoing smartphone at personal monitoring and review by the NICE expense. It has to be said that Board. only a small minority of updates in teh BNF are actually of day-to- day utility

Consultant in I understand the idea behind an Accessibility. Only the need to keep the print Thank you for your comments, they Palliative enhanced BNF but I prefer to form available. have been considered along with Medicine have print copies available at all the other comments received in the times. Computer access is not consultation, to inform the always easy and some mobile development of the enhanced BNF. aps are difficult to use if signal is NICE acknowledges that digital poor. infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 153 of 383 senior clinical The NHS is not yet ready to I agree with the vision (section Not sure but it'd be interesting Thank you for your comments, they pharmacist make full use of digital formats 2) but should also include to know the similarities and have been considered along with as not enough investment in IT unlicensed medicines. differences between UK & NZ the other comments received in the systems (hand held devices, use of and how they achieved consultation, to inform the smartphones or PC screens) to reliance on digital format in NZ development of the enhanced BNF. allow appropriate access at the NICE acknowledges that digital bedside, whether within NHS infrastructure and access to premises or patients' homes. portable devices throughout the Currently it is much quicker to NHS is not fully developed. access information via paper Distribution of print formats will copies of the BNF which are not continue in line with user subject to power failures or requirements, subject to ongoing system failure. monitoring and review by the NICE Board. health Good idea. That the information is concise No Thank you for your comments, they visitor/practice and easy to access. have been considered along with teacher the other comments received in the consultation, to inform the development of the enhanced BNF.

Lead It assumes that users have It needs to be intuative to use Should consider linking in with Thank you for your comments, they Pharmacist- access to electronic BNF where and the information needs to be other authoritative resources have been considered along with Medicines in reality this is not the case. On easily retrieved. Currently this is such as the electronic PCF the other comments received in the Mangagement a busy hospital ward there may not the case. There is a lot of consultation, to inform the be only 1-2 computers which are useful information at the development of the enhanced BNF. also being used for prescribing beginning of chapters and sub NICE acknowledges that digital and administering drugs. Most chapters but currently this infrastructure and access to Trusts discourage the use of information is not easy to portable devices throughout the personal mobile devices. retrieve from the eBNF. NHS is not fully developed. Therefore most users of the BNF Distribution of print formats will will still struggle to get electronic continue in line with user access and therefore rely heavily requirements, subject to ongoing on the paper BNF. monitoring and review by the NICE Board.

[Insert footer here] 154 of 383 Senior Nurse It will be easily accessible. Most Ease of use. Accuracy of Look forward to the new Thank you for your comments, they services in our organisation have information and links to other service have been considered along with easy access to the internet and important advice and guidance. the other comments received in the computer technology. Putting The NICE guidelines for consultation, to inform the your hands on an up to date example. development of the enhanced BNF. printed form of the BNF can prove difficult. Even community based services now have access to mobile technology. So it is all good.

Social Worker A good idea Any information that To ensure that the information is To ensure that there is a user Thank you for your comments, they is aimed in the right place, at the displayed in a user friendly way friendly document in place for have been considered along with right time at service users and To ensure that the information is users and carers To provide the other comments received in the their carers can only be positive. cicurlated in the right places and information in other languages consultation, to inform the The information needs be aimed at the right people development of the enhanced BNF. distributed outside of the health NICE acknowledges that digital service infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. chief sounds excellent to bring all the i think having full links to NICE i think more information on Thank you for your comments, they pharmacist current facilities with additional pathways, comparative efficacy prices/generic prescribing have been considered along with ones which will support decision and a more comprehensive would assist in the overall the other comments received in the making. one of the biggest information on drug interactions target to reduce prescribing consultation, to inform the problems we have is getting staff costs development of the enhanced BNF. to utilise the electronic version especially the non medical prescribers or district nurses in the community as although there are already app version staff do not find them very useful when

[Insert footer here] 155 of 383 used on small screens.

Cancer Drug I think this is the way forward. My I think a lot of it has been I, as a commissioner, also Thank you for your comments, they Fund and concern has always been that summarised above. The would like to see price have been considered along with Individual due to many individuals being important elements of the information included in the the other comments received in the Funding relaint on the paper version of enhanced BNF are that it is enhanced BNF. Obviously this consultation, to inform the request the BNF and BNFC, you often easily accessible and regularly would only be the listed NHS development of the enhanced BNF. Manager see that they are using out of updated. The links to guidance prices and not local agreement NICE acknowledges that digital (North) date information and making the are essential. Organisations will prices. It is really useful to infrastructure and access to assumption that entries have not certainly find it useful to have have such information to hand. portable devices throughout the changed as have been common access to the NICE Who is the responsible NHS is not fully developed. practice. This has the potentail Accreditation standards and an commissioner for such drugs? Distribution of print formats will for extreme error.A lot of understanding as to how Something simple as stating continue in line with user clinicians and pharmacy teams recommendations are made. My whether CCGs or Area Teams requirements, subject to ongoing often say that they prefer the only slight concern is that some are responsible for funding. monitoring and review by the NICE paper version because they like Trusts have an online BNF that Obviously NICE supercedes all Board. to be able to carry it around but they then amend to reflect their guidance, but will there be Enabling download of BNF and to me this is quite a poor excuse. own organisations formularies. links to NHS guidance too? BNFC content to local formularies is There is no reason that Are these provided by included in NICE’s vision for an individuals can not get access to yourselves? It almost seems as enhanced BNF. NICE provides via online. Due to the ever if there is potential for 2 lots of access to the BNF in all formats for changing NHS, it is essential that different information. Could it be the NHS. individuals have access to that the enhanced BNF could be updated guidance and the adapted to allow organisations enhanced BNF should have links to reflect their local formularies? to all national guidance. It would We all work in organisations be extremly useful that for now that have reasonable IT example, at each quarter if there systems. There is no excuse for was a way of highlighting the need for paper versions

[Insert footer here] 156 of 383 changes and updating online. The key attraction to me has to the addition of key information on effectiveness, safety, patient factors and resource implications.

[Insert footer here] 157 of 383 GP The BNF is almost perfect. The As above As above Thank you for your comments, they only flaw is that too many 'side- have been considered along with effects' are listed, with no the other comments received in the indication of whether these are consultation, to inform the common, rare, or of unproven development of the enhanced BNF. causation, or reported via the yellow card system. Many side- effects are clearly unrelated to the drug concerned, take up much print space, and the resultant 'clutter' distracts from important side-effects. I would like to see a more selective list for each drug, with the common and important side-effects listed. Perhaps very rare or unproven side-effects can be listed in small print on the web version but not the print version, and even these should be listed as 'rare' or 'unproven' or 'yellow card' etc.

Senior Medical Happy with progress but there As above See above. When electricity is Thank you for your comments, they Practioner are many areas where we down electronic BNF would be have been considered along with Tribunals cannot access a digital version, utterly useless. Look at the the other comments received in the Service Courts whilst sitting or in present climate this last week consultation, to inform the session. At racing circuits, on the and the forthcoming week. The development of the enhanced BNF. roadside, Accessing any digital BNF is as essential in medical NICE acknowledges that digital data is often infinitely slower than practice as is water to live. !!! infrastructure and access to using a hard copy. Aps are all portable devices throughout the very well but signal is important. NHS is not fully developed. Where I live there are dead spots Distribution of print formats will for signal. Also Windows phones continue in line with user do not support aps for android or requirements, subject to ongoing apple monitoring and review by the NICE Board. Since they work offline, a

[Insert footer here] 158 of 383 connection to the internet is not required once the BNF and BNFC apps are downloaded onto a mobile device.

Clinical Sounds good. The reason I For information about individual Consider including links for Thank you for your comments, they assistant don't access BNF on line more drugs, the Electronic Medicines individual drugs to Electronic have been considered along with often is because I find it harder Compendium is better/more Medicines Compendium the other comments received in the to locate the information I want detailed. The most important consultation, to inform the than the paper copy. Would be role to me of the BNF is development of the enhanced BNF. happy to use it on line if I could providing guidance on choice find the same information. between the different (classes of) drugs for a particular indication. retired excellent initiative and wholly 24/7 online access to timely and yes indeed. you have failed to Thank you for your comments, they consultant support research based evidence address the known bias in have been considered along with psychiatrist/ published studies caused by the other comments received in the postgraduate the drug companies consultation, to inform the student suppression of results. the development of the enhanced BNF. manchester advice that you give is The issues of bias and methods of university therefore considerably less reporting of adverse effects are than trustworthy. second, the outside of the scope of the methods for reporting side proposed enhancements to the effects (the yellow card BNF. system) is wholly inadequate and needs radical revision

[Insert footer here] 159 of 383 Medical I agree that the BNF and cBNF Remaining up to date, allowing Ensure a mechanism whereby Thank you for your comments, they Information print is out of date almost as companies to change their Pharma companies can easily have been considered along with Manager soon as it is published, electronic product information easily. update product information. the other comments received in the access would help to ensure that Ensuring there are justifications consultation, to inform the the BNF is kept more up to date. for discrepancies between development of the enhanced BNF. As a pharmaceutical company approved product labelling and we often find that the information the BNF/ NICE guidelines. in the BNF / cBNF conflicts with our SmPC / PIL (approved product information), this can be difficult when there is no explanation of why the BNF has reached this conclusion. HCPs tend to believe the BNF rather what is written on approved product information, this can be extremely frustrating for pharmaceutical companies when there is no justification as to why the BNF/ cBNF have included certain information.

Not medical I think it's critical that end users It would be good to see the As listed above Thank you for your comments, they of medication (patients, carers information better laid out for have been considered along with etc) continue to have access. I online access. Most importantly the other comments received in the note that this seems to be it should be free consultation, to inform the missing from the vision - it's all development of the enhanced BNF. about medical professionals NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 160 of 383 Diabetes It will improve accesss to Enable professionals to have No Thank you for your comments, they Specialist information and patient safety access to the enhanced BNF or have been considered along with Nurse BNFs in all venues in secondary the other comments received in the and primary care setting. consultation, to inform the development of the enhanced BNF.

Locum GP Would be delighted to have an Accessibility - o.e. not just for Would welcome a little more Thank you for your comments, they easily accessible, reliable and people with smartphones. clarity about the authority of have been considered along with detailed source of prescribing Needs to be on every desktop ( NICE ( and thus the BNF) in the other comments received in the info as described. No need for then no need to be scrabbling Scotland - does it apply to consultation, to inform the anything else - can throw out for a paper version). Authority - Scotland? No doubt work is development of the enhanced BNF. MIMS etc etc we want a clear understanding underway to integrate BNF NICE currently provides access to of current mainstream views on with local prescribing all formats of the BNF to NHS prescribing. Detail - need guidelines? National Services Scotland. advice on e.g. regimes for

complex medication Enabling download of BNF and BNFC content to local formularies is included in NICE’s vision for an enhanced BNF.

Doctor Whilst I agree with using I think frequent updates on the Please continue to produce the Thank you for your comments, they online/digital resources, as they medications are the most print version of the BNF. have been considered along with are often the most up to date, I important. I also greatly the other comments received in the worry that phasing out print appreciate the liver and renal consultation, to inform the versions will hinder my function dosing advice on each development of the enhanced BNF. prescribing abilities on the of the medications. NICE acknowledges that digital wards. Frequently, computers do infrastructure and access to not work or are out of use or are portable devices throughout the being used and I need to refer to NHS is not fully developed. a BNF quickly to initiate patient Distribution of print formats will treatment. The print version of continue in line with user the BNF provides this service requirements, subject to ongoing most practically. I don't think that monitoring and review by the NICE we should rely solely on Board. digital/online versions and that a back-up print version should always be available on the

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Psychotherapis BNF is used, or should be used, Easy of access, search facilities As a therapist I would Thank you for your comments, they t in private by more people that just that are flexible and offer encourage a section on have been considered along with practice prescribers. In my profession we suggestions as Google does psychotherapies. I understand the other comments received in the work with people who often have would be helpful. All the NICE's somewhat restricted consultation, to inform the not had the time to talk through enhancements including Medical view on 'evidence' and yet to development of the enhanced BNF. all the complications and benefits Devices will be helpful especially encourage a diversity of of their medication. The single in sexual therapy. services and to encourage source and continuous update is patient choice I would ask welcomed. It's more work but some information is provided. short sections written in lay A link to UKCP language would help as well. (http://www.ukcp.org.uk) would help people find more information. You may even ask UKCP to create a UKCP/BNF page to help guide enquirers.

[Insert footer here] 162 of 383 NHS Patient For health professionals BNF on Quick, ease of use with various For patients, they need an Thank you for your comments, they (NHS line does need updating ways to search meds. trusted UK site to inform them have been considered along with Professional & Interactions needs to be about their medications. 1/ the other comments received in the IT Design for highlighted. Link to alternatives What questions I need to ask consultation, to inform the clinical meds when allergy info is sort. my GP on this medication 2/ development of the enhanced BNF. software) Overdose information & patient What to expect when I take it monitoring when med is taken 3/ What happens if I do not incorrectly take it (Stopping med suddenly ETC) 3/ Side Effects that are normal with this medication 4/Side effects I need to tell my GP 5/Side Effects I need to seek urgent/Emergency help 6/ Interactions with other meds, food, drink & environment 7/ Is it on the GP list for prescribing, special measures. private funding (or places for trials on research) There are a few web sites in the USA focusing on such questions & are good, but aimed for the USA market. NHS Choices has advice on Meds but is not patient user friendly & often use clinical terminology. BNF is in the right position to offer. I know this is outside of the remit, but patients do need on line advice for their meds.

GP I strongly feel that digital Up to date, easy access to drug No Thank you for your comments, they versions are the way forward for interactions. Advice on have been considered along with handheld and tablet devices. I management of conditions could the other comments received in the find these so much easier to use be expanded as well as consultation, to inform the than the paper version which I diagrams and embedded development of the enhanced BNF. abandoned 18m ago. content like videos showing

[Insert footer here] 163 of 383 administration of devices eg inhalers, unusual injections etc.

Trust Librarian The vision is broad and if It would be useful if an Equitable access to all all NHS Thank you for your comments, they implementented should result in enhanced BNF and BNFc was in all regions of the UK. have been considered along with the reduction and eventual also linked/ embedded to a high the other comments received in the removal of reliance on print quality point of care decision consultation, to inform the resources for medicines making tool, ideally used by all development of the enhanced BNF. infomration in the NHS. Such in the NHS. NICE acknowledges that digital reliance has the potential of NHS infrastructure and access to using out of date informaiton in portable devices throughout the the delivery of patient care. The NHS is not fully developed. other aspect is of course the Distribution of print formats will financial cost of producing and continue in line with user distributing print BNF and BNFc. requirements, subject to ongoing However, I would be concerned monitoring and review by the NICE if print BNF and BNFc ceased Board. entirely given that current access NICE is working with Queens to the BNF app for example, is University Belfast to make the NICE not availble in to NHS staff in BNF and BNFC apps available in Northern Ireland, despite Northern Ireland. becoming avaialble elswhere in 2012. Access to and enhanced BNF needs to be equitable to all NHS workers, regardless of geographical location in the UK.

[Insert footer here] 164 of 383 Pharmacy As a user of technology in Enhanced BNF means it is up to Areas you have over looked Thank you for your comments, they Technician and pharmacy since 1985, as a date with the latest drugs and are contingency plans for upto have been considered along with IT trainer former Hospital Pharmacy protocols approved at the time date information in printed the other comments received in the Computer Systems Manager. I and you do not have to wait for form when powercuts or major consultation, to inform the applaud this consultation to the twice a year update. The incidents happen. The use of a development of the enhanced BNF. ensure that local formulary's and incorporation of local hard copy BNF is a great help NICE acknowledges that digital BNF and NICE guidelines are Formulary's is a great step for study at all levels from infrastructure and access to placing the information in an up forward for all services to NVQ2 or 3 or Degree level portable devices throughout the to date format re ready access in access, making the system when they are writing things up NHS is not fully developed. all the latest advances in more transparent. The idea of on a computer. As an NVQ Distribution of print formats will technology. However as central access to local assessor and IT Trainer, there continue in line with user someone who now lives and formulary. BNF BNFc and Nice is a time when the written requirements, subject to ongoing works in rural parts of the South guidelines is a step forward with down information is required monitoring and review by the NICE West mainly Dispensing Doctors, using technology available but Technology is not the answer Board. retail chemist. I feel there is still a be aware in rural area they do to it all. Not everything can be need for a hard copy of the BNF. not have access to the electronic. Cost implications All pharmacy or areas that technology due to reduced for local run pharmacies and dispense drugs and have some internet access and financial rural GP's to provide all staff sort of access to prescribing constraints on the independent with access to these software to product the label and chemist allowing all staff access documents on tablets or PC is prescriptions, meaning there is a to handhelds as well as the not practical in areas with no computer on site. However there prescribing software. This is a mobile phone signal, which is normally more body's in a work major step forward to ensure there are a lot in Devon. place than a computer, so the that primary and secondary care chance to grab a book is very use the same prescribing helpful. As someone who has recommendations but would like also been involved in to be reassured that the 2 areas contingency planning in the past of local dispensing and hospital the you need to think about lack dispensing are given the chance of power in doctors surgeries to liaise and communicate better and retail chemist. They do not so the patients drug changes have the resources like large are update more effectively and hospitals for generators. As the messages are passed on. Devon is the largest and most rural county in England, we also do not have full coverage of phone systems or wifi for the rural gps to gain access to the

[Insert footer here] 165 of 383 apps on their phone or tablet. So a hard printed copy is essential even on an annual basis. The use of on-line versions that link to current software packages means we are embracing the leaps made in electronic prescribing over the last few years but the use of apps on tablets and phones is not wide spread practice throughout the country yet.

Paramedic As I use a digital format now I I often encounter patients who in the search tool please Thank you for your comments, they welcome the move to a digital have overdosed on prescription enable searching for all the have been considered along with format. When using a hard copy drugs, an easy dose calculation names a drug is sold as and the other comments received in the of BNF I am always aware that tool showing the dose and % provide a link to the generic consultation, to inform the the information may be out of over the safe dose for a patients name as I often encounter development of the enhanced BNF. date. weight would be usefull foreign supplied or purchased drugs. This would be easier and safer than using Google.

Senior It will be valuable to have a Information on drug interactions No - can't think of anything at Thank you for your comments, they Medicines version that builds on existing and unwanted effects including the moment have been considered along with Information links to NICE guidance. However rating of their frequency and the other comments received in the Pharmacist there is a danger of over- seriousness and being able to consultation, to inform the complicating it and trying to cram search and browse in multiple development of the enhanced BNF. in too much. The picture of a ways, such as by drug, condition NICE acknowledges that digital health care professional (HCP) and patient characteristic - are infrastructure and access to and patient (e.g a GP during a two potentially very useful portable devices throughout the 10-minute consultation) browsing features NHS is not fully developed. and discussing information from Distribution of print formats will a link to a "high quality continue in line with user information" source for patients requirements, subject to ongoing is unrealistic. Also the enhanced monitoring and review by the NICE BNF assumes the universal Board. availability of fast reliable online and mobile digital devices

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Retired due to Good idea Ease of use, ease of access Giving out of the BNF to Thank you for your comments, they Disability using media other than hard places like Doctors surgeries have been considered along with copies to cut down on the and Walk In Centre's who the other comments received in the Earth's resources consumption have access to computers and consultation, to inform the are sitting directly in front of development of the enhanced BNF. one during patient consultations. This would save a lot of the Earth's resources as they can easily access the BNF from the internet or a copy uploaded to their computers. The only people that ought to be given a hard copy is people like nurses who walk around wards giving drugs out, or community doctors who could take one of the surgery's group copies with them, but they certainly don't need enough copies for one each. gp good ideas, however print book searchability plenty places have no mobile Thank you for your comments, they is still quickest to obtain onfo signal, eg large parts of have been considered along with from. also i do not have a smart scotland, and within our steel the other comments received in the phone, so all the apps etc are framed health centre! consultation, to inform the useless to me. development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE

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Consultant I find the vision attractive. integration with other guidance Don't underestimate humans. Thank you for your comments, they wil be useful- ensuring One think I miss in the have been considered along with consistency of advice wil be electronic BNF is an index- if the other comments received in the useful. Ther are often you don't know how to spell consultation, to inform the discrepancies between BNF something ot the patient can't development of the enhanced BNF. advice and advice from other remember a name exactly you sources Info on frequency of can use an alphabetical index side effects would be very to look things up. If they say helpful The most important 'I'm on a blood pressure tablet' thing is ease of use- I fear that it and can't remember the name could become over complicated it's easier to scan paper and make finding information version and prompt with more difficult. I aleady find suggestions than click through navigation a bit tricky multiple pages in the eBNF. sometimes. The CKS summaries are virtually unuseable as they are so complex

Distance The BNF should be as widely Combining information in a way It appears comprehensive to Thank you for your comments, they Learning Tutor available as possibe and which eradicates discrepencies me have been considered along with accessible through all media, to between authoratitive sources the other comments received in the ensure ease of access to consultation, to inform the accurate and up to date development of the enhanced BNF. information on all medicines

[Insert footer here] 168 of 383 Research I think the vision is "Be searchable and browsable I would be interested in seeing Thank you for your comments, they Advisor commendable, how it will in multiple ways, such as by the proposed visual layout of have been considered along with translate in practise is less drug, condition and patient the EBNF before it is rolled the other comments received in the certain. With an enhanced BNF characteristic, so it can be easily out. It needs to be Google consultation, to inform the comes the attendant risk that it accessed" says it all as a priority quality simple, with as little development of the enhanced BNF. will become less user friendly as far as I can see. clutter as possible. and cumbersome. Particular attention, advice and consultation on the design and presentation is vital to make sure the finished product is workable.

Medicines Need to be able to access BNF Accessibility to up to date Ways we could possibly have Thank you for your comments, they Management in places where there is not an information up to date versions of the BNF have been considered along with Pharmacist internet connection available. without the need to print hard the other comments received in the Having an annual hard copy copies, regular need for consultation, to inform the does not provide accessible up internet connection or times development of the enhanced BNF. to date information for those when the internet is not NICE acknowledges that digital without internet connection e.g. available. 4 updates each infrastructure and access to during care home visits, home month is 48 updates a year. If portable devices throughout the visits. Practice pharmacist do those updates are around NHS is not fully developed. not have access to work smart safety concerns, it could be Distribution of print formats will phones to access the app. dangerous. continue in line with user Patients may feel a barrier when requirements, subject to ongoing using personal mobiles to open monitoring and review by the NICE app. Board.

[Insert footer here] 169 of 383 Resuscitation I think any move to a fully I think that the most important No Thank you for your comments, they Officer electronic version is a good part of any electronic portal is have been considered along with thing, it will allow not only rapid the User Interface, getting that the other comments received in the updating but also interlinking to right is vital. Ease of navigation consultation, to inform the various sources of information between pages /subject matter development of the enhanced BNF. for prescribers & also for those of is a make or break feature. NICE acknowledges that digital us who review case notes for infrastructure and access to audit & patient safety reasons. It portable devices throughout the will also allow a more media NHS is not fully developed. appropriate presentation for the Distribution of print formats will information. I do however have 1 continue in line with user reservation; I think it's always requirements, subject to ongoing safe & useful to have some form monitoring and review by the NICE (maybe simplified & focused on Board. certain drug groups?) of hardcopy version available in the event of IT or power failures.

Pharmacist Agree with print version Drug interactions could be more No Thank you for your comments, they potentially being out of date comprehensive have been considered along with before it leaves print but the other comments received in the practically an online only consultation, to inform the reference would not work in a development of the enhanced BNF. busy community pharmacy. NICE acknowledges that digital We've managed so far with infrastructure and access to this...would find it very difficult if portable devices throughout the print version were to disappear NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 170 of 383 GP I would like to be able to see abov no Thank you for your comments, they immediately look at electronic have been considered along with SPCs references and so on in the other comments received in the NICE BNF. I would like to have consultation, to inform the reverse look up such as listing of development of the enhanced BNF. drugs having a specific side effect, contraindication or indication match drug ingredients down to the level of route of administration to interactions and side effects, contraindications or indications. Also be able to seamlessly link all this into my GP clinical system to get real time decision support based on the coded entries in my system. hospital I think that you need to change I use the BNF mostly for doses, I found it difficult to down load Thank you for your comments, they pharmacist to paperless as I constantly see appendix 1 (interactions) and a the eBNF and eBNFc onto my have been considered along with out of date BNFs and BNFCs quick view of hepatic and renal phone - I think it used up too the other comments received in the lying around wards, out-patient cautions, and these are easily much space. consultation, to inform the areas and GP surgeries, and I found. I think where I prefer the development of the enhanced BNF. worry about this easily book is when you want to look at NICE acknowledges that digital accessible information being out more than one drug in a class - infrastructure and access to of date and even dangerous. the this I find difficult on the eBNF portable devices throughout the eBNF is linked to the electronic NHS is not fully developed. prescribing system we us in Distribution of print formats will hospital so is very quick to continue in line with user access. I am however old- requirements, subject to ongoing fashioned and like the security of monitoring and review by the NICE having a book on my person Board. which I can access quickly rather than having to fight someone for a laptop. But in terms of providing the most up-to-date information I prefer to use the eBNF

[Insert footer here] 171 of 383 medicines good idea to enhamce and use ability to find informatiion quickly not at this stage as info given Thank you for your comments, they optimisation an online version as the main search facility that gets the right isn't very detailed have been considered along with pharmacist version information initially format may the other comments received in the need to resemble the print copy consultation, to inform the as all users are so familiar with development of the enhanced BNF. current format not too much information gievn at first veiw of drug ....basic on first screen eg side-effects - basic list then ability to quantity them if needed , not automatically given as this would be too much info for general reference consultant A Service is only as strong as its cross-link with NICE More data on side-effects of Thank you for your comments, they weakest link. In our case, the recommendations will be useful. medications, and on have been considered along with weakest links are the poeple on appearances/time of the other comments received in the the ground, who generally do not absorption would be useful (I consultation, to inform the have ready access to a computer am a pathologist, and having development of the enhanced BNF. terminal. For instance, very few some idea of what am I looking NICE acknowledges that digital have computer access during at before asking for toxicology infrastructure and access to ward rounds, or in A&E. When would come in handy) Es: portable devices throughout the under pressure, these people are "pink tablets, approx. 8 mm in NHS is not fully developed. the ones who will have the diameter, hexagonal, smooth; Distribution of print formats will greatest problems finding gastric transit approx. XX continue in line with user information in the book. The BNF hours when taken on an empty requirements, subject to ongoing needs to be focussed on these stomach" Some of this monitoring and review by the NICE people. Those with an online information is available on Board. access will find the information Toxbase, but it would be good easily anyway. And we cannot to have all in one place. expect everybody to buy a Transit data might be useful for personal smartphone or tablet clinicians too ("I took my tablet, just for reasons of service. Doctor, but then I vomited about 2 hours later...")

None Sounds good! The links to NICE guidance Links to product SPCs might Thank you for your comments, they sounds particularly useful. be useful, since the BNF, as it have been considered along with stands, sometimes omits the other comments received in the

[Insert footer here] 172 of 383 useful details. consultation, to inform the development of the enhanced BNF.

Lead Digital not always accessible e.g On line version would be easier see above Thank you for your comments, they pharmacist computer downtime or fault, on to navigate. More information on have been considered along with Surgery and call of site, lack of computers at interactions and the clinical the other comments received in the Anaesthetics ward level, staff training, significance consultation, to inform the knowledges and ability to use development of the enhanced BNF. online resources. Over NICE acknowledges that digital complicates content? BNF is a infrastructure and access to starting point and excellent portable devices throughout the source of information for drug NHS is not fully developed. information. If user wants Distribution of print formats will specific information on guidance continue in line with user then know to look on NICE. Does requirements, subject to ongoing it dilute down the value of the monitoring and review by the NICE information? Local polices and Board. formularies often vary from NICE. Practioners become too reliant on reference source instead of thinking logically and outside of the box Would an NHS forum with signposts to appropriate refernce sources be better?

[Insert footer here] 173 of 383 Registered Reducing the use of print and of Be available to all devices, The consultation document is Thank you for your comments, they Nurse secondary sources of data [eg desktop, laptop, mobile phones, too generic to be able to tell have been considered along with MIMS] will encourage people to tablets in a format that is yet. the other comments received in the use an online BNF. suitable for each. Using a "one consultation, to inform the size fits all" website will drive development of the enhanced BNF. consumers away to something more convenient, therefore a tailored format for each device is more appropriate. Ensuring data is complete, up to date and easy to access is key. Having a bit of information here and there [eg in appendices] encourages people to ignore them, especially if the appendix is a few pages long and there is no easy way to tell which part is relevant to your query. Bring all medication information into one section, with subsections for use in different situations, illnesses etc, rather than having "for respiratory" in 1 section, "for cardiology" in another. An example of poor formatting is this website, and how you click on a link to see the consultation document, which links to another page where you need to click on another link to see the document itself. Also having 3 links for the same document is confusing, especially since two of them are the same text and the other being completely different. Having 1 link and a second for the reader would make more sense.

[Insert footer here] 174 of 383 Dentist I think it's a good idea, but care Ease of use Up to date Good Would be nice to have a dental Thank you for your comments, they would need to be taken that the search engine Free section. have been considered along with online BNF is easy to use as the other comments received in the currently it's often easier to use consultation, to inform the the book. development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Emergency Online version of the book is the Simple search. Nope Thank you for your comments, they Care best that is currently provided. have been considered along with Practitioner / The BNF from NICE is not a lot the other comments received in the Custody HCP of use to me because it needs an consultation, to inform the internet connection to access. development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Medicines I think it would be useful and ease of use i.e. searching. For No Thank you for your comments, they Management easier to use. Particularly within some, it would be the visibility of have been considered along with Pharmacist/ a consultation, where access to texts as paper-copies has small the other comments received in the Senior Lecturer information should be quick and fonts that can make it difficult for consultation, to inform the effective. The over-reliance on some to read, whilst digital development of the enhanced BNF. digital BNF however poses its version can be enlarged. NICE acknowledges that digital own problems in the event of no infrastructure and access to internet access. For example portable devices throughout the

[Insert footer here] 175 of 383 during home visit, or during NHS is not fully developed. internet downtime. The concern Distribution of print formats will is that health professionals may continue in line with user lose the skills to actually look requirements, subject to ongoing things up on a 'non-enhanced' monitoring and review by the NICE version of paper-copy BNF. This Board. can of course be resolved by ensuring the same format is used throughout and across the digital and paper-copy.

Community I believe the 'onestop' BNF which As a community pharmacist I linking to prescribing systems Thank you for your comments, they Pharmacist provides all the additional would appreciate information would benefit as with up to have been considered along with material mentioned in the such as interactions, adverse date information on products the other comments received in the consultation would be of benefit reactions and their probability. available prescribers would be consultation, to inform the to both prescriber and patients. This would help to facilitate aware of what has been development of the enhanced BNF. BNF is a trusted resource and conversations with patients and discontinued or shortages like more needs to be made of the to have common data with those listsed by PSNC advantages of technologies to prescribers to facilitate the best provide further trusted care for the patient. information as there is a multitude of mis information to be found online elsewhere

Community I am in agreement with the I think being able to access up My only concern would be if I Thank you for your comments, they matron vision. However,I will require the to date information is really was unable to obtain a signal have been considered along with correct equipment to access the important to maintain patient (which can happen in some the other comments received in the internet. My current work mobile safety. Also being able to have rural areas) and could not consultation, to inform the does not connect to the internet. information about drug access the internet to find development of the enhanced BNF. Although I can access the interactions in an easy to use information. NICE acknowledges that digital internet in the office, I need to format would be of great help. infrastructure and access to have access while I am out portable devices throughout the visiting patients. NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 176 of 383 Senior Medical I am happy with the vision. It should be possible to search No Thank you for your comments, they Advisor by multiple criteria such as drug have been considered along with name (generic and branded), the other comments received in the drug class, indication, side consultation, to inform the effects etc. More comprehensive development of the enhanced BNF. details about each drug should be present, in line with the wording of the SmPC, plus explanatory notes relating to NICE, SMC and AWMSG guidelines, technology appraisals and other national guidelines. It should be frequently updated and these updates should be automatically pushed out to all devices that connect to the internet.

Pharmacist The basis of the term A multi drug interaction search Ease and reliability of Thank you for your comments, they "enhanced" seems to revolve will be a godsend in many use...... over complexity can in have been considered along with mostly around the intention of respects but in others with the itself draw in grey area which the other comments received in the getting rid of the paper based degree of polypharmacy that may not be to the prescriber consultation, to inform the form in favour of digital means? takes place these days it may nor the patient benefit. Any development of the enhanced BNF. Where of course there will be the also open a whole host of grey enhancements added in NICE acknowledges that digital advantage of being able to add area dilemmas the degree to should be tested for their end infrastructure and access to interactive interaction criteria and which the e based programme point value on all levels before portable devices throughout the possibly other add ons and in will most probably not be able to becoming core. That said NHS is not fully developed. some respects I can see the offer cast iron answers and many steps in the right Distribution of print formats will advantage especially when therefore decision making. To direction are to be encouraged continue in line with user sitting down in a lone role be able to link directly into NICE if they can be evidence based requirements, subject to ongoing researching or thinking a drug pathways and prescribing without too many grey areas monitoring and review by the NICE related situation through. That algorithms would be especially and must be meaningful to all Board. said, when sat with patients and usefull alongside any published areas of practice but especially needing to keep it simple and evidence to the relative risk of with the patient in mind so that away from a reasonable size and from side effects? all clinicians can sing the same screen where I need to flick back song from the same hymn and forth with relative ease using sheet in the same way bookmarks...... you still can't beat

[Insert footer here] 177 of 383 a paper based version...... and lets face it paper books don't run out of battery and need recharging. The current situation is ideal albeit the BNF paper distributed every twelve months now and of course an anhanced onlime facility if and when the time and situation relies. I have full access to the online version in practice on a daily basis but find the paper version so much more convenient and would miss it dreadfully. That said, if I want to sit down and research and update then I will often use the electronic version and the paper based version dependent upon what I want to achieve and how. Although the updates provided are important, for the core information they are not the be all and end all and so long as regular practice specific updates are reviewed on an ongoing basis then there is little from a practical practice point of view that will be out of date and t retired Need to continue publishing a Would want to use a printed Importance of continuing to Thank you for your comments, they Consultant hard copy copy publish a printed hard copy have been considered along with Clinical the other comments received in the Oncologist consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will

[Insert footer here] 178 of 383 continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant I approve of the enhancements, I app for handheld devices more Nope. Thank you for your comments, they Microbiologist disapprove of the proposal for likely to be useful than have been considered along with concomitant reduced reliance on availability on desktop. Internet the other comments received in the print. On hospital wards it is access often slow or unreliable consultation, to inform the often not true that e-access is in clinical areas so ideally most development of the enhanced BNF. easy and convenient. We might information held locally on the NICE acknowledges that digital wish it were true but that's not device and updated by push. infrastructure and access to the same. Hence people will Depends on download size I portable devices throughout the continue to use print regardless suppose. Would need to be NHS is not fully developed. of the undoubted fact that it written for android, iOS and Distribution of print formats will becomes out of date, and going mobile windows platforms. continue in line with user to once a year rather than six- requirements, subject to ongoing monthly will increase the clinical monitoring and review by the NICE risk not reduce it. Board.

Nurse I agree that the BNF should be That it is more up to date and No Thank you for your comments, they Practitioner more accessible and up to date. more navigable/searchable have been considered along with The current written version is old the other comments received in the when it is published i do consultation, to inform the currently find the online version development of the enhanced BNF. of the BNF difficult to navigate hospital oral I don't like the idea of the BNF I like the current format and Don't under estimate the Thank you for your comments, they surgeon not being available in print and would wish to see that format importance of keeping the have been considered along with this version being updated at retained. It might benefit from present format. Look at the other comments received in the least once/year the occasional illustration software, once a product has consultation, to inform the become established, users development of the enhanced BNF. don't like to change and for NICE acknowledges that digital good reason. Using a new infrastructure and access to system takes time (less portable devices throughout the productivity) to get used to. NHS is not fully developed. obviously the more change the Distribution of print formats will less productive a system will continue in line with user

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Pharmacist The idea of linking the BNF to Key information about Access to information Thank you for your comments, they local and national guidelines and medicines and their place in technology is often limited I'm have been considered along with formularies is good. therapy. the health service in light of the the other comments received in the Standardizing information in one computer systems being consultation, to inform the place is a good idea although substandard and inadequate. development of the enhanced BNF. having multiple sources of ideally the new BNF should not NICE acknowledges that digital information can he'll inform rely on the internet as infrastructure and access to decision making. connection is often very out in portable devices throughout the hospitals. NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Specialty I think this could really work well, clear search choices - by drug should it be chargeable, with Thank you for your comments, they doctor, it's an exciting development. The name, generic and brand, and institutional logins, or am I too have been considered along with palliative palliative care formulary works in by type, as well as by symptom cynical? the other comments received in the medicine a similar way, with subscribers consultation, to inform the being emailed about updates. I development of the enhanced BNF. feel keeping a papercopy is NICE acknowledges that digital helpful at some situations, but infrastructure and access to wonder if the runs might end up portable devices throughout the being only every 2 years? NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 180 of 383 Student With increasing digital I would want to use it Access is reliant on the Thank you for your comments, they Specialist knowledge, it seems logical to instantaneously at the location individual having the devices have been considered along with Community take the BNF forward into the where I am working and many of to enable access. Who will the other comments received in the Public Health digital era. Creating an up to us are prohibited from using meet this cost the individual or consultation, to inform the School Nurse date digital version that can be personal phones, including employer? What if electronic development of the enhanced BNF. accessed 24/7 affords a smart phones which would make access is not possible (IT NICE acknowledges that digital community based nurse instant us reliant on Health Board problems). My Health Board is infrastructure and access to access and would be invaluable interfaces/work stations and unable to provide continuous portable devices throughout the providing up to date information there are insufficient of these. uninterrupted internet access NHS is not fully developed. regarding the most appropriate and this is likely to represent a Distribution of print formats will drug or appliance, both in serious flaw in the vision. continue in line with user formulation and cost , right dose, Health Board IT systems are requirements, subject to ongoing and also known and potential so heavily impeded by monitoring and review by the NICE drug interactions. BUT if we protective software that the Board. become totally dependent on speed at which information can electronic access, it will not work currently be accessed on for those of us who work in the paper will prove difficult to community because of the match. inability of any Health Board to ensure Broadband access in the community and yet health policy is trying to keep patients in the community.

GP Fantastic idea- app is perfect for Easy access- quick interface N Thank you for your comments, they home visits. Would be great to Comparability with practice have been considered along with have local formulary based software - Vsion, EMIS etc the other comments received in the tightly on Bnf consultation, to inform the doses/indications/interactions development of the enhanced BNF. alerts specific to each patient's records - with alert flags for problems/ACBS endorsement etc medical Additional resources and Making sure that it takes into I think what can be improved is Thank you for your comments, they student comparisons of effectiveness account all the relevant , high the section of how the drugs have been considered along with between the same type of drugs profile, and up-to-date research work. Having a brief note on the other comments received in the is a good way to improve quality. while recommending and each drug's probably consultation, to inform the

[Insert footer here] 181 of 383 Additional clinical decision informing about drugs. mechanism of action development of the enhanced BNF. support via online and mobile (pharmacology) provides a lot devices. of insight in to matching and unserstanding the beneficial and harming effects of drugs in a patient. I looked at the latest version of BNF and I think to better inform all the health professionals it is mandatory to provide a mini section under each drug about its modes of action in terms of pahrmacological sciences. This would be such a useful way to equip and provide knowledge to all the health professionals to undestand the basis of drug action in clinical practice.

GP In agreement. Easily searching SERIOUS Suggesting alternative drugs Thank you for your comments, they ADVERSE interactions of for treating certain conditions have been considered along with multiple drugs when prescribing the other comments received in the for patients ie if a patient is consultation, to inform the already taking 10 drugs if the development of the enhanced BNF. nexy drig you want to add interacts with any of the others. Easily searching if the drug you want to prescribe is CONTRAINDICATED in a perticular opatient with multiple conditions

[Insert footer here] 182 of 383 Dentist If it works! Fuzzy search is How about a cross link to drug Why not trial it and ask this Thank you for your comments, they probably essential. I suspect interactions from an entered again. Are you willing to go have been considered along with strongly many people use the agent. In addition, how about an live and then change it when it the other comments received in the paper BNF prescicely because interaction risk from a doesn't work as advertised. consultation, to inform the the mark 1 eyeball and brain can combinatiuon of drugs that could Look carefully at the NHS development of the enhanced BNF. resolve spelling issues. If we be linked to give a realistic risk. record in poor information NICE will undertake extensive user have to spell it correctly to find it technology. Why should you testing on any enhancements made in an electronic system than get it right against all the to the BNF. we're going backwards odds? Why should you be trusted?

Pharmacist, I love the idea of having LA care providers believe CQC I would like to see embedded Thank you for your comments, they provider of downloadable and online require care homes even without videos for the use of devices have been considered along with training to care formats. BUT although in the nursing to have BNF /cBNF. such as inhalers. This could be the other comments received in the staff UK I have to BUY the BNF as I Working with social care used for other basic consultation, to inform the run an organisation whose main providers I am aware that they techniques eg various development of the enhanced BNF. focus is to train social carers in have no idea how to use the injections. Please note that BNF and BNFC the safe handling of medicines BNF with it's very compact content is freely available online at and are not a public body. format and medical / prescriber www.evidence.nhs.uk language, so I think a how to use tutorial would be helpful. Using plainer language would be helpful, freeing the BNF from print format would allow this.

GP You are being arrogant and Additional to hard copy, but not Electronic is not mission- Thank you for your comments, they meddling where change is not a replacement. Having an critical secure. Computers go have been considered along with needed. BNF is a resource for update is sometimes useful, but down, mobile phones find the other comments received in the those who prescribe and not so is still being able to view past unable to update, or might stall consultation, to inform the targeted at the public as some guidance (else can be difficult to with their limited memory. On development of the enhanced BNF. dumbed down web app for understand why certain line interactive is reliant on NICE acknowledges that digital patients to look through their treatment approaches were data/wifi connection and this infrastructure and access to treatment options. For this there used in the past) often not the case. Hard copy portable devices throughout the already exists the excellent, well is easier to read than NHS is not fully developed. constructed NHS Choices that I electronic on screen and often Distribution of print formats will find a useful resource discussing need have screen open for continue in line with user investigations treatments and the clinical notes and BNF open requirements, subject to ongoing reasons behind these - that separately (i.e. it wont all fit on monitoring and review by the NICE

[Insert footer here] 183 of 383 already goes a long way for the screen at same time) Board. vision you have and I would Since they work offline, a prefer that be developed further. connection to the internet is not NICE is not I'm afraid seen as required once the BNF and BNFC authorative as BNF, it is seen as apps are downloaded onto a mobile subject to political steering, and device. the robustness of its decisions views is often laughable (eg childhood fever claiming research shows no benefit from paracetamol plus ibuprofen,which was misinterpretation of the 2 papers cited, and further study a few months later showed approach superior. Or selecting CKD proteinuria level of its own choosing rather than going with internationally de facto standard). The real problem with your vision is that electronic is not mission critical secure - lack of data/wifi connection when on visits, or smart phones limited memory meaning can't always install or at least update the app. I always want a hard copy in my visiting bag. In surgery far easier to read a book and move across sections or flip back and forth than be shown a small panel of one subsection, and good to have a book to refer to while having clinical system up on screen. I object if BNF becomes sycophantic to NICE's monopoly advice

[Insert footer here] 184 of 383 Salaried Gp I think the vision of an up to integrating current guidelines eg ONLY that I still think paper Thank you for your comments, they date,evidencebased bnf is good. nice, making sure interactions copies are essential for safety. have been considered along with HOWEVER NOT ALL GPS are easy to fin dout Also I find the current bnf is the other comments received in the HAVE ACCESS TO DIGITAL NOT USER FRIENDLY. It consultation, to inform the MEDIA EG ON HOME VISIT could be improved a lot to development of the enhanced BNF. AND I THINK WE STILL ALSO makeit easier tofind what you NICE acknowledges that digital NEED A PAPER COPY WITH want. infrastructure and access to BASIC PRESCRIBING portable devices throughout the INFORMATION TO BE SAFE NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Senior Brand Integrating NICE and BNF and Accuracy Ability to share how to NICE have always been open Thank you for your comments, they Manager making it more aligned, accurate implement NICE Guidance and transparent, working with have been considered along with and up to date is a great through local practice and the industry as well as the other comments received in the ambition. recommendations. clinicians. This is not the case consultation, to inform the with the BNF who ignore development of the enhanced BNF. emails from industry even NICE acknowledges that digital when we are trying to help infrastructure and access to them keep the prices in the portable devices throughout the BNF accurate. Sadly, our NHS is not fully developed. efforts have been ignored and Distribution of print formats will the BNF prices are innacurate continue in line with user when it comes to Nutricia's requirements, subject to ongoing product range. I hope the monitoring and review by the NICE enhanced BNF will be better, Board. however this will require a massive culture change within the BNF organisation.

Head of I agree with the vision for an Most important elements: * Availability of accessible Thank you for your comments, they Medicines enhanced BNF as described. quickly including evidence- computers, smart phones and have been considered along with Management based information as it becomes tablet devices across the NHS the other comments received in the available * links to ther sources will be a major factor in consultation, to inform the of high quality patient successful adoption. Within development of the enhanced BNF.

[Insert footer here] 185 of 383 information * ease of searching * our community setting, staff NICE acknowledges that digital widespread accessibility - not deliver care in patients homes, infrastructure and access to just restricted to 'named so need a personal device portable devices throughout the prescribers' but to all healthcare rather than access to a shared NHS is not fully developed. professionals. computer back at base. Distribution of print formats will Availability of 3G networks to continue in line with user enable Apps/web versions to requirements, subject to ongoing be viewable is also key - there monitoring and review by the NICE are a number of blackspots in Board. our city, and across the Since they work offline, a country. connection to the internet is not required once the BNF and BNFC apps are downloaded onto a mobile device.

STAFF NURSE The use of on-line and other Immediacy of access to the The non-availability of digital Thank you for your comments, they digital BNF versions will ensure most up to date information. readers in all practice settings. have been considered along with the most up to date information the other comments received in the is available. However, in an consultation, to inform the acute ward setting in the NHS development of the enhanced BNF. access to a NICE acknowledges that digital computer/smartphone/tablet is infrastructure and access to not always immediately available portable devices throughout the and an up to date print version NHS is not fully developed. still has a place for swift Distribution of print formats will reference. continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

GP The BNF is great as is. The NHS Just the same as they are now. Yeah Change isn't necessarily Thank you for your comments, they has a spectacularly bad record in Clear, consistent good advice. always better. If it ain't have been considered along with IT and might be best to keep it's broke.... the other comments received in the hands off the BNF rather than consultation, to inform the ruin it by making it too complex. development of the enhanced BNF. By all means use the ability of an electronic format to keep it up to

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Consultant in The advantage of the printed Unbalanced question - you The needs of patients at the Thank you for your comments, they Palliative form is that it is easier to read should also be asking about the end of life are occasionally have been considered along with medicine than a computer screen; it is advantages of the printed form, overlooked. I was recently in the other comments received in the (NHS); Medical more readily portable, especially unless you have already made contact with the BNF about consultation, to inform the Director of in community work; on a your mind up. It needs to be new advice on the use of development of the enhanced BNF. Hospice crowded ward with insufficient more user friendly than the metoclopramide, which did not NICE acknowledges that digital computers it is more readily current eBNF. The drop down take its palliative care use into infrastructure and access to consulted (unless replaced in the lists can be a bit difficult to consideration. I was portable devices throughout the wrong area!); it is quicker to look navigate at times. Links to immensely gratified by the NHS is not fully developed. items up; it is quicker to look at specialist formularies from the respect shown for my opinion Distribution of print formats will other drugs or related items on main BNF will be important - for and the speed of the response continue in line with user the same page; one can find example the paediatric BNF, the to this, more speedily dealt requirements, subject to ongoing alternatives more readily with the Palliative Care Formulary, more with on line than in the paper monitoring and review by the NICE printed form than with the current detailed product characteristics. form. Doctors will use the BNF Board. electronic BNF. Updating more Links to specific sections - e.g. to help decision making (if not I quickly will be beneficial and a palliative care, renal or liver would worry!). If the advice significant advantage. Errors or failure, interactions The ability to changes, and there is a omissions can more readily and go from link to link to gather subsequent challenge to speedily be dealt with. more information or enhance decisions, it will be necessary lateral thinking is useful. The that one can refer back to trail of breadcrumbs back to (dated) changes somehow. where one started remains The recognition of misspelt important so as not to lose one's drug names has improved a thread (sorry, mixed metaphor). lot. However, I would like to see a warning about potentially similar drug names when errors are known (e.g. fluconazole and flucloxacillin). Could consider adding photographs of drugs, especially when these relate to doses (e.g. in slow release

[Insert footer here] 187 of 383 opioid preparations). Enhanced drug interactions section - some individual reactions are included in generic descriptions (e.g. opioids and MAOIs) The ability to open more than one page at a time is helpful, especially when making complex decisions. Can only do this now by opening multiple copies of the eBNF.

Dr I should be a good addition to Easily accessible with up to date none Thank you for your comments, they the BNF portfolio, it will reduce links including NICE but also have been considered along with the need for paper copies and other evidence based studies. the other comments received in the could be combined with the other Will need to available on other consultation, to inform the versions of BNF platforms including windows development of the enhanced BNF. android IOS systems together with links to the major medical software suppliers.

Formulary and in theory all presented reliable access to envisaged full Would you include hyperlinks Thank you for your comments, they HAndbook imrovements and functions make digital format (which sadly to SMC advice which is have been considered along with Support sense and could be beneficial seems a lon way away and currently documented in the other comments received in the Pharmacist partly outwith your power) printed version? There are still consultation, to inform the considerable issues in development of the enhanced BNF. availability of suffcicient IT NICE acknowledges that digital points for all staff to have infrastructure and access to quick, reliable, easy access to portable devices throughout the any online program; be that at NHS is not fully developed. ward level or within pharmacy Distribution of print formats will departments. Unfortunately, I continue in line with user do not see this beeing requirements, subject to ongoing resolved within the next few monitoring and review by the NICE years. I would therefore Board. advocate to keep a printed version for the foreseeable

[Insert footer here] 188 of 383 future (even it will come with obvious lack of interconnectivity to other sources)

Consultant I would anticipate that BNF Detailed indexing and useful No Thank you for your comments, they Obstetrician & should be only accessible as a cross-linking have been considered along with Gynaecologist digital on-line resource, either the other comments received in the directly or via an interface with consultation, to inform the other packages, especially development of the enhanced BNF. prescribing or EPR software..

Medicines An enhanced BNF is all well and Needs to be quick, consise and Possibly the fact that paper Thank you for your comments, they Information good, but it still needs to be practical at the point of care. copies are still preferred by have been considered along with Pharmacist mainly focused on point-of-care Personally, as an MI pharmacist, many medical, pharmacy and the other comments received in the use. That is where the BNF I am looking for more in-depth nursing staff. consultation, to inform the works best. It needs to be clear information, but I have other development of the enhanced BNF. and concise in the first instance, resources where I look for that. NICE acknowledges that digital but with links to further The BNF's place, in my view, is infrastructure and access to information if required. Please as a reference point for details portable devices throughout the also don't underestimate how about medicines that are NHS is not fully developed. many people still prefer paper needed urgently, i.e. doses, Distribution of print formats will copies. administration instructions, continue in line with user cautions and contra-indications. requirements, subject to ongoing monitoring and review by the NICE Board.

Prescribing Good, will be excellent to To improve the search function Could links be made to the Thank you for your comments, they Advisor combine sources of information online would be good SPCs from EMC? have been considered along with the other comments received in the consultation, to inform the

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Pharmacist Problems if the technolgy is not Good idea for it to be continually see above Thank you for your comments, they available to individuals and if no updated- but see problems with have been considered along with internet connection available access to individuals the other comments received in the consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Ret Forensic The enhanced BNF should Rapid access to information Access to the enhanced BNF Thank you for your comments, they Physician and greatly enhance what is an about a drug and/or medical could be very poor in some have been considered along with GP excellent information and condition then to be able to circumstances. In my 30 years the other comments received in the decision-aiding resource. make quick high quality working in the NHS, the NHS consultation, to inform the However there is a risk of it comparisons of key information. has had a dreadful record in development of the enhanced BNF. becoming bloated or loosing implementing IT (especially in NICE acknowledges that digital some of its balance of clear, hospitals). Wards, surgeries infrastructure and access to concise and accessible and clinics may have too few portable devices throughout the information that have made it a screens that are slow. Wi-Fi NHS is not fully developed. very valuable tool. I think the and 3G or 4G reception can be Distribution of print formats will addition of drug half-lives would poor. At present there is continue in line with user be helpful for some drugs and severe weather with loss of requirements, subject to ongoing "t/2 2hr" does not take up much electrical power for days in monitoring and review by the NICE space. some parts of the country. Board. More medical care is intended to be done in the community where IT, Wi-Fi and 3/4G access varies greatly (I worked in a part-rural GP practice

[Insert footer here] 190 of 383 which covered approximately 80 sq. miles). I worked for the Police for 12 years where there were sometimes complex medical issues in custody suites that had poor mobile phone reception and the only Police computer screens that were not medically confidential. Given the above, there is a very strong case for still making the print copy of the BNF widely available accepting its limitations. Better that than no BNF/NICE information being available at times.

GP I think the vision is essential in Needs to be easy to access and Very good ideas - as above Thank you for your comments, they this computerised age and being quick to find information in wide just do not forget that internet have been considered along with able to update frequently will be variety of settings. Hence the not accessible everywhere the other comments received in the really useful BUT paper copy importance of a paper copy as consultation, to inform the also essential. I personally find it part of the provision Needs to be development of the enhanced BNF. much quicker and easier for updated regularly Needs the NICE acknowledges that digital referring to during consultations sections on interactions, infrastructure and access to but more to the point it does not palliative care etc all very useful portable devices throughout the rely on internet access or Would like to see the sections at NHS is not fully developed. electricity - can be carried to end re pregnancy and breast Distribution of print formats will visits, used at branch surgery or feeding back again even though continue in line with user carried in pocket etc. As a GP I now included with individual requirements, subject to ongoing find having a paper copy drugs monitoring and review by the NICE invaluable though I can accept Board. that an annual edition will be more cost effective. The paediatric version also extremely useful

[Insert footer here] 191 of 383 Prescribing I welcome the vision for Having timely access to Can't think of any Thank you for your comments, they Adviser enhanced BNF which seem to be accurate and up to date have been considered along with a positive development in information and being able to the other comments received in the sourcing the latest medicines download to local formulary consultation, to inform the information but this would need development of the enhanced BNF. to be user friendly and not over complicated to the extent BNF looses its identity. One advantage of current BNF is easy to interpret and find drug information by healthcare professionals whatever their level of experience.

Locum We can only go forwards to The opportunity to digitally Ease of access to the lower Thank you for your comments, they Pharmacist embrace the opportunities new search for items rather than rely waged users of the BNF might have been considered along with technology gives us, but we on the index provides a lot of be compromised if there is a the other comments received in the need convenient quick access to additional information. total switch to an electronic consultation, to inform the the information. Digital devices in Hyperlinks to external version. Perhaps a suitable development of the enhanced BNF. the pharmacies I work in are very information quickly cross tablet could download the NICE acknowledges that digital busy performing essential tasks references or embellishes on the entire BNF whenever it was in infrastructure and access to for dispensing including ETP and core information. range of "home" Wi-Fi? portable devices throughout the also "domestic" in house tasks. allowing instant access to the NHS is not fully developed. There is a reluctance to data wherever the user might Distribution of print formats will purchase more PC's and be with out the constrains of a continue in line with user software licences to allow digital network or internet requirements, subject to ongoing integration of our PMR and BNF access being necessary. At monitoring and review by the NICE facilities in an environment one point, the Encyclopedia Board. where margins and hence any Brittanica could fir on ONE overheads are being squeezed. DVD! how much storage is The App on my phone is very now easily at our fingertips? useful but too slow for patient Look at Tesco's HUDL - consultations. Perhaps a large national availability, reputable group discount for all registered firm, easy collection/repair pharmacists, GP's etc could be base. Log in like google obtained on a good quality chrome - your desk appears tablet? when you log in with all your work available.

[Insert footer here] 192 of 383 Pharmacist It sounds as though the Simplicity of use - search criteria I think links to information in Thank you for your comments, they information which the BNF would easy to manipulate so as not to the PCF (palliative care have been considered along with link to would be vast - I think receive too many or irrelevant formulary) (which is currently the other comments received in the prescribers would struggle to facts. Similar look to current free to access online in consultation, to inform the filter through and find the piece BNF perhaps with use of URL Scotland) would be something development of the enhanced BNF. of information that they were links below the usual text which important not to be forgotten. NICE acknowledges that digital looking for. It sounds as though are well described. When I previously worked in infrastructure and access to the BNF would become community pharmacy, some portable devices throughout the something similar to nhs shops did not have access to NHS is not fully developed. evidence - which is already the internet and so these Distribution of print formats will available, but can be difficult to shops would have access only continue in line with user search and find exactly what you to an out-of-date paper copy of requirements, subject to ongoing are looking for. Where the BNF - I don't know if this is monitoring and review by the NICE prescribers are looking for a still a problem. Not all hospitals Board. quick answer they may give up have easy access to the and look in an out-of date print internet without leaving the copy of the BNF instead. patient's bedside and moving to a computer e.g. behind a nurses station (which is often already in use by someone else) to look up information. Allowing their staff access to an up to date BNF would therefore incur additional IT costs for some NHS Trusts. UKMI will need to be heavily involved with this as they are currently a vital and trusted source of medicines information for all healthcare professionals. They would have practical advice about how to make this project more successful.

[Insert footer here] 193 of 383 CONSULTANT The print versions are much Go back to the old format of As above Thank you for your comments, they MICROBIOLOG more convenient to use so I do having separate Interactions, have been considered along with IST not think they should be Breastfeeding, pregnancy, renal the other comments received in the scrapped sections etc. It was much consultation, to inform the quicker to use because the development of the enhanced BNF. drugs were automatically in NICE acknowledges that digital alphabetical order. Now you are infrastructure and access to forced to look up the index at the portable devices throughout the back to find which page number NHS is not fully developed. you need for the individual drug. Distribution of print formats will This was a retrograde step continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant Long overdue - the books clutter Easier access to all uses of Opportunity to gain on line cpd Thank you for your comments, they hospitals and are often 2 years drugs for instance Haloperidol points in therapeutics - senior have been considered along with out of date doctors especially in surgical the other comments received in the specialties should be required consultation, to inform the to do this development of the enhanced BNF.

GP retired now Good idea. My worry is internet Up to date Pt can share Probably! Thank you for your comments, they locum connection when I need it if I am experience but I doubt there have been considered along with away from practice. My ipad is would be a majority of patients the other comments received in the wireless and my phone is not able to do this and we would be consultation, to inform the always a good signal. Also small interpreting the info for them so development of the enhanced BNF. screen. that they could decide The idea NICE acknowledges that digital of attaching risks as numbers is infrastructure and access to long overdue, quantifying will be portable devices throughout the a big step forward and will help NHS is not fully developed. some patients accept drugs. Eg Distribution of print formats will statins. _it will blunt some of the continue in line with user bias in newspapers but there will requirements, subject to ongoing be journalists who seize on monitoring and review by the NICE figures. A healthy change Board. however. Initially would want print as backup

[Insert footer here] 194 of 383 GP lack of internet access makes needs to link to clinical system seems to be going the right Thank you for your comments, they utility limited paper version is direction but NHS needs to have been considered along with always available come into this century with its the other comments received in the IT systems otherwise we will consultation, to inform the effectively be back to the years development of the enhanced BNF. after 1976 when the only BNF NICE acknowledges that digital was the 1975 one and MIMS infrastructure and access to filled the gap portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Clinical A good idea as need to look at More detail on drug interactions, Mechanism of action and half Thank you for your comments, they Pharmacist other sources for MOA, detail of bit that BNF says refer to data life are my commonest have been considered along with drug interactions , plus some sheet, pregnancy more info as reasons for needing to go the other comments received in the summary of recommendations lady on medication or needs it eleswhere consultation, to inform the already included. But I use only so want more detail on actual development of the enhanced BNF. work computer no laptop etc and risks ward/pharmacy computers aren't connected to Internet

Specialist great idea, the more easily accessibility of format nothing obvious Thank you for your comments, they Optometrist accessible this information the have been considered along with better, safer prescribing, better the other comments received in the treatment consultation, to inform the development of the enhanced BNF.

GP Sounds like a sensible plan Advice on non licensed use of Not sure, not enough detail Thank you for your comments, they medication. Incorporate HIV here have been considered along with drug interactions Liverpool the other comments received in the website. consultation, to inform the development of the enhanced BNF.

[Insert footer here] 195 of 383 Director of I think it will be a welcome The fact that it will be kept up to Clinical and cost comparative Thank you for your comments, they Pharmacy addition to the format and date on a regular basis and to ensure that prescribers are have been considered along with information held in the BNF include evidence based making a choice based on the other comments received in the increasing the value as a medicine on the effectiveness of clinical need and cost consultation, to inform the reference source. the drugs effectiveness of the drug. development of the enhanced BNF.

Clinical QA balance will have to be The format would need to be far The infrastructure MUST be Thank you for your comments, they Pharmacist struck between providing ready more user friendly that the 100% reliable if this is to have been considered along with and rapid access to important current eBNF. Not being and IT replace the printed version in the other comments received in the information, and being an in expert, I would like to be its entirety. And while this may consultation, to inform the depth encyclopaedia. assured that it would not be off- be the case in major centres, it development of the enhanced BNF. line while updates are being is not always so in rural areas, NICE acknowledges that digital carried out. where high-speed broadband infrastructure and access to is far from universal. portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Independant Good no comment You have updated to include Thank you for your comments, they Prescribing nurse prescrubers by group have been considered along with Optometrist name but not IP pharmacists the other comments received in the or IP optometrists consultation, to inform the development of the enhanced BNF.

Principal This would be extremely helpful It would be helpful to include no Thank you for your comments, they Pharmacist to practioners as the majority of links/information to palliative have been considered along with Clinical commonly used resources will be care formulary as this is a the other comments received in the Development/O in one place and easily source that we often use in consultation, to inform the nc-Haem accessible. palliative care and there is development of the enhanced BNF. pharmacy Lead limited information on palliative care meds included in BNF. Links to onc/haem protocols eg CDF list

[Insert footer here] 196 of 383 Pharmacy It will be quicker to access the Links to NICE guidelines and Currently pre-registration Thank you for your comments, they Healthcare full range of relevant information. interactions will be very useful. pharmacists are required to have been considered along with Governance Ability to link information in to take a paper copy of the BNF the other comments received in the Manager local formularies. into their open book GPhC consultation, to inform the registration assessment. development of the enhanced BNF. Presumably the paper BNF will NICE acknowledges that digital eventually be phased out infrastructure and access to altogether. How will the GPhC portable devices throughout the enable the pre-reg's to access NHS is not fully developed. the BNF electronically without Distribution of print formats will also having access to other continue in line with user resources which are not requirements, subject to ongoing permitted. Unfortunately not monitoring and review by the NICE all hospital Trusts have access Board. to sufficient PC/hand helds in clinical areas. What will the publis perception be if they see healthcar eprofessionals (particularly in a ward environment) using their mobile phones to access this information? They may think staff are texting or using social media sites.

Principal It is a good idea to have a 'one Free access to a wide range of As above answers Thank you for your comments, they Pharmacist stop reference stop', although it practice-based resources, as have been considered along with Medicines is essential that the 'key sources highlighted in previous answer the other comments received in the Information of guidance' it links with, are consultation, to inform the reflective of those used in development of the enhanced BNF. practice and not just structured guidelines that don't provide useful practice-based guidance for the many patients with conditions/drug use that sit outside of national guidelines. These resources also need to cover a full range of clinical

[Insert footer here] 197 of 383 specialties, some of which have commonly used resources that are currently only available via subscriptions e.g. The Palliative Care Formulary, Stockley's Drug Interactions, and many many more. Availability to these resources will need to funded nationally. Also it is important to realise that the location of information is just the first step, how that information is applicable to the individual in question is the next essential step, and due to the many variables (previous/concomitant medications/disease states, gaps in the evidence base etc), no 'data only' information resource can provide this tailored advice. Therefore, users of the enhanced BNF looking for answers to questions about individuals, will often need to be directed to clinical advisory services such as UK Medicines Information who specialise in turning the available information into practical directive answers tailored to the individual patient. Many enquiries we receive are from specialists who have all the relevant data, but require practical advice on applying it to their specific patients needs.

[Insert footer here] 198 of 383 Consultant Excellent. The BNF is an Access to uptodate information Patient information. Consider Thank you for your comments, they haematologist essential element in my clinical regarding medicines in a format developing an information have been considered along with practice. Paper copies of BNF that is easily accessible and can system that has components the other comments received in the frequently cannot be found when search under drug name/ drug of UpToDate for specific consultation, to inform the needed, and at times are 'old' class/ condition. Utilise disease disease areas to support good development of the enhanced BNF. versions which introduce clinical pathways such as in map of clinical care/ prescribing (need risk- there is a need to have a medicine. It is essential that it is to prescribe drug at single, easily accessable source linked to local prescribing appropriate dose and be of information. There is need to information. Must be easily aware of interactions/ side integrate information by disease navigatable and intuitive. Would effects but even moreso need area- in my field of practice be nice to be linked to patient to know if drug required at all, (venous thrombosis and information so that relevant and if so which is best to anticoagulation), the ability to patient information sheets can choose). search for treatment under 'DVT' be accessed, printed off and or 'PE' and to be given a choice given to patients. Must be of treatment options with uptodate (we do not have recommendations as to which access to Uptodate in our are best suited to specific organisation but had a trial circumstances (eg LMWH if subscription- access to updated cancer or pregnancy) then that informaiton regarding different would be hugely helpful. Whilst disease areas would be hugely many hospitals (such as mine) beneficial to delivering a safe have paper prescribing, the service). junior staff use digital software for discharge/ to access results etc. so access to an enhance digital BNF would be integrated into the clinical practice easily. The opportunity to tailor this to local formularies is essential (we use only 1 LMWH to minimise clinical risk so it is essential that the enhanced BNF would support this). I agree that paper copies should be phased out as you propose

[Insert footer here] 199 of 383 GPST1 Good in theory. That it has a user-friendly I don't think we currently have Thank you for your comments, they format. I don't find the current the technological facilities for have been considered along with BNF online version nearly as this. Wards/community the other comments received in the user-friendly as the book which settings often don't have consultation, to inform the is the main reason I don't use it. enough computers and very development of the enhanced BNF. often when they do you can't NICE acknowledges that digital log on/can't access the infrastructure and access to internet/can't print from them. portable devices throughout the If you want to look something NHS is not fully developed. up briefly and it will take 10- Distribution of print formats will 15minutes to do so then you continue in line with user run the risk of people doing requirements, subject to ongoing things from memory which is monitoring and review by the NICE worse than using BNF Board. guidance that is several months old (as with the paper versions). Also, I believe that forcing people to use their own personal devices is a bit presumptious given that this is work related. Even if the NHS decide to provide personal devices to use for this, then there will need to be much better training on them than is currently given and it creates something else to get lost/broken etc. I think there are several potential areas where things could fall down.

Consultant in Looks exciting Browsable in different ways Consider specialty specific Thank you for your comments, they palliative formularies such as teh have been considered along with medicine Palliative Drugs formulary. the other comments received in the coudl this be incorporated. consultation, to inform the development of the enhanced BNF.

[Insert footer here] 200 of 383 Infection The vision is excellent but I am Up to date. Searchable on Not providing an up to date Thank you for your comments, they management concerned about accessibility at condition (I really miss the hard copy will make people have been considered along with pharmacist all times to a computer. I still use removed appendices) resort to old copies, thereby the other comments received in the a hard copy on a daily basis in using even more out of date consultation, to inform the my hospital when computers are texts. This will affect - Older development of the enhanced BNF. all occupied, I am using a room prescribers (less used to apps NICE acknowledges that digital without a computer, I am at a etc) - Visiting patients in their infrastructure and access to patients bedside, I wish to own home without portable devices throughout the 'browse' - more easily done with internet/phone signal (common NHS is not fully developed. a hard copy. I am also an older in my area) - Inconvenience Distribution of print formats will pharmacist, less at home with e during the working day when continue in line with user BNF (though fully au fait with access to computers is already requirements, subject to ongoing other technology). My iPhone is under pressure - Ward monitoring and review by the NICE too old to use the app. My NHS rounds/MDT meetings where Board. trust does not provide tablets one person has 'control' of the and phones are not allowed to computer and 'the pharmacist' be used on all wards - except by usually use their own BNF doctors. This does not allow nurse/pharmacist prescribers to use their own phone with the app.. If forced to only use eBNF, then I'm sure I would cope (though with a bit of muttering)

MI pharmacist Excellent. Need to encourage As above. Use of an enhanced Not really - challenge will be to Thank you for your comments, they users to access the BNF/BNFc BNF will ensure users have encourage all users to access have been considered along with electronically to ensure they are access to the most up to date electronically and reduce the other comments received in the using the most up to date information and are fully aware reliance on carrying hard consultation, to inform the information. Use of electronic of important changes eg codeine copies development of the enhanced BNF. versions will allow much easier in children. Can be quite linking /access to further dangerous to rely on hard resources such as relevant NICE copies which are often out of guidelines, PILs etc date as soon as they are published. Will need hyperlinks to other relevant documents eg NICE guidance and possibly other sources eg MEDUSA guide for IV drugs, Stockley

[Insert footer here] 201 of 383 Drug Interactions

Lead The BNF is designed as a point I’m not sure what needs Access to hardware provided Thank you for your comments, they Pharmacist of care reference to allow rapid enhancing within the BNF – it by employers to access digital have been considered along with Community access to information on the safe already contains the majority of resources. The ease of use of the other comments received in the Services and effective use of medicines medicines information that is electronic products and the consultation, to inform the and it is this type of publication needed at the point of care and assumption electronic access development of the enhanced BNF. that is required for day-to-day there are many other references suitable in all situations. The NICE acknowledges that digital clinical practice. Although some and guidelines available for vision also suggest the BNF infrastructure and access to elements of this are captured in clinician to refer to if needed. will help health care portable devices throughout the the ‘vision’ it appears to have Combing all of this in one professionals choose NHS is not fully developed. become muddled by trying to publication would appear to be appropriate medicines for Distribution of print formats will include a wider scope which will confusing make the BNF patients with more than one continue in line with user then take away the uniqueness potentially less useable. clinical condition; although it requirements, subject to ongoing of the BNF and it perhaps its sounds beneficial it would be monitoring and review by the NICE clarity; for example I’m not sure if problematic to be able to Board. integrating guidance from other provide this guidance as the sources would be beneficial as it evidence behind such would dilute the current recommendations does not information and take BNF away appear to exist. This is from its primary aim. This also highlighted by the recent Kings appears to be duplication and Fund report into polypharmacy therefore wasteful, if there are and medicines optimisation other guidelines in available then (http://www.kingsfund.org.uk/p a clinician will refer to those as ublications/polypharmacy-and- needed and there does not medicines-optimisation) appear to be a need to have

[Insert footer here] 202 of 383 valuable focus on medicines and modify or discuss the not add much additional value to applicability of their the publication. recommendations for patients with multiple co-morbidities or for older patients; nor do they take account of patient preferences.> The ‘vision’ also states that the BNF will need to include information on ‘resource implications’, although it is not clear what is meant by this, again I would not see this as the BNFs role and appears to be perhaps be covering similar work as NICE and other organisations.

Pharmacist Good idea in principle but care Evidence based medicine must The BNF still needs to be a Thank you for your comments, they must be taken to avoid making underpin everything we do for suitable size for reference. have been considered along with the drug monographs too big to our patients so I agree in the other comments received in the be useful. New information principle with the changes. What consultation, to inform the should not be added at the my prescribers want to know is development of the enhanced BNF. expense of the basics. more 'what does nice say' and 'which of this class should I prescribe' not necessarily the evidence base behind the inclusion in the formulary. Would we not be better giving direct guidance such as this rather then providing evidence that may be irrelevant?

[Insert footer here] 203 of 383 retired I used to work in drug Availability on a mobile device Seemingly not. Just a thought Thank you for your comments, they pharmacologist information and would be useful to clinical and though, there is a new have been considered along with ; carer; patient; pharmacovigilance in the pharma pharmacy practitioners. My teaching scheme planned, as the other comments received in the member of industry and from that needs are somewhat different part of the PSA scheme which consultation, to inform the public; still perspective this seems broadly (although representative of many medical schools are development of the enhanced BNF. active in fine to me. many others I know) so the main taking up, so I wonder if any Please note that the PSA currently science issue for me would be online connection between the links directly to the BNF online. availability of the information electronic BNF and this and emailed alerts to any scheme might be workable, in changes. The BNF should due course. continue to be available to the public including the hard copy via libraries as a foil to all the sometimes doubtful information they may access via the web.

Locum GP Good idea but: Not everyone has Flexibility Sensible graded See above Thank you for your comments, they access to the internet advice on s/e and interactions have been considered along with (disadvantages the elderly, etc) Ability to act outside NICE the other comments received in the We will need internet access in guidelines where appropriate consultation, to inform the the community on visits (not a development of the enhanced BNF. smart phone please) It may NICE acknowledges that digital contrain prescribing outside infrastructure and access to guidelines, off licence portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 204 of 383 VP IMI Excellent idea to have an It can not only provide the The enhanced digital version Thank you for your comments, they collaborations enhanced digitial version. expected high quality should be continuously have been considered along with IMED However, this can be much more information prescribing reviewed with feedback from the other comments received in the AstraZeneca than just an electronic version of information but can link to other users and continuously consultation, to inform the the paper copy. The app is data sources such as enhanced improved. development of the enhanced BNF. currently only available to NHS adverse events, HCPs but it could also be genetics/genomics data which available to others, patients, would automatically appear with carers, etc. a more useful classification such as: 1. contraindicated in combination with x or in patients with a specific genetic profile eg Abacavir and HLA type. 2. caution when used in combination with x or in patients with a specific genetic profile eg warfarin - please provide feedback on outcome to improve prescribing in the future 3. no clear recommendation when used in combination with x or in patients with a specific genetic profile - please provide feedback on outcome to improve prescribing in the future. head of the enhanced information will be up to date, searchable no Thank you for your comments, they medicines useful, specifically the additional have been considered along with management information on the importance of the other comments received in the east staffs ccg drug interactions and improved consultation, to inform the search facilities development of the enhanced BNF.

[Insert footer here] 205 of 383 Consultant Seems like a good idea I have one important comment, no Thank you for your comments, they ophthalmologis about which I have been in have been considered along with t correspondence with the BNF. the other comments received in the The BNF felt obliged, possibly consultation, to inform the for fear of litigation, to repeat the development of the enhanced BNF. side effects, cautions, interactions etc as published by the licensing authorities. I have no problem with this, but some words of sensible explanation, and published data from later evidence, can be added in many cases and make prescribing safer. The BNF seemed oddly reluctant to do this. An example: Many drugs list "glaucoma" as a caution. This is because some drugs have the potential to induce acute angle closure (not in point of fact a type of glaucoma at all, but a nasty condition with potential to cause glaucoma). Patients who have "glaucoma" will either have open angle glaucoma, or will have been diagnosed with a potential angle closure issue and had this treated. Neither can develop angle closure. So - the only patients at risk from drug caused acute angle closure are patients who do not know they have glaucoma. This makes the warning pointless and confusing - and this one confusion causes me at least one letter per week, and many other patients dont get antidepressants etc from

[Insert footer here] 206 of 383 doctors who dont ask for clarification. 1% of the population has glaucoma so this is a common issue. Allow the enhanced BNF to provide useful and updateable information on issues such as this and you will have done a good job!

Professor of Looks good. Need to include Need to include Thank you for your comments, they Dermatology recommendations for pre-drug recommendations for pre-drug have been considered along with investigations (which baseline investigations (which baseline the other comments received in the investigations should be investigations should be consultation, to inform the conducted) and conducted) and development of the enhanced BNF. recommendations for the recommendations for the frequency and type of regular frequency and type of regular investigations to assess for investigations to assess for adverse effects when patient is adverse effects when patient is taking the medication. At taking the medication. At present this is rather haphazard present this is rather and left to the prescribing haphazard and left to the clinician. The BNF tells us how prescribing clinician. The BNF to prescribe, adverse effects, etc tells us how to prescribe, but does not generally provide adverse effects, etc but does advice on relevant investigations not generally provide advice and the frequency of these on relevant investigations and investigations in order to monitor the frequency of these for adverse effects. investigations in order to monitor for adverse effects.

Band 7 Sister Agree - text books are out of As we use electronic prescribing Only concern for other trusts Thank you for your comments, they date at the time of print the electronic resources work well when continuing to use paper have been considered along with majority of the time. and are timely prescription and do not have the other comments received in the access readily to a computer - consultation, to inform the this could cause implications development of the enhanced BNF. and delay. NICE acknowledges that digital infrastructure and access to portable devices throughout the

[Insert footer here] 207 of 383 NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant in A link/inclusion to the A link/inclusion to the A link/inclusion to the Thank you for your comments, they palliative PCF/Palliative care formulary PCF/Palliative care formulary PCF/Palliative care formulary have been considered along with medicine would be useful as much of it is would be useful as much of it is would be useful as much of it the other comments received in the not currently included in the not currently included in the is not currently included in the consultation, to inform the BNF. BNF. BNF. development of the enhanced BNF.

Consultant Seems like a good plan. I would like to be able to put in Ensuring that the apps are Thank you for your comments, they Nurse Trainee all the medicines a patient is available on all platforms, have been considered along with taking and for it to check for Windows, Android, BlackBerry the other comments received in the interactions. Searchable by and Apple. Should all be able consultation, to inform the condition as well as by to work without internet development of the enhanced BNF. medicine. Automatically suggest connection and will alternatives in the case of automatically update when allergy or interaction. there is an internet connection again.

[Insert footer here] 208 of 383 Specialist Making the most of digital media I currently access the bnf in a Need to consider other Thank you for your comments, they clinical and improving frequency of wide range of formats, reference sources that are have been considered along with pharmacist, updates are both fantastic aims. unfortunately none of the already available.....eg the the other comments received in the respiratory electronic formats currently martindale. It seems to be consultation, to inform the medicine and match the reliability and ease of there is a danger the bnf will development of the enhanced BNF. medicines use of the paper version. I know just become a more frequently management my way around the bnf very well updated version of the but often find it difficult to access martindale. The unique selling / locate information in the point of the bnf is that it's the electronic formats that I know is basic info you need and just there. If I was less familiar with that, nothing else, there's a the paper copy I would easily danger that by adding all the miss vital information using the extras the basic info will be electronic editions as they lost. With medicine becoming currently are. Some big more complex all the time, a improvements need to made basic source like the bnf before I will feel confident using becomes even more essential. the electronic format. For all most all drug reference sources I use frequently I prefer the electronic format except the bnf. The great thing about the bnf is that all the basic info you need to prescribe a drug safely are there in a small space. It shouldn't be clouded with lots of extra information. The extra info should be available via links but not part of the standard text that the user gets.

[Insert footer here] 209 of 383 FY1 Doctor I think digitising the surface and I already mostly use the BNF Thank you. Thank you for your comments, they completely using the potentials online. The search function, its have been considered along with of digital technology is a move in presentation and ease of use is the other comments received in the the right direction. It should be the most important part so that consultation, to inform the easier to search for interactions the search results are presented development of the enhanced BNF. between multiple drugs online, in a logical order, with intuitive as well as different approaches filters. The pages should not to prescribing in special cases take up much data/bandwith to such as multiple morbidities or load and use, with simple clean for example, renal impairment. code. Help finding alternatives when switching between oral and parentral routes to continue providing normal medication when a patient condition changes is also helpful.

GP I think the idea of online access Excellent news re NICE Not sure Thank you for your comments, they is great and was delighted when guidance. have been considered along with I discovered theBnF iPhone app. the other comments received in the I thought no more home visits consultation, to inform the lugging the paper copy with me. development of the enhanced BNF. BUT you have got to make it NICE acknowledges that digital work better. The paper copy is infrastructure and access to invaluable. It's easy to search portable devices throughout the and it works when there's no NHS is not fully developed. electricity or internet connection. Distribution of print formats will The current app is continue in line with user temperamental and unreliable to requirements, subject to ongoing the point I deleted it from my monitoring and review by the NICE phone. Hugely disappointed with Board. it.

[Insert footer here] 210 of 383 Former Making the right information The challenge has always been While there is a mention of Thank you for your comments, they Pharmacist. available at the right time to the about how best to 'distil' down citing the likely frequency of have been considered along with Asst Editor right person in a right format is a the vast quantity of available adverse effects, my view is the other comments received in the BNF, Clinical laudable aim and has been so information to key elements that that this is of little relevance consultation, to inform the Editor BMJ for many years for those of us will quickly and properly inform when there is no information development of the enhanced BNF. Clinical involved in attempting to improve the complex decision making about how these adverse Evidence health outcomes through process at the point of care. I effects are presented clinically desimination of information. think that the most important and more importantly how to element of an enhanced BNF deal with it. For the person would be to make clear what it suffering the adverse effect, it cannot do i.e. replace the base is a life changing experience knowledge about the complexity yet it is rarely properly of drug action and reaction. diagnosed or even recognised. The word 'rare' in a description of an adverse event would generally lead to the dismisal of a drug being the the actual cause of clinical symptoms.

Specialist Ensure dosing information is Dosing and up to date evidence Still need done paper copies! Thank you for your comments, they Orthopaedic clear and not too confusing! base Computers love to crash! have been considered along with pharmacist Ensure it is easy to find for the other comments received in the appropriate conditions consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 211 of 383 GP Good idea but I like the Ready access without having to Hope not Thank you for your comments, they navigation round the print and remember login details Easy have been considered along with app versions not the online navigation through all the the other comments received in the version Easy for those of us with information from dose guidelines consultation, to inform the smart phones How will you back to choice of drug options, development of the enhanced BNF. support those who traditionally and interactions and side effects NICE acknowledges that digital inherit older print versions such profiles. Excellent search facility infrastructure and access to as medicines management staff, eg tried searching for chlamydia portable devices throughout the nursing homes for their drugs and cam up with nothing til I NHS is not fully developed. trolleys. The app cant be searched azithromycin. Distribution of print formats will dependent on 3G or wifi cover to continue in line with user work . GPs need it in areas of requirements, subject to ongoing poor cover on visits. monitoring and review by the NICE Board.

General In general these proposals look Full text search is a major Don't underestimate the Thank you for your comments, they Medical excellent. The BNF works best in potential advantage of an Luddite tendencies of NHS have been considered along with Practitioner electronic form. Making this the electronic document, compared staff. At my surgery all the the other comments received in the dominant or only version will to a paper index. Also, size. I consulting rooms have PCs consultation, to inform the save money and make the BNF already save weight on house with web access but my development of the enhanced BNF. better and more up-to-date. I calls by having the BNF app on colleagues still mainly use the NICE acknowledges that digital particularly like the proposals for my Android phone rather than paper BNF. Also remember infrastructure and access to giving better explanations of BNF the paper BNFs. In future an all- that online access is not yet portable devices throughout the policy and to be more electronic BNF could be very universal in General Practice, NHS is not fully developed. comprehensive by including much larger when not limited by let alone hospitals. Our web Distribution of print formats will medical devices. As a GP, I use the constraint of being a pocket- connection can be slow and continue in line with user the BNF dozens of times each able paper book. One thing I sometimes breaks down and I requirements, subject to ongoing working day and I already much don't yet have is integration of often have no phone signal monitoring and review by the NICE prefer the web version to the the BNF with my clinical when on home visits. The BNF Board. paper one. prescribing system (Vision from app on my Android phone is a INPS, with Gemscript drug little slow and fiddly and not database). This would be a everyone has a supported great help. More broadly, the smartphone. Please put BNF should link seamlessly with images into an enhanced Summaries of Product electronic BNF - e.g. asthma Characteristics, Patient inhalers, spacers and pictures Information Leaflets, NICE of tablets and capsules. guidance and local formularies. Please be careful to maintain

[Insert footer here] 212 of 383 the BNF's reputation for independence. NICE guidance is sometimes very obviously influenced by politics (including Government, pharmaceutical industry and patient pressure groups). The lesser public scrutiny of BNF advice gives it the freedom to make sensible suggestions in situations where the available published evidence is incomplete or biased (as is so often the case with drugs, where most trials are sponsored by manufacturers and only selected ones get published).

Consultant It should provide the most up to The links to other resources will No Thank you for your comments, they Burns & Plastic date prescribing information with enable this information to be have been considered along with Surgeon links to NICE and other drug reached easily without having to the other comments received in the information making the whole look too far. consultation, to inform the system safer and more robust development of the enhanced BNF. with easy access to information about the drugs used.

[Insert footer here] 213 of 383 GP The eBNF as now is excellent. Here is the "killer ap" that Probably not! - except perhaps Thank you for your comments, they Well done. regarding 3.2 - from impresses everyone I show: the - see above - to remember to have been considered along with print to digital: I'm conscious that intelligence of the BNF: the tell us foot soldiers of what the other comments received in the it's only three or four years since abililty for me to look up drug X you've developed; and the to consultation, to inform the I made the transition to using the in the adult BNF, realise I want tell us again; and then to development of the enhanced BNF. eBNF first and always. I wouldn't the Children's BNF, and with remind us.... ;) Best wishes, now go back to paper book one click switch to cBNF, and and thanks again. (except in the emergency of a still have that drug showing. I power failure, or while out on cite that, as one brilliant element visits...); but I know that there is that I know that many other a time cost to making the clinicians don't know of; and so I transition. That may well be less think it's very likely that there will than an hour in total - and so be be other "unknown time very well invested - but that unknowns" for me too. investment needs to be made. I am daily conscious - both in my daytime general practice and when I work at our out of hours organisation - that many clinical colleagues have not been "taken by the hand and shown gently" how easy is the eBNF. It may very well be that some of your energy and effort can more efficiently be invested there than (even) in further enhancing the electronics.

Practice I would support the integration of Searchability and simple user I combine my use of the BNF Thank you for your comments, they Learning those useful sources. interface. and NICE with the Maudsley have been considered along with Facilitator Guidelines for prescribing in the other comments received in the psychiatry very often. consultation, to inform the development of the enhanced BNF.

Paediatric Staff This would be helpful if it covers Same as at present giving the no Thank you for your comments, they Nurse confilcts in differing guidance correct information about a drug have been considered along with such as BTS and BNF and its doesages the other comments received in the consultation, to inform the

[Insert footer here] 214 of 383 development of the enhanced BNF.

StR General An overdue redistribution of Moving it onto mobile devices in As above Thank you for your comments, they Surgery emphasis. Rather than A more accessible manor than have been considered along with developing sverel versions of the current apps. the other comments received in the apps for different mobile consultation, to inform the operating systems why are you development of the enhanced BNF. not developing a single website specifically designed for mobile devices - this seems far more efficent and presumably easy to keep in a similar structure to the main bnf website making it more familiar.

Consultant laudable aims importnat for this easy access to information in NOT really ....just to mention Thank you for your comments, they Child & to be a true digital format rather readable format - MUST be mental health a huge area have been considered along with Adolescent than a book app. with all the possible to view offline (patchy even through we use realtively the other comments received in the Psychaitrist potent functionality that this may internet coverage or if used on few drugs. Important to think consultation, to inform the offer (design, searchable personal device with no access about delivering information to development of the enhanced BNF. informaiton, upto date to wifi at work). ability to book our patients who may limited NICE acknowledges that digital information, relevant links) The mark commonly used drugs or reading skills (so if there is a infrastructure and access to blurb at the start of the sections pages (e.g. interactions) user version to ensure there portable devices throughout the are very good and it is helpful to interactions search would be are some simple pictures for NHS is not fully developed. have a this information remaining good (i.e. put in list of drugs that those with learning disabilities Distribution of print formats will as impartial and balanced as they are on and have the search or indeed younger children to continue in line with user possible. a link or summary engine do a little of the work for be able to be involved in the requirements, subject to ongoing relevant nice guidance where you). Sometimes the conversation). monitoring and review by the NICE available would be very good. medication is not as clearly laid Board. link to patient leaflets might be out as it could be (i.e. vs printed handy pictures for learning version) - especially when disability and younger patients comparing generics vs might be helpful. proprietary

[Insert footer here] 215 of 383 n/a as stated as stated Access via book still relevant Thank you for your comments, they for patients/carers where have been considered along with electronic access not available the other comments received in the or inappropriate (e.g. non- consultation, to inform the users of computers) development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Clinical I totally agree with the While the "top-level" evidence- Yes, the consideration for Thank you for your comments, they Pharmacologis consultation document, on the based information and the Global Health of a Public have been considered along with t from the electronic version being made background would be important Health Good (BNF/BNFc) the other comments received in the Developing freely available and the paper for high income countries, it is funded by public funds being consultation, to inform the World version taking a back seat. From the basic information such as commercialised for profit by development of the enhanced BNF. the international perspective, indications,dose, common the current publishers NICE is only responsible for there would be immediate adverse effects, (Pharmaceutical Press and provision of the BNF publications to distribution and access through contraindications that would be BMJ). The modes of access the United Kingdom. electronic sources (as would be important for the health care for those in developing seen from NICE publications professionals in low and middle countries do exist but are which are freely available on the income countries who do not heavily weighted in favour of Internet). Access to BNF through have access to such the publishers perception of smart phones is not "pie in the information. Just simply making potential market. Health sky" as there is increasing the information available on carries very little in these penetration of smart phones in multiple electronic platforms access schemes. For example, low and middle income countries would be sufficient. Up-to-date Indian healthcare and health care professionals information is "nice to have" but professionals would greatly disproportionately having a share not essential. This was seen in benefit from the BNF - of ownership of smart phones. low and middle income countries certainly India is a low income The argument that funds are where the printed copies of country but is excluded from needed to maintain the app is BNF's were in great demand access as the publishers specious and self-serving. Once although they may have been 4 consider it a future potential the app is finalised, then it would - 5 years old. Further, if lucrative market. So let the

[Insert footer here] 216 of 383 be a question of updating countries want to make their patients and healthcare content. Yes, there could be own "National Formularies" the professionals suffer until the improvements to the app but that electronic source document potential can be realised and would not be very frequent. The should be made available, of profits made. This major question in the course on official terms with consultation focuses on the international context is whether appropriate restrictions, to the situation in the United the BNF in its electronic versions Ministries of Health. This would Kingdom - however the biggest is primarily for health not only for help the ministries to develop potential impact is in global the UK but also for the global their own formularies without health if the BNF is seen as a community, especially for having to "reinvent the wheel"; it Public Health Good funded by healthcare professionals in low would make a monumental task the taxpayer and the UK and middle income countries. into a "bite-size"project. The government and provided relevant information from the directly to healthcare BNF for national needs could be professionals reaching out to extracted, modified (with local the lowest levels of health information such as contact care. The information in the numbers of medicines BNF being made available to information services, available doctors, pharmacists, nurses brand names, prices) and then and students of health care published as the National professions would mean that Formulary. An electronic version those who actively search for that is constantly updated would good independent unbiased be a huge advantage in access medicines information would and distribution even in low and have the strongest tool to middle income countries. improve health care and to deal with the distorted medicines information that is prevalent in these countries, and has a very detrimental effect on patient care and health outcomes.

[Insert footer here] 217 of 383 GP and I think the print version must be I wouldn't prescribe without it Not really, except moving to e Thank you for your comments, they academic maintained as it is far easierto versions at the expense of the have been considered along with navigate and use in variety of book would be a problem the other comments received in the situations unless it links more completely consultation, to inform the to IT prescribing systems development of the enhanced BNF. seamlessly. Book annually at a NICE acknowledges that digital minimum please. Not always infrastructure and access to able to use computer or phone portable devices throughout the on visits or when reception NHS is not fully developed. poor or IT goes down. Books Distribution of print formats will in GPs bag is always there continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

GP It sounds good but would like to Include information on drug Make sure you don't loose the Thank you for your comments, they see some prototypes as they are interactions and unwanted essence of the BNF or make it have been considered along with developed. effects including rating of their too complicated to navigate. It the other comments received in the frequency and seriousness, to needs to remain authoritative consultation, to inform the minimise the risk of harm Llinks and simple at its heart. development of the enhanced BNF. to high quality information for Incorporate QR code patients, including information to recognition on product labels? help healthcare professionals Link BMI and renal function to and patients reach decisions doses? together Allow quick comparisons of key information on effectiveness, safety, patient factors and resource implications

[Insert footer here] 218 of 383 clinical I think this is a good idea. As Drug dosing in renal dysfunction It would be useful to have a Thank you for your comments, they pharamcist - itu mentioned, there are many both with or without dialysis, link form each of the have been considered along with / theatres resources we refer to in our work either intermittenet or interaction to illustarte why the other comments received in the as the BNF is not complete for continuous. Drug dosing in these are included i.e. is this consultation, to inform the complex patient care due to its obeseity. Drug dosing options in from trial data? what development of the enhanced BNF. development from a primary care NBM patients. Drug percentage of patients suffered resource for pharamcists. administartion down NG/PEG from the affliction. or is this Combining additional information tubes. Intravenous dosing in from post marketing data, if so such as the information provided Fluid restricted patients. Fluid how many yellow cards to give within the renal drug handbook, prescribing guidance. Drug an idea of the incidence. With uptodate, micromedex, UKCPA interactions which can be contraindications it would guide for administartion in fluid tailored to the medication the again be useful to provide a restricted patients, UKCPA guide patient is taking, i.e. not a long link to the evidnce behind for administartion in obese list of every potential interaction. these. For example melatonin patients and I am sure there are is contra-indicated in auto- other resources individulas immune disease, which is a would use regularly, it could very specific choice of disease enhance the current information state, but on conversation with to make the BNF a one stop drug the manufacture one can guide for all health care establish that this is founded professionals. on nothing of substance and is related to trials looking at using the product as a treatement for diseases of this origin that have been shown to be ineffective. opat cns Using electronic versions good easy to use. Quick Papaer copies for when IT fails Thank you for your comments, they idea but must have upto date (signal servers etc) have been considered along with paper version for when IT fails the other comments received in the consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user

[Insert footer here] 219 of 383 requirements, subject to ongoing monitoring and review by the NICE Board.

Prescribing I agree with some of the Enabling to download to local Drug monitoring frequency Thank you for your comments, they Advisor proposed changes however, formularies, interaction data what to monitor. ie. drug safety have been considered along with however the BNF becoming a the other comments received in the single authoritative source of consultation, to inform the medicines information, providing development of the enhanced BNF. information from a wide variety of nationally and internationally recognised sources will be a bit of information overloadand adding medical devices will make searching the BNF for quick information more ardous

Pharmacist No view Access to the palliative care As above Thank you for your comments, they formulary is a necessity and this have been considered along with should be available in the same the other comments received in the way as the BNF and the consultation, to inform the children's BNF development of the enhanced BNF.

Macmillan fine, but please do not ditch the not really looked- just want to no time to mull it over, sorry, Thank you for your comments, they Pharmacist book...... we sometimes have emphasise the book format is but please keep the book have been considered along with servers down/work in areas with essential. the other comments received in the no signal. I do not have a smart consultation, to inform the phone & neither do many others. development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing

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pharmacist Great idea - looking forward to User interface Will ot interact with CKS, map Thank you for your comments, they seeing. of medicine etc? have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF.

Senior All sounds excellent and eagerly Regular monthly updates to It would be useful to link in Thank you for your comments, they Pharmacist welcomed. Would be interested facilitate making decisions NICE clinical decision aid into have been considered along with to know more about downloading better. Having trusted sources the on-line and App versions? the other comments received in the to local formulary platforms and of prescribing information consultation, to inform the how this would work in practice accessible from one platform development of the enhanced BNF. when there are numerous would be most helpful. different formats being utilised nationally, some more sophisicated than others? For example locally we may not wish to download all content but selected sections unsure if this could be made possible?

[Insert footer here] 221 of 383 Community I currently use both the print and Systems to ensure that I find See above Thank you for your comments, they Services local Trust on-line versions of the and use all relevant pieces of have been considered along with Pharmacist BNF. However, via hte on-line information for the drug I am the other comments received in the version I find it difficult to be sure looking up. Online, there is a consultation, to inform the thath I have accessed all the tendency to navigate from one development of the enhanced BNF. relevant inforamtion and find it section to another and not NICE acknowledges that digital much easier to do so using the necesssarily to return to the infrastructure and access to print version. previous sections, amnd to portable devices throughout the compare all inforamtion. I would NHS is not fully developed. like a system where more than Distribution of print formats will one page can be open at the continue in line with user same time so they can be requirements, subject to ongoing compared/ information can be monitoring and review by the NICE used at the same time. Board. palliative care i have always felt that UK-wide trust, familiarity and pallaitive care inclusion in an Thank you for your comments, they pharmacist specialised palliative care accessiblity otherwise excellent infomration have been considered along with information ought to as source the other comments received in the accessible as general BNF consultation, to inform the information. at present very development of the enhanced BNF. valuable formulary information is available via palliativedrugs.com and the hard copy of the palliative cre formulary but this cannot be provided free of charge on line any longer this restricting the ease and extent of access. as a great deal of what we use in palliative care is very specialised and not available via non specialised sources- and indeed is often contradicted by what is published in non- specialised sources- this causes multiple problems. the content of the PCF/palliative drug.com is excellent, up to date and obviously extensively

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Prescribing I agree with the principles of the Very careful consideration The current eBNF does not Thank you for your comments, they suppport change, and fully agree with the needs to be given to the cope with mis-spelled drug have been considered along with pharmacist improvements suggested (linking availability of computers to names, this makes it more the other comments received in the (primary care) to NICE, enhanced search access the BNF. E.g. in difficult to search for things consultation, to inform the facility etc). I see a lot of out of pharmacy dispensaries the than using an index. Links development of the enhanced BNF. date paper BNFs in use, and computer is needed for through to SPCs would be NICE acknowledges that digital although in the long term dispensing almost continuously, useful too. It would be very infrastructure and access to switching to electronic will and several members of staff useful if local electronic portable devices throughout the eliminate this, in the short term I may share one paper BNF, formularies (e.g. Inform in NHS is not fully developed. feel people will hang on to their which they would want to access Wales) could link in to the Distribution of print formats will paper copy knowing it's not at the workbench, an electronic relevant BNF chapters. continue in line with user going to be replaced. version would need to be on a requirements, subject to ongoing portable device, not on the main monitoring and review by the NICE dispensary computer. I have Board. concerns about how the accesibility will be managed, I work in rural Wales, and although I have the BNF and BNFc apps, I very rarely use

[Insert footer here] 223 of 383 these due to poor mobile phone signal. Out of hours and home visits are particularly risky times for prescribing, and availablilty of an up to date BNF is vital. A downloadable format (perhaps with automatic updates) is needed for areas with poor mobile signal, and other connectivity problems. For example, our GP practice lost both internet connection and all mobile phone signals for over 24 hours in the recent storms. Being unable to access a BNF during this time would have been a major risk. Careful consideration needs to be given to the formatting of the electronic version, especially bearing in mind that many NHS users only have out-dated software.

Day unit sister Not able to access due to Not able to access due to As above Thank you for your comments, they internet connectivity problems with connectivity have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 224 of 383 consultant in Makes sense App the way to go I'd like to see the palliative care No Thank you for your comments, they palliative linked to NICE formulary added and other have been considered along with medicine specialist formularies supported the other comments received in the consultation, to inform the development of the enhanced BNF.

Antimicrobial I think incorporating NICE Ensuring that it user friendly as I No. Thank you for your comments, they pharmacist guidance would be extremely am not that comfortable with the have been considered along with useful. online BNF. If more information the other comments received in the will be made available regarding consultation, to inform the national guidance it needs to be development of the enhanced BNF. set out in a logical manner.

Pharmacist I think embracing technology and Particularly multiple ways of I personally would really find Thank you for your comments, they digital media to enhance the searching as I find I have to do a useful a list of drugs that need have been considered along with BNF can only be a good thing. lot of cross-referencing at the dose modification in renal the other comments received in the moment. I'd really like the impairment so that as well as consultation, to inform the interactions section to be able to the current set up where development of the enhanced BNF. link to Stockley's free of charge individual drugs can e checked for those occasions where I in the monograph to see if need more in depth information renal imapirment affaects the about how to manage an dose, if I could search say for interaction in practice. regular all antihypertensives that need updates are essential to ensure dose reduction in CKD3B for robustness of data and if we example that would be very truly want the BNF to be a single useful. If you could include trusted source of prescribing some of the features of MIMS information. such as useful tables for insulin duration of action etc.

[Insert footer here] 225 of 383 Pharmacist I'd like to see links to NICE It would be useful to see which Is there a way of BNF app Thank you for your comments, they guidance etc and original are the key documents in a updates taking less than 10 have been considered along with references. This is currently a particular area all drawn minutes to download? I often the other comments received in the problem as nothing is referenced together for bulletin writing eg. have to skip the update until I consultation, to inform the in the BNF to support the clinical antiepileptic drugs, changing have time eg. over lunch, development of the enhanced BNF. advice & show what the between different which means using information We recommend that you use a wifi evidence base is. I appreciate manufacturer's products from the previous month and connection to download the app the need for keeping content (categories 1, 2 and 3). possibly missing something updates. brief in the hardcopy format, but important clinically. digital formats allow greater flexibility with links to pages beyond the main body of the text.

Gp I wish to continue to receive a I do not always have access to I do not have reliable internet I. Thank you for your comments, they paper copy which is reliable and internet in a rural setting A rural setting have been considered along with portable and does not rely on an the other comments received in the internet connection consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

SpR Please edit your iPhone app so ------Thank you for your comments, they Emergency that it automatically updates in have been considered along with Medicine the background, like all other the other comments received in the iPhone apps. It is very frustrating consultation, to inform the when it keeps asking you to development of the enhanced BNF. update at work where invariably, you don't have enough WiFi connection or time to wait for an

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consultant I would welcome it. Easy searches under a variety Will there be links to the Thank you for your comments, they psychiatrist Unfortunately, I do not have of headings evidence bases? Prescribing have been considered along with computer access at all my in pregnancy is a major the other comments received in the outpatient clinics, so I do heavily concern - I need up to date consultation, to inform the rely on having an uptodate paper evidence regarding the development of the enhanced BNF. copy. likelihood of potential adverse NICE acknowledges that digital effects on the fetus/newborn, infrastructure and access to rather than the simple "not portable devices throughout the recommended in pregnancy" NHS is not fully developed. or "not to be used unless Distribution of print formats will benefit outweighs risk", in continue in line with user order to have fully informed requirements, subject to ongoing discussions with the patient monitoring and review by the NICE about risk/benefits. Board.

Consultant in Laudible - woul.d be greatr if this Links into to nationally No Thank you for your comments, they palliative could be made to happen but recognised expert sources. For have been considered along with medicine must be easliy accessible by a me this would be the electronic the other comments received in the number of platforms and cheap Palliative Care Formulary which consultation, to inform the enough for acute trusts like mine provides fantastic up to date development of the enhanced BNF. that say they have no money to information on all the drugs I use NICE acknowledges that digital purchase. Would still need some as a palliative care consultant in infrastructure and access to paper copies for the times (not considerably more detail than portable devices throughout the infrequent) when technology fails the BNF. Quicker referencing NHS is not fully developed. or is all in use. and searching on topics like Distribution of print formats will drug interactions and effects of continue in line with user overdose would also be useful requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 227 of 383 Pharmacist The suggested enhanced BNF It needs to be intuiative and user An enhanced BNF needs to be Thank you for your comments, they could have advantages, however friendly. The content needs to easy to use, simple to seach have been considered along with the changes must not result in be straight forward and give without a reliance on the the other comments received in the something which is too difficult or practical information which is not person spelling the drug. It consultation, to inform the technical to use. It will be overly complex of contradictory. needs to be responsive and development of the enhanced BNF. important that a paper version is Key areas of the BNF such as NICE need to be adaptive to NICE acknowledges that digital still an option as some areas do interactions and user feedback e.g. if an error infrastructure and access to not have ICT advances and are advice/guidance needs to retain. occurs as a result of the portable devices throughout the still highly dependant on paper. It would be useful for the drugs layout. NHS is not fully developed. to e-link to NICE CGs/TAs or Distribution of print formats will exisiting NPSA alerts for continue in line with user additional information or requirements, subject to ongoing resources. monitoring and review by the NICE Board.

Senior A vendor neutral open API to We would like to be able to link Insurers often quote the BNF Thank you for your comments, they Systems enable integration with other an enhanced BNF into our indicative price when querying have been considered along with Developer digital systems would be of great Clinical Portal, create a local invoices so digital access to the other comments received in the benefit. formulary and use the indicative this data would be a great consultation, to inform the prices as a basis for billing. help. development of the enhanced BNF.

Project Officer I think that this will be a good Ensuring that the latest most up How offline access would work Thank you for your comments, they - Pharmacies thing. It will ensure we always to date information is available. and automatic updates when have been considered along with (Kent Stop have the same up to date Comprehensive search facility connected. Will there be clear the other comments received in the Smoking information, and should reduce for ease of use. Print facility if user notes, for example, how consultation, to inform the Service) any discrepancies. Is there the needed. Push notifications of will the download to local development of the enhanced BNF. ability for offline access as well important changes or alerts. formularies work? as online access? Is there any assurance that the links will not lead onto further links, creating confusion?

NHS patient Digital is the way forward. An A format suitable for mobile Please ensure the BNF Thank you for your comments, they online resource is easily and devices and desk top screens. I remains available to non have been considered along with cheaply kept up to date. I guess have no views on its content. professional users like myself. the other comments received in the all users of the BNF have Thank you. consultation, to inform the internet access (office based or development of the enhanced BNF. mobile) these days. How often is

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Specialist This would be ideal as As above. The most improtant No. Overall, a great idea if it Thank you for your comments, they Respiratory immediate access to up to date thing is ease of access to look is workable and accessible. have been considered along with Nurse info would be vital in patient up side effects, etc. Maybe an the other comments received in the safety. However, the biggest option to 'hold open' pages consultation, to inform the problem would be wifi access when cross checking against development of the enhanced BNF. and loss of access if there is a another page. NICE acknowledges that digital poor reception. Also, not all infrastructure and access to nurses have a tablet, or smart portable devices throughout the phones for access. Great for NHS is not fully developed. the environment too as less Distribution of print formats will paper wastage. continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Registered It would be advantageous for all In my area of practice, palliative To include the palliative care Thank you for your comments, they Nurse medical and nursing staff to have care, it would be of great value formulary in this format. have been considered along with access to current drug changes to have access to a current the other comments received in the palliative care formulary. It consultation, to inform the would also be of benefit for out development of the enhanced BNF. of hours GP's, on call medical and nursing staff to have this access as time is often taken up phoning hospices for advice on drug dosages.

[Insert footer here] 229 of 383 Divisional These seem entirely reasonable, Clear concise up to date Support to link with electronic Thank you for your comments, they pharmacist a reliable electronic source information that can be prescribing systems to provide have been considered along with would be a big bonus. accessed potentially even live patient specific information the other comments received in the without internet access will be the big step forward in consultation, to inform the (downloaded and updated when patient centered care. development of the enhanced BNF. possible). Clear guidance about renal and hepatic impairment and information on absolute contraindications.

Consultant Excellent idea, overdue if The main advantage to me of an This is a great opportunity for Thank you for your comments, they Chest anything. BNF is such a reliable online version over a paper enhanced antibiotic advice, for have been considered along with Physician and authoritative source of version is the ability to search example being able to access the other comments received in the information. efficiently, especially with information about common consultation, to inform the respect to interactions. drug susceptibility, in the development of the enhanced BNF. Unfortunately, until now the manner provided by Sanford online interaction section is Antibiotic guide and ePocrates merely a repetition of the printed (unfortunately both American). version, and is totally inadequate and often very difficult and slow to use. You need to know what class many drugs are in, and scroll through a huge list to find relevant interactions.You must improve this and make it fit for the 21st century in the new online BNF. As an example, try looking up interactions with itraconazole or rifampicin. You should be able to click on an "Interactions" tab to search for interactions with a specific medication from the home page, and from the page about the relevant drug. This should take you straight to a list of interactions with that medication, without having to

[Insert footer here] 230 of 383 click on several unclear links and wade through pages of potentially irrelevant interactions to get to the ones you want. Better still would be the ability to search for interactions between multiple medications, as you can in ePocrates.com, and http://www.hiv- druginteractions.org/Interactions .aspx (although the in the latter case the way in which you use the search function is rather clunky and couldn't be applied to the huge list of medications in the BNF).

[Insert footer here] 231 of 383 General It would be a major improvement Indications information clearly Information about non- Thank you for your comments, they Practitioner - but portability does need to be set out - making off-label use prescribable devices and have been considered along with maintained e.g. through clearly apparent Cautions and medicines (e.g. foot orthoses, the other comments received in the smartphone apps for use on contraindications clearly set out which in some instances are consultation, to inform the domiciliary visits. I would - and ideally to be cross- advised but not prescribed or development of the enhanced BNF. particularly value the facility to referenced (so that a drug referred for) assess the severity of suitable for prescribing for interactions through the BNF as condition x in the presence of the current integrated prescribing comorbidities y and z can be advice via the clinical IT system found, for example) Expanded flags up an enormous number of side effect information with alerts, many of which do not frequencies as in the feature in the BNF at all. This Summaries of Product causes alert fatigue and reduces Characteristics Highlighed the usefulness of the inbuilt NICE-approved first options for system. common conditions (e.g. products with lowest acquisition costs) Pricing information - ideally with information about more cost-effective alternatives Links to patient information sheets (as these can be useful prior to prescribing, especially high cost medicines, to aid shared decision making) Links to other information such as Option Grids http://www.optiongrid.org/ or Cates Plots http://www.npc.nhs.uk/evidence/ eidm4_shared/pda.php#MUS (again as an aid to shared decision making)

[Insert footer here] 232 of 383 Clinical Lead Currently use a paper version of Frequent updating, wider access Do not have any comment on Thank you for your comments, they Community the BNF as do not have the IT to different types of information this area have been considered along with Dermatology/C support systems to allow easy in one place the other comments received in the ommunity access to electronic versions consultation, to inform the Dermatology when visiting a patient in their development of the enhanced BNF. Specialist home. I have no problems with NICE acknowledges that digital Nurse using electronic platforms but infrastructure and access to have to be convinced that they portable devices throughout the would be easily accessible and NHS is not fully developed. that in areas where there was Distribution of print formats will poor connectivity that there continue in line with user would be alternatives for requirements, subject to ongoing accessing the information monitoring and review by the NICE Board.

Specialist The vision sounds like a marked Links to local formulary. Up to No Thank you for your comments, they Medicines improvement from the current date information on drugs, have been considered along with Management systems. including costs. Easily the other comments received in the Analyst searched, and user friendly with consultation, to inform the a good graphic user interface development of the enhanced BNF.

Consultant in Bring it on! But make it easy to All the information of the print Yes, it must be reliably Thank you for your comments, they pain medicine access please. I hate having to copy, plus being up to date and available. There must be have been considered along with log-on when using BNF on having live interactivity data, resilience built-in to your the other comments received in the computers outside of my pack sizes, prices, etc. website so that the risk of not consultation, to inform the hospital. being able to get information is development of the enhanced BNF. negligible. (Just failed to make get into the NZ formulary....) I need to be able to prescribe 24/7.

[Insert footer here] 233 of 383 Salaried GP It would be great to have an The BNF should include up to Include photos of medications. Thank you for your comments, they enhanced BNF to access online date locally tailored guidelines. It have been considered along with but in my place of work the should include immediate up to the other comments received in the computers are slow and internet date warnings on medications consultation, to inform the access very poor for many e.g. Metoclopramide warning development of the enhanced BNF. websites. There is no wi-fi and when looking it up as soon as NICE acknowledges that digital poor mobile network coverage so new guidelines and warnings infrastructure and access to accessing something like an App come to light. The ability to portable devices throughout the is completely impossible. This have doses calculated for you NHS is not fully developed. practice is in Hampshire not a when they require a weight and Distribution of print formats will remote part of the UK. The "web suggestions by concentration of continue in line with user infrastructure" and computing formulation. Information requirements, subject to ongoing equipment needs improving or presented in a clearer way. monitoring and review by the NICE these resources will only be able Rather than having to read Board. to be used by those working in through a lot of text e.g. cities. Monitoring blood tests presented in a box. The ability to input current medications of a patient and have drug options presented.

Palliative care I think it is an excellent proposal, Clearly defined chapters / No Thank you for your comments, they CNS at present we cross reference sections featuring drugs used in have been considered along with bnf with our palliative care certain field such as cancer the other comments received in the guides which can cause some drugs and palliative drugs with consultation, to inform the confusion and reluctance from clear cross referencing links to development of the enhanced BNF. medical staff to follow generalised medicine recommendations.

[Insert footer here] 234 of 383 Prescribing I agree with the challenges - Accessibility - in Jersey we are Is it possible to incorporate Thank you for your comments, they Support particularly addressing upgrading currently unable to access the treatment algorithms from have been considered along with Pharmacist IT across the NHS. online BNF or BNFc as this is NICE guidelines? the other comments received in the blocked although we can access consultation, to inform the other NICE medicines development of the enhanced BNF. information resources likes NHS NICE acknowledges that digital evidence and CKS. We cannot infrastructure and access to get free access to the Apps. We portable devices throughout the need to be able to negotiate a NHS is not fully developed. contract which enables more Distribution of print formats will than printed copies going continue in line with user forwards Medicines usage in requirements, subject to ongoing special situations - continued monitoring and review by the NICE clear information and advice, Board. where it is available for medicines in pregnancy and breastfeeding and on drug interactions If possible - information on herbal preparations including known side effects and information on known drug interactions

Pharmacist Fully supportive of Being in a format that is easy to Just to ensure appropriate Thank you for your comments, they HSCB enhancements-links to additional navigate and search via a links such as evidence-based have been considered along with info such as when a patient has number of different routes. Also advice on e.g. possibilities the other comments received in the a swallowing difficulty and the timely updates when new when patient has poor consultation, to inform the evidence-based options would evidence emerges e.g. links to swallow, for advice on IV development of the enhanced BNF. be helpful e.g. can the MHRA advice/warnings. dilutions and admin etc. preparation be (Medusa?) crushed/dissolved/ require switch to a recommended alternative.

[Insert footer here] 235 of 383 Salaried GP sounds good, however it means emphasis on key side effects, hopefully not Thank you for your comments, they we all need ipads or similar with interactions, and prescribing in have been considered along with internet access - what about pregnancy, kidney impairment the other comments received in the when we are doing visits?. Also and breast feeding. Clear pages, consultation, to inform the paper versions once per year no multiple lines of search development of the enhanced BNF. does not fit with the need to keep results as in current online NICE acknowledges that digital up to date. version infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Macmillan Fully support. Access to relevant Links to relevant evidence base Free access to these Thank you for your comments, they Palliative & portable devices in all areas with e.g. SMC/NICE appraisals, resources in an interactive way have been considered along with Community supported wifi, broadband etc SIGN/NICE guidelines, Renal would hugely assist the other comments received in the Care will be required by all relevant drugs handbook, Drugs in Liver practitioners to find information consultation, to inform the Pharmacist staff. In current financial disease, Administration of in a single place to support development of the enhanced BNF. constraints this may not be medcines via enteral tubes, practice which was up-to-date, NICE acknowledges that digital possible. Not all areas receive Palliative Care Formulary, NHS evidence based and enabled infrastructure and access to signal to permit access to Inform patient information, links the more difficult to find portable devices throughout the electronic formats. to relevant drug tariffs especially information to be found NHS is not fully developed. around specials, Stockleys Drug Distribution of print formats will Interactions, Herbal Medicines, continue in line with user Martindale potentially requirements, subject to ongoing Comprehensive access to monitoring and review by the NICE advice around medicines use Board.

[Insert footer here] 236 of 383 Medicines I think that the time is right to It should provide easily Practitioners may not always Thank you for your comments, they Management develop the BNF into a more up accessible, current and be able to access the digital have been considered along with Pharmacist to date comprehensive comprehensive information on form of the BNF and therefore the other comments received in the accessible prescribing resource. medicines including costs with a paper copy may still need to consultation, to inform the links to supporting information. It be produced. development of the enhanced BNF. sould be maintained and up NICE acknowledges that digital dated regularly. It should include infrastructure and access to information on off licence uses portable devices throughout the and doses of medicines with NHS is not fully developed. links to supporting inform. It Distribution of print formats will should contain information on continue in line with user adjutsing doses in renal and requirements, subject to ongoing hepatic impairment. It should monitoring and review by the NICE also have comprehensive Board. information on dressings, appliances, and nutritional products especially those for special diets.

Senior The vision sounds great if it All information available at a Not sure Thank you for your comments, they pharmacist works with the IT structure in the button have been considered along with Education & hospital. I worry the dosing the other comments received in the Training, information - for which it is consultation, to inform the Medicines mostly used will be buried in the development of the enhanced BNF. Review reams of information. It may not NICE acknowledges that digital become that user friendly if you infrastructure and access to rely on paper copy. portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Clinical Nurse It's an exciting opportunity. The That it is searchable and The user interface needs to be Thank you for your comments, they Lead notion of integrating the BNF browsable in differing ways simple to understand & have been considered along with with other NICE and NICE enabling users to maximise the navigate - especially for those the other comments received in the accredited sources is particularly evidence available to inform who are less computer literate consultation, to inform the

[Insert footer here] 237 of 383 good, this will inform and support decision making. than others. Is there going to development of the enhanced BNF. safe, robust point of care be a 'fall back' print edition still NICE acknowledges that digital decision making. available in each clinical area? infrastructure and access to What would be the safety portable devices throughout the mechanism if, for example, NHS is not fully developed. internet connection was Distribution of print formats will lost/telephone lines down and continue in line with user took a long time to repair? requirements, subject to ongoing monitoring and review by the NICE Board.

ADVANCED I like the idea of continuous brand names, doses and costs n/a Thank you for your comments, they NURSE updates. I have the BNF app and have been considered along with PRACTITIONE do not find it user friendly or the other comments received in the R IN particularly helpful. I like the idea consultation, to inform the PALLIATIVE of having an electrical data base development of the enhanced BNF. CARE in my hand especially as I work in the community.

Consultant A great opportunity. I currently Easily accessible, free, concise Ensure that drug-drug Thank you for your comments, they Physician access Medscape, the NICE and can be downloaded for later interactions are as easily have been considered along with BNF App and Qx calculate (a use that doesn't rely on a wifi or accessible within the App as in the other comments received in the risk stratification tool) on a daily 3G signal on a smartphone. the online version (ie. entering consultation, to inform the basis to inform my ward rounds. Much better to give links to the names of two drugs in the development of the enhanced BNF. snappy "care bundles" rather search facility should NICE acknowledges that digital than long winded guidelines as automatically give a list of infrastructure and access to more concise advice is more interactions). portable devices throughout the likely to be followed. Include a NHS is not fully developed. user friendly risk stratification Distribution of print formats will tool as well as a reference App. continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 238 of 383 Manager Sounds great!! I manage a Day For us the following would be I cannot think of anything Thank you for your comments, they Centre for Adults with Learning most important: Be searchable have been considered along with Disabilities and having the ability and browsable in multiple ways, the other comments received in the to look online for details of the such as by drug, condition and consultation, to inform the medication they are on has been patient characteristic Include development of the enhanced BNF. invaluable - previously we were commonly prescribed medical using outdated BNF publications. devices as well as medicines The ability to research Include links to high quality medication in a more integrated information for patients fashion sounds really useful

Macmillan Lead This sounds like a sensible way It needs to be easily available It would be fantastic if we Thank you for your comments, they Pharmacist for forward for the future. on-line and in App form. could get access to the have been considered along with Palliative Care Palliative Care Formulary via the other comments received in the this route as this is an consultation, to inform the essential information source development of the enhanced BNF. for my speciality.

Retired Whatever changes are made Incorporation of NICE guidance no Thank you for your comments, they digitally the print copy of the BNF have been considered along with should continue the other comments received in the consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 239 of 383 Team Leader / I agree that a single authoratitive Accurate, up to date information BNF does nor currently Thank you for your comments, they Specialist resource is a good one, however changing in real time. incorporate the extensive have been considered along with Nurse current BNF does not meet my specialist content of the the other comments received in the Specialist needs as a prescriber in Palliative Care Formulary consultation, to inform the Palliative Care Specialist Palliative Care. PCF4 which is available hard development of the enhanced BNF. copy, and by subscription on- line. This has been commissioned for open-access in Scotland. It should be commissioned for NHS open- access in England too.

Nurse It all sounds good. The most important elements for If I am doing any work on Thank you for your comments, they me would be accuracy and ease medications for eg have been considered along with of which to obtain the policies/PGDs I can spend the other comments received in the information I am after. It would quite a time looking at the BNF consultation, to inform the also be important to be able to for a particular drug. I use the development of the enhanced BNF. access it when I need to. book to try and reduce the NICE acknowledges that digital amount of time spent looking infrastructure and access to at computer screens. Whilst portable devices throughout the trying to reduce reliance on NHS is not fully developed. print it would be great if you do Distribution of print formats will need to print that you can print continue in line with user off the all the info you need for requirements, subject to ongoing that particular drug without monitoring and review by the NICE having to print each little Board. section of info/link on separate bits of paper.

[Insert footer here] 240 of 383 Salaried GP It sounds great in principle. Ease of use Format/clarity of Not everyone has (or wishes to Thank you for your comments, they However, the website will need desired prescribing info Low use) smart phones during have been considered along with to be clearly thought out as the data pages so quick to consultations, therefore this the other comments received in the current website is very 'clunky' download Linked to computer needs to be based around web consultation, to inform the and it is much easier to access systems Links or info from other sites/medical computer development of the enhanced BNF. desired info via the book. Our prescribing references such as systems NICE acknowledges that digital practice has VERY slow internet Palliative Care Formulary infrastructure and access to also - many website sites time portable devices throughout the out before a page has loaded, so NHS is not fully developed. the site will need to be functional Distribution of print formats will yet small data-wise. Having the continue in line with user functionality suggested requirements, subject to ongoing incorporated into the computer monitoring and review by the NICE systems would be preferential to Board. me as this is the most ideal way to access prescribing info.

Macmillan Please make palliative care Access to palliative care Access to palliative care Thank you for your comments, they clinical nurse formulary available as this is formulary online formulary online have been considered along with specialist in most valuable and more the other comments received in the palliative care comprehensive than the bnf. consultation, to inform the This is costly to subscribe to and development of the enhanced BNF. therefore patients would be safer.

Palliative Care Please allow palliative care Palliative care formulary access Palliative care formulary Thank you for your comments, they CNS formulary to be made available access have been considered along with via NICE as is widely required the other comments received in the across healthcare settings in consultation, to inform the conjunction with bnf development of the enhanced BNF.

GP In theory- great - I myself have It has to be easily accessible No- but don't throw the babies Thank you for your comments, they led the productoion of a practice and user-friendly Few online out with the bath water in order have been considered along with formulary backed by explicit resources interface well with GP to meet laudable but rigid the other comments received in the evidence from high level sources ITsystems at the present time - standards - no standard is consultation, to inform the eg Cochrane, NICE, clinical it's much quicker to pick up the perfect development of the enhanced BNF. evidence, and understand the hard copy of the BNF/C. NICE acknowledges that digital undertaking. The BNF covers Admittedly sometimes it will be infrastructure and access to

[Insert footer here] 241 of 383 vast areas of evidence, and will last year's copy, but rarely is this portable devices throughout the need to provide detail and surety a pronlem in parimary care. I NHS is not fully developed. that as a single practice was not undertook an audit and reaudit Distribution of print formats will necessary. In contrast NICE of this in 2011 and 2013 but continue in line with user guideline groups have very imagine it will be less of a requirements, subject to ongoing circumscribed roles and limit problem in more compact monitoring and review by the NICE their breadth through scoping practices than ours. Board. exercises, and yet take ages to reach conclusions. How are you going to ensure that the BNF can maintain its essential role of covering all areas of practice, provide the depth of transparent information that you require, with the level of evidence you require, and do it for and with the same or similar resources as it does today? I don't think this is feasible

GP I agree with the vision and aims Intuitive. Continuously updated. I think you underestimate the Thank you for your comments, they as described in the consultation User friendly. Links to NICE problems of access to have been considered along with documents - appropriate for this Guidelines with management adequate IT equipment for all the other comments received in the digital age. I am particularly guidance will be of great help to for those who would need to consultation, to inform the enthusiast about the proposed professionals and improve use the BNF. Consideration of development of the enhanced BNF. linking between NICE Guidance patient care. Enabling download lack of sufficient, or indeed NICE acknowledges that digital and BNF content - as a GP I to local Formularies. any, Internet access in rural infrastructure and access to would welcome this and find this areas and when away from portable devices throughout the very useful in my day to day desk - especially when visiting NHS is not fully developed. clinical practice caring for patients at home. Distribution of print formats will patients. My main concern would continue in line with user be that access to the BNF's requirements, subject to ongoing content remained as wide and monitoring and review by the NICE inclusive as possible. Digital Board. resources much be well designed, well thought out, user friendly and (key) intuitive to use. Access to appropriate IT equipment for all staff is a key

[Insert footer here] 242 of 383 issue. Also access to adequate Internet connections - a particular concern in rural areas like Cumbria where we have areas without any broadband at all and other areas with only very slow access. As a GP I do need a paper copy for the key purpose of reference whilst out visiting patients at home. Any Prescriber who visits patients at home will be in the same position. We do not yet have tablets for all staff. Also, referring back to my previous point, Internet access is a major issue and even with my Smartphone I might be unable to access Internet via mobile networks as coverage is nowhere near universal.

Consultant in It is important to make the BNF I would like to use the offline app See above Thank you for your comments, they palliative searchable and interactive but to make sure that is have been considered along with medicine particularly searching according frequently updated and able to the other comments received in the to disease will be important. As a link to other resources through consultation, to inform the palliative care physician I think the app. development of the enhanced BNF. providing links to the palliative care formulary on pallliativedrugs.com would be particularly useful.

[Insert footer here] 243 of 383 Emergency I support the principles, but Simple, reliable digital access The current woeful state of Thank you for your comments, they Nurse access to digital formats is would be brilliant - only if it is digital access at the have been considered along with Practitioner patchy and limited for a lot of us. quicker than picking up the workplace. Don't believe what the other comments received in the Continuing access to the book book. Trust IT leads tell you about it - consultation, to inform the format is critical. Nurses doing the practical experience at the development of the enhanced BNF. drug rounds with a ward drug coalface is very different! NICE acknowledges that digital trolley rely on it for safety. Digital infrastructure and access to access is not available for most portable devices throughout the in this situation, and it will be NHS is not fully developed. years before it is. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Head of Whilst improbving the As above Not applicable Thank you for your comments, they Service - accessibility of the BNF is have been considered along with residnetial supoprted, i woudl like to see this the other comments received in the Care being made available to Social consultation, to inform the Care practitioners who may not development of the enhanced BNF. be prescribers, but NICE acknowledges that digital administrators for medication. infrastructure and access to Access to information that can portable devices throughout the help determine changes in NHS is not fully developed. wellbing of a patient whilst in Distribution of print formats will soacil care would be welcomed. continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Medicines Supportive of approach outlined Include high quality prescribing No Thank you for your comments, they Management information to help improve have been considered along with Adviser patient outcomes by supporting the other comments received in the health professionals to choose consultation, to inform the the right medicine, at the right development of the enhanced BNF. time for the right patient, including patients with more

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Senior Cancer I agree witht the vision Need to get away from printed Linking the on-line Palliative Thank you for your comments, they Care media and encourage use of Care Formulary to the BNF have been considered along with Pharmacist digital/online resources would further enhance its the other comments received in the usefulness consultation, to inform the development of the enhanced BNF.

Primary Care Fast access to reliable, Accessible, orderly information No Thank you for your comments, they Pharmacist respected and referenced and signposting to provide a have been considered along with information is vital for health quality reference resource for the other comments received in the professionals. I support the NHS professionals to support consultation, to inform the vision for enhanced BNF Consultations, mediciation development of the enhanced BNF. reviews, prescribing, drug/drug interactions,

Consultant If It can be as easy to use, As above Links to other important stuff Thank you for your comments, they Palliative Care reliable, authoritative, detailed such as in my world the have been considered along with and intuitive as print BNF that Palliative Care formulary and the other comments received in the would be good. But only 3 days syringe drive compatibility consultation, to inform the ago did I get smart phone charts development of the enhanced BNF. capable of actually accessing it.

Clinical Would be able to have up to date Easy point of access, User No Thank you for your comments, they Facilitator data available friendly have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF.

Palliative Care The consultation document I think a digital information Another source of information Thank you for your comments, they Pharmacist provides a valuable service to source will ensure that all as well as the BNF and BNFc have been considered along with enable all prescribers and professionals dealing with to be included in the the other comments received in the

[Insert footer here] 245 of 383 healthcare professionals to medicines can rely on medicines consultation document is the consultation, to inform the access up -to-date infomation information that is easy to Palliative Care Formulary, development of the enhanced BNF. about medicines. access. currently PCF4 soon to be PCF5. All prescribers and healthcare professionals will need information to help them come to a decision about medicines for palliative care patients, cancer and non- cancer patients.

Medicines The enhanced BNF as described It will be important that any Search functionality Thank you for your comments, they Information will be an invaluable information search function is easy to use, have been considered along with Pharmacist source - significant important and results can be easily the other comments received in the information will be easily limited/filtered to find what you consultation, to inform the accessible in one place, want. It will need to clear where development of the enhanced BNF. information from a number of each piece of information different sources will be pulled originates from. Also one of the together in one place ensuring main features of the current BNF relevant information is is that it is a "quick" reference accessible. guide - that is you can quickly locate information - such as a dose - without having to trawl through lots of information. It will be important that the if using the enhanced BNF there will be a way of quickly accessing "basic" information without having to search lots of pages or trawl through lots of detailed information

[Insert footer here] 246 of 383 Senior Lecturer N/A The resource would need to 1. Will the online version also Thank you for your comments, they consider 'accessibility' for those be available offline as many have been considered along with with additional visual needs, Trusts/Hospitals do not have the other comments received in the ability to change the back open access internet, which consultation, to inform the ground colour, font size etc means someone visiting the development of the enhanced BNF. hospital would not be able to NICE acknowledges that digital gain access to the internet or if infrastructure and access to the internet was not working portable devices throughout the access would be problematic NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. consultant The vision is admirable, the bnf More frequent updating of Sadly the app is not available Thank you for your comments, they community is a wonderful resource. From information Easier access to for Blackberries have been considered along with sexual and time to time it is much easier to information about interactions the other comments received in the reproductive use the book rather than the will be most useful Being able to consultation, to inform the health electronic version, for example search in different ways should development of the enhanced BNF. looking up interactions or reading be very helpful the introductary paragraph about a group of drugs.

Lead I currently prefer using the print Links to other resources, such In my area of work, it is vital to Thank you for your comments, they Pharmacist for version as accessibility of as NICE guidance Improved and access the Palliative Care have been considered along with Palliative Care computers in my workplace is more user-friendly interaction Formulary online on an almost the other comments received in the limited by lack of sufficient information (plus links to daily basis. NHS-wide free consultation, to inform the devices in a timely fashion. This Stockley for more detail) Clearer subscription to this invaluable development of the enhanced BNF. would need to change layout of information Inclusion of resource needs to be made NICE acknowledges that digital siginficantly if we are to be information about OTC available to all NHS staff (as it infrastructure and access to expected to use only electronic preparations in an electronic already is in Scotland) as a portable devices throughout the versions and risking patient version matter of urgency, particularly NHS is not fully developed. safety by not doing so. Until such in the light of the drive for more Distribution of print formats will time, the papaer version needs community-based palliative continue in line with user tio be kept up-to-date until there care activity. requirements, subject to ongoing is national investment in monitoring and review by the NICE sufficient and state of the art IT

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FY2 doctor I believe that a move to digitise As mentioned, the features I One addition I would like to Thank you for your comments, they the BNF will allow for a more would value the most are: - make would be to include have been considered along with authoritative and comprehensive ability to browse drugs references to important trials the other comments received in the document to be produced, one organised by multiple or meta-analyses that involve consultation, to inform the which today's health professional characteristics (drug class, the drug, so if the prescriber development of the enhanced BNF. requires and demands. In the disease / indication, patient wishes to find out more about NICE acknowledges that digital current BNF it is clumsy to click characteristic) -listing the the evidence base behind a infrastructure and access to on sub-sections (such as brand frequencies of adverse effects / particular medication, it is easy portable devices throughout the names), which then open in risks -the ability to compare to do so. Ideally, an enhanced NHS is not fully developed. another 'page'; it would be better different drugs in order to BNF should be publicly Distribution of print formats will to have a 'drop down' menu on compare their efficacy (where available for access the world continue in line with user the parent page reveal the such information exists), and the over, as the UK should requirements, subject to ongoing content, so that content on the frequencies of their various maintain its lead in medical monitoring and review by the NICE parent page is still viewable by adverse effects -downloadable research and education. This Board. scrolling up and down. I am BNF onto mobile 'smartphone', would be a valued output by NICE’s remit is to make the BNF certain that this can be thus negating the need to hold our country. Finally the publications available in the United programmed in; this is the type an unwieldly paper copy (this submission system used here Kingdom. of usability improvement that has has already been realised). If is abhorrent! A consultation of the potential to become reality in possible, it would be a welcome this magnitude should allow the proposed enhanced BNF. gift to the entire world if this one to look at the free text Furthermore, I find the planned were to be made publicly questions without having to ability to search by drug, available. As a comparison, click “next” through other condition and patient some universities in the United questions, and answer them characteristic potentially very States of America publish some in one's own time (e.g. using a useful; one may remember the textbooks or learning resources word processor to store the top three classes of drug used online gratis; I believe that it is answer, then copy+paste them

[Insert footer here] 248 of 383 for a particular disease, but if our duty in the United Kingdom, into the free-text boxes.) The these fail it would be useful to as a leader in medical research, GMC Shape of Training have presented some of the less practice and education, to open consultation system was better common drugs. Similarly, for the up such a valuable resource to a as the questions were pregnant patient, it would be global audience. published as a PDF, and (if I useful to know which drugs are remember correctly) it was licensed for them at a glance. possible to skip between The proposed ability to list different parts of the survey frequencies / probabilities of using a menu. adverse events is revolutionary. For too long, the profession has used terms such as “common”, “uncommon”, “rare”, with huge variation in their interpretation by patients, and undoubtedly some ignorance on the part of the prescriber. Where better a place to specify these frequencies than the place the adverse effect of every drug is listed, viz. the BNF?

Consultant About time but while hospitals Must be searchable by all drug Must not lose the sections at Thank you for your comments, they Paediatrician block wifi and internet access names. Current paper index that front and back - how to have been considered along with due to concerens re patient data just redirects you to another part prescribe remains an essential the other comments received in the safety then paper remains of the index is useless. Abolish tool for training juniors. The consultation, to inform the essential. the meaning less section references for BSA etc in development of the enhanced BNF. numbers. For paediatric BNFc are essential. Finally - NICE acknowledges that digital practice make it clear which you have overlooked infrastructure and access to drugs are licenced and to what advertising what you currently portable devices throughout the extent. Clear details re breast provide - apps etc will only NHS is not fully developed. feeding and interactions - help if you make them widely Distribution of print formats will possibly a link for each medicine known. continue in line with user rather than having to look up requirements, subject to ongoing seperately. Icons highlighting monitoring and review by the NICE those drugs which have special Board. issues - eg non-generic prescribing, drugs which have liver or renal dose adjustments

[Insert footer here] 249 of 383 etc - can be clicked on to take to more details.

Consultant I like the idea of a continuously The exciting challenge is to link Our Trust has a Pharmacy Thank you for your comments, they updated BNF. However, in my an online BNF resource to a Medicines advice service. Will have been considered along with specialty (Anaesthesia) the hospital's e-prescribing. Whilst this development make them the other comments received in the frequency of changes is low. I recognising that we are moving redundant or are there consultation, to inform the also welcome the move to to a digital world I still feel that a possibilities for linkage? Will development of the enhanced BNF. ensure that information does not paper-based resource has a notice of withdrawal of a conflict with other sources. place eg problems with a Trust's medicine be posted ahead of Although linking with NICE IT server etc. its removal from formulary. guidance is a good idea care Also could this be used to needs to be taken not to limit a highlight problems with prescriber's ability to use supply? alternative medications. Put another way I would not support developments that limit clinicians to being able to prescribe NICE - medicines only. Easily accessible information on drug interactions is also a good idea

[Insert footer here] 250 of 383 Palliative Care As a palliative care pharmacist, In my area of clinical speciality Just to include a free link to the Thank you for your comments, they Pharmacist having a free link to the on-line having a free link to the on-line on-line PCF. have been considered along with PCF would enhance the BNF PCF would be the most the other comments received in the immeasurably in my opinion. important element of an consultation, to inform the Currently there is only a small enhanced BNF. development of the enhanced BNF. amount of palliative care info in the BNF and it doesn't necessarily agree with well respected and frequently used references such as the PCF. In my opinion, free access to the PCF online would be an invaluable resourse for both generalists and specialists in palliative care. I would suggest that it would be an excellent education tool as well as being a very practical and helpful reference.

[Insert footer here] 251 of 383 Senior Overall an excellent idea. The I use BNF as a source for drug In an economic evaluation it is Thank you for your comments, they Researcher in continuous updating seems to be prices and dosing as an input important to make sure all have been considered along with Health the best innovation. into economic evaluations of prices are to a common price the other comments received in the Economics healthcare interventions year. This is preferably the consultation, to inform the latest year for which price data development of the enhanced BNF. are available for all resource use items, and tends to be a year or two prior to the date of the analysis (e.g. economic evaluations I do today would probably use a 2013 price year, or possibly 2012 if more recent data sources are not available for some items). Previously I have always used printed back issues of BNF to do this, but this is a bit tedious and risks errors, and having these back issues online would be extremely valuable. With continuous updating this may create a problem though as the price of a drug may change half way through an analysis! I would love to be able to get a 'snapshot' of the BNF at a particular date, e.g. 31st March 20xx so that I can ensure my analyses are using a consistent price year. If this was implemented as a part of the changes this would be of enormous benefit to all analysts undertaking economic evaluations for the NHS, NICE or others.

[Insert footer here] 252 of 383 Head of Greater and more timely Include information on drug Yes, Im unconvinced from the Thank you for your comments, they Prescribing integration with NICE would be interactions and unwanted colleagues that I interact with have been considered along with Support Unit useful. You argue that ensuring effects including rating of their that many prescribers (other the other comments received in the prescribers have timely access frequency and seriousness, to than younger ones) use consultation, to inform the to accurate and up to date minimise the risk of harm - this electronic / app type devices. development of the enhanced BNF. information on medicines is sounds potentially useful, as Many still rely on paper BNFs. NICE acknowledges that digital essential. This is only the case if long as you dont just copy what In my hospital, there is infrastructure and access to prescribers have the time to is in a drug's SPC. Include links uncertainty over routimne portable devices throughout the access that information and have to high quality information for access on wards to an NHS is not fully developed. realised that they need to access patients, including information to electronic device whereas Distribution of print formats will that information. Doesnt most help healthcare professionals grabbing a paper BNF is a continue in line with user prescribing happen out of habit? and patients reach decisions relatively easy task, especially requirements, subject to ongoing With people doing what they together - this sounds valuable. for nurses. Likewise will monitoring and review by the NICE always do and only when there is community pharmacies be Board. a query or a concern, do they able to access an electronic seek help? version in real time? They seem to struggle to use their dispensing systems for activities other than dispensing. Anything that does not resemble the tried and trusted BNF will be hard for many to accept. Has there been any work in NewZeland to show the success and value of their electronic only formulary?

Staff Nurse I feel that any resource that Be searchable and browseable I can not see anything at this Thank you for your comments, they makes it easier for a nurse or in multiple ways to make it easily present time have been considered along with doctor to make evidence based accessable. Being continuously the other comments received in the decisions on what is the best developed providing up to date consultation, to inform the way forward for our patients is information. Include information development of the enhanced BNF. the best way forward. I think on drug interactions and NICE acknowledges that digital there is a place for both the unwanted effects including infrastructure and access to digital version and the hard copy rating of their frequency and portable devices throughout the version. Sometimes it is easier seriousness, to minimise the risk NHS is not fully developed. and more conveinient to flick of harm Distribution of print formats will

[Insert footer here] 253 of 383 through the pages of a book continue in line with user rather than find a digital version. requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant As long as the paper version The enhanced features are very Do not scrap the paper version Thank you for your comments, they Cardiologist continues to be produced that nice but only if you do not scrap have been considered along with will be fine. Loss of the paper the paper version the other comments received in the version would be a grave consultation, to inform the mistake development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Senior Medical The plans sound very sound to Being searchable and It isn't specified in the Thank you for your comments, they Adviser, me, and take into account the browsable. Being rigourously consultation document, but I have been considered along with European changing ways for how people checked for accuracy and presume the new BNF would the other comments received in the Qualified routinely access information. completeness of information, still include information on consultation, to inform the Person for Also the attention to detail eg. and updated regularly. Including contraindications, warnings development of the enhanced BNF. Pharmacovigila utilising national and information on drug interactions and precautions for each drug nce international sources of and unwanted effects (this is (not just the interactions and information, continuously extremely important for all those unwanted effects). Another updating the information and physicians and other health suggestion is additionally to being fully searchable and professionals working in the provide links to other standard browsable are particularly good area pharmaceutical medicine, reference information for each points. Good idea to include especially pharmacovigilance). drug (eg. Martindale - The commonly prescribed medical Complete Drug Reference, devices. Meyler's Side Effects of Drugs etc). Finally it would be excellent if the key OTC (over the counter) drugs could be included within each section as

[Insert footer here] 254 of 383 appropriate (by active ingredient, not necessarily by brand name).

GP good to have up to date version accurate and up to date When out on visits I carry a Thank you for your comments, they information paper BNF; I will miss the book have been considered along with version if it is not available the other comments received in the consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 255 of 383 Consultant in I think that this is a very good Be continuously updated with Include the Palliative Care Thank you for your comments, they Palliative Care idea. It would be very useful to content updates pushed out to Formulary version4 have been considered along with have links to the Palliative Care inform continuing professional the other comments received in the Formulary verison 4 too. development. Include high consultation, to inform the quality prescribing information to development of the enhanced BNF. help improve patient outcomes by supporting health professionals to choose the right medicine, at the right time for the right patient, including patients with more than one medical condition. Include information on drug interactions and unwanted effects including rating of their frequency and seriousness, to minimise the risk of harm Be searchable and browsable in multiple ways, such as by drug, condition and patient characteristic, so it can be easily accessed Allow quick comparisons of key information on effectiveness, safety, patient factors and resource implications

Community To include latest evidence based Up to date information. no Thank you for your comments, they Matron practice. Up to date information, have been considered along with this may be compromised for us the other comments received in the as it is now to be only updated consultation, to inform the annually, we have no way of development of the enhanced BNF. accessing online infomration when out in peoples homes.

Medicines I think the vision that is set out People knowing what's in their I think that switching from Thank you for your comments, they Management works much better if using the and how to access it. twice yearly to yearly have been considered along with Pharmacist, BNF as an online document that Pharmacists know the BNF back distribution is a serious error. It the other comments received in the Whittington you can search, rather than in to front but from what I see on a gives an inconsistent message consultation, to inform the

[Insert footer here] 256 of 383 Health ICO paper. Information is often daily basis a lot of other doctors - either you support paper development of the enhanced BNF. missed on paper as you skip in particular will go to google versions of the BNF or you NICE acknowledges that digital straight to the drug monograph first. Having a really effective don't. Supporting September infrastructure and access to and miss the general information search tool is important. but not March could give the portable devices throughout the 'above' the drug monograph. I message that it's ok to use an NHS is not fully developed. would welcome the more out of date BNF, or that Distribution of print formats will comprehensive information on updates throughout the year continue in line with user drug interactions, as an MI are 'minor' and the most requirements, subject to ongoing pharmacist, the BNF interactions important changes are monitoring and review by the NICE section is of little use other than published in September. I think Board. to 'flag' interactions and direct it is right to look at the most you to more comprehensive effective use of resources, and resources e.g. Stockleys. reducing the amount of BNF's Prescribers often see this sent is part of that, but a much information and then don't really better option by far is to halve know what to do with it. the amount of BNFs you send Comparisons would also be out, and continue to do so highly useful. twice a year. not send out the same amount but only half the time. I haven't spoken to anybody who can understand the sense of your decision. I wholeheartedly support the push to use online electronic versions of your resources where available, and promote these all the time in practice.

[Insert footer here] 257 of 383 Medicines This is a welcome development. It needs strong search tools, Is it possible to have a patient- Thank you for your comments, they Information including patient conditions, e.g. friendly version alongside? have been considered along with Lead Pharmacy able to find a medicine even if the other comments received in the Technician the user has made a minor consultation, to inform the spelling mistake, or has used a development of the enhanced BNF. brand name. I like the focus on reduction of risk and harm; e.g. the suggestion of rating adverse effects and interactions by seriousness. I would like to see a much stronger and more comprehensive interaction search function, e.g. by putting in a patient whole medication profile, rather than searching each medicine one by one. I like the links to the most recent NICE guidance and would like to see other approved clinical guidance (e.g. that published and acknowledged by the Royal Colleges) and to MHRA approved publications, e.g. SPC/PILs It is important to retain the links to the Yellow Card Scheme; perhaps make these more obvious by flagging it on medicines that are black triangle. Able to communicate/link effectively with e-prescribing and e-dispensing systems

[Insert footer here] 258 of 383 GP Registrar Promising vision. I hope to see it Mobile access, browseable in See above Thank you for your comments, they integrated with 'bedside' clinical multiple ways. Including have been considered along with reference services similar to measures such as NNT, to the other comments received in the UpToDate or BMJ Best Practice, assist in patient information. consultation, to inform the which go beyond just medication Links to Patient Decision Aids development of the enhanced BNF. prescribing information - this where available. Linked and would mean that Healthcare integrated with bedside clinical Workers could, at a glance, see reference services drug and non-drug treatment options for problems and further background together with diagnostic criteria and investigations. At present, purchase of resources such as these is done by individual NHS trusts and universities. The opportunity here would be to purchase or commission such a resource on a national basis, which would have the advantages of cost effectiveness and ensure all NHS staff are using the same, UK specific resource. aseptic seems sensible to get the most accessibility and currency no Thank you for your comments, they services up to date information available have been considered along with operational the other comments received in the manager consultation, to inform the development of the enhanced BNF.

[Insert footer here] 259 of 383 End of life care It can only be of benefit to all with current technological as a palliative care nurse who Thank you for your comments, they facilitator health care professionals advances any format that is currently on the NMP have been considered along with whether prescribers or not to ensures you are prescribing or prescribing course one area the other comments received in the have acccess to the most up to having the most up to date that would be highly beneficial consultation, to inform the date information and with all the information is invaluable. I will to my currect and new role development of the enhanced BNF. changes in modern technology it be looking at the BNF app and would be linking to the on-line NICE acknowledges that digital is great to think something as the links within it, as I was PCF as I believ this could infrastructure and access to used as the BNF will be keeping unaware of this modification. enhance the BNF. I think one portable devices throughout the up with the advances available. of the most difficult issues you NHS is not fully developed. especially when the paper face is ensuring all health care Distribution of print formats will version will only be available professionals are aware of the continue in line with user annually. updates, where to advertise requirements, subject to ongoing and getting all relevant people monitoring and review by the NICE are informed - as there are so Board. many different professions in so many settings across the whole of the UK.

Community I use the BNF book daily in my The enhanced format might I hope you receive feedabck Thank you for your comments, they Specialist work. I prescribe in patients' provide more regular updated from a wide range of users so have been considered along with Palliative Care homes using a prescription pad information which would be that you understand the reality the other comments received in the Nurse & pen. I work in a rural area & do useful for some practitioners. of prescribing in remote rural consultation, to inform the NOT have access to technology areas, rather in cities with development of the enhanced BNF. in patients' homes & may not be good inetrnet access. NICE acknowledges that digital near a GP surgery to access the infrastructure and access to internet. My prescribing would be portable devices throughout the severely hampered if I did not NHS is not fully developed. have a BNF in paper format. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. lecturer I use BNF on a daily basis but it I would like to have access to no Thank you for your comments, they Practitioner in would be helpful to have access PCF on line also. have been considered along with Palliative Care on line for when in clinic settings the other comments received in the consultation, to inform the

[Insert footer here] 260 of 383 development of the enhanced BNF.

Consultant Agree with the vision electronic version for smart No Thank you for your comments, they Anaesthetist phone is the way forward, free to have been considered along with users. the other comments received in the consultation, to inform the development of the enhanced BNF.

Patient The changes which are The ability to inter-relate I am EXTREMELY concerned Thank you for your comments, they researcher envisaged are to be between medications, that there will be a total loss of have been considered along with commended. If one was able to particularly in respect to a the ability to have something the other comments received in the waive a magic wand over the particular condition, is of physical to handle and refer to consultation, to inform the whole intended new computer paramount importance. The as one investigates a development of the enhanced BNF. based BNF, you might just get programming must include many subject/medication. No matter NICE acknowledges that digital me to agree it is the best thing interfaces one of which will allow how much you try to convince infrastructure and access to since bread and cheese. interrelation between me, you have an uphill climb to portable devices throughout the However, life is not like that. medications in a variety of inter- show how a computer based NHS is not fully developed. PLEASE, PLEASE, do not stop related conditions. As an format can take over Distribution of print formats will printing both the BNF and BNFc example, in the treatment of completely the advantages of continue in line with user until you have set up a non-valvular atrial fibrillation, hard copy to refer to. requirements, subject to ongoing consultation period as we have research based ACTUAL risk Computers when first made monitoring and review by the NICE here, as to whether the medical figures, as opposed to, were supposed to save paper Board. professional consider it SAFE to RELATIVE risk figures in in that it would be unnecessary do so. respect of the benefits and risks to have books to refer to in the of anticoagulation, comparing future. To a degree this is true the various ACOs and NACOs in that it is not necessary to available from time to time. have a hard copy of a novel or something which does not need referral to content. Just think, however, before computers, did you see A4 copy paper being sold in virtually every conceivable shop as occurs today due to the necessity to copy FROM a computer to get your hard

[Insert footer here] 261 of 383 copy to refer to for future use. I challenge you to find someone in the medical profession who is willing to give up the hard copy BNF for a computer edition, certainly as things stand for the for the time. Therefore do not stop printing the BNF and BNFc until the medical profession is ready for you to do so. Perhaps this is case for The Innovations Unit on 02072508098 or through , [email protected] might come into their own.. I have made these comments without the benefit of a hard copy of the consultation document before me and therefore further comments may follow.

Nurse I think it is a good idea, I have inclusion of dressing hosiery and No Thank you for your comments, they Practitioner tried to access the BNF app but other items with pip codes to aid have been considered along with do not have an Athens number. I prescribing the other comments received in the would prefers any access should consultation, to inform the be by professional registration development of the enhanced BNF. number.

Consultant in I am very much in favour for an Easy to use Link to important Will it be free for everyone if in Thank you for your comments, they palliative enhanced BNF but need to documents - palliative care health role? have been considered along with medicine check the things that are linked formulary, renal handbook the other comments received in the in are well researched I think this consultation, to inform the would have to be electronic - development of the enhanced BNF. don't want paper version any NICE acknowledges that digital bigger Also - please don't get rid infrastructure and access to of paper version altogether - portable devices throughout the

[Insert footer here] 262 of 383 very readable, easier than little NHS is not fully developed. phone screens etc Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Medicines In essence I think this is a good Not Sure Medicines Management Thank you for your comments, they Management idea. Need to ensure that Technicians regualrly use the have been considered along with Technician electronic copys are available on BNF - (For example I use mine the other comments received in the all systems and devices. upto 10 times a day) consultation, to inform the Especially portable as this is, i Personally I think MMT should development of the enhanced BNF. imaginge, how most people will get a print copy of the BNF - NICE acknowledges that digital access the BNF when out and we are often doing solo work infrastructure and access to about, with no access to a and out on our own. BNF App portable devices throughout the desktop PC. only avaliable at the moment NHS is not fully developed. on Apple, Android, and Distribution of print formats will Blackberry smartphone - not continue in line with user accessible on a blackberry requirements, subject to ongoing tablet. Needs to be thought monitoring and review by the NICE about making the app Board. accessible on Windows phones - used by Nokia - and other providers. To make it accessible to all electronic users. consultant would be a major advantage to would improve widely avaialble no Thank you for your comments, they have free online access to PCF free safe information prescribing have been considered along with of palliative care drugs the other comments received in the consultation, to inform the development of the enhanced BNF.

[Insert footer here] 263 of 383 Marketing This from our point of view is n/a Is there perhaps some area for Thank you for your comments, they essential as it allows us to showing updates (perhaps this have been considered along with update and maintain our key is already done) and laos new the other comments received in the prescribing points within the BNF licensed products being listed, consultation, to inform the also whether the products are development of the enhanced BNF. licensed, medical devices or unlicensed, and finally what their status is regarding NICE

Chief I can't disagree with any of this Being fully searchable and Currently I rely on the SPCs Thank you for your comments, they Pharmacist & as to be able to access all these providing links to other guidance for more complete advice on have been considered along with Controlled benefits from a single point of Authoritative up to date many aspects of medicine use. the other comments received in the Drug reference would be ideal. I am information on drug doses, Incorporation of this resource consultation, to inform the Accountable concerned that many of us in cautions, contraindications and or easy links to it would be development of the enhanced BNF. Officer community care / mental health drug interactions. helpful. NICE acknowledges that digital do not currently have the infrastructure and access to technology provided to access portable devices throughout the these systems, particularly when NHS is not fully developed. working remotely. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Independent Offers exceptional potential to Accessibility: needs to be readily Used, recently outdated print Thank you for your comments, they consultant improve a valuable resource available on the spot in all copies have been useful in have been considered along with withouot losing the key elements clinical settings. Browsable as developing countries without the other comments received in the that have made the BNF such an well as searchable: reading the the resources to buy new ones consultation, to inform the asset. Although it's a while since general sections on prescribing - not sure this will translate to development of the enhanced BNF. I've been a prescriber personally, areas was a valuable way to enhanced version. NICE acknowledges that digital the pocket book version was a refresh knowledge, particularly infrastructure and access to constant companion, and to for specialists who need a portable devices throughout the ensure it stays so for future working knowledge of areas NHS is not fully developed. generations its accessibility outside their specialist area but Distribution of print formats will needs to be in line with their don't come across them continue in line with user custom, practice and regularly. Rapid updating and requirements, subject to ongoing expectations. The opportunity to potential links to other systems, monitoring and review by the NICE link with other systems could be

[Insert footer here] 264 of 383 an important mechanism in as outlined in the document. Board. reducing the significant contribution of prescribing errors to patient harm.

Consultant It is abreast with current 1. Easily accessible, both paper Some stioll do not have access Thank you for your comments, they Psychiatrist developments in technology and and online versions 2. Links to to smartphones at work, hence have been considered along with need for evidence based relevant references, texts, they may be disadvantaged. the other comments received in the information at one's fingertips. journals 3. Expert views to be Probably helpful to ensure consultation, to inform the Howevre, there is significant incorporated as they often email updates are an available development of the enhanced BNF. onus of responsibility on influence local practice 4. Timely option on key NICE acknowledges that digital ensuraing 'continuous updates' alerts on side effects/serious drugs/conditions/area of infrastructure and access to and its unclear whether this will adverse events interest as ana laternative to portable devices throughout the be sustainable or at odds with a regular searches. NHS is not fully developed. random online search on the Distribution of print formats will day. continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Hospital great links to NICE guidance easy access finding info quickly no Thank you for your comments, they pharmacist - useful patient info good have been considered along with manager comparisons good the other comments received in the consultation, to inform the development of the enhanced BNF.

Consultant in It would be helpful if it linked to Without linkage to the Palliative As above Thank you for your comments, they Palliative the Palliative Care Formulary Care Formulary it is unlikely it have been considered along with Medicine which is the gold standard for would be used differently to the the other comments received in the palliative care prescribing simple paper BNF consultation, to inform the development of the enhanced BNF.

[Insert footer here] 265 of 383 Prescribing I agree that the enhanced BNF Quick easy searching or access Probably fuerther ideas will Thank you for your comments, they Information should be accesible in as many via chapters to individual forthcome from the workshop have been considered along with Support digital formats that prescribers monographs and interactions. attendees. the other comments received in the Pharmacist and other clinicians use. Also the integration within GP consultation, to inform the and pharmacy clinical systems development of the enhanced BNF. should be imperative. As a prescribing pharmacist i often access BNF online or BNF iphone app to check interactions- if this could also be easly accessable via the prescrining systems that would be great. - ie Vision and EMIS the approved GP systems for Wales. links to product SPCs will be useful.

GP and I have switched to the online Must be very fast to search and I think more thought should be Thank you for your comments, they epidemiologist version of the BNF and BNFc. In must be able to access it easily. given to the user interface. have been considered along with a primary care consultation Web version and mobile apps GPS want a resource that is the other comments received in the searching this is quicker than are ideal bit only if they are easy and quick to search first consultation, to inform the using a paper book. I still use the straightforward to use. Linking to and foremost. The transition to development of the enhanced BNF. book for home visits because other resources is useful but a more integrated resource NICE acknowledges that digital although I have downloaded the should not take priority over that links to other data is infrastructure and access to iOS apps they are very poor. speed and ease of use. promising but will not be used portable devices throughout the They always need login details I as frequently. NHS is not fully developed. can't remember and always Distribution of print formats will seem to require wifi access to continue in line with user update when they load which requirements, subject to ongoing prevents using the previous monitoring and review by the NICE stores version. I would use the Board. iOS version if it were better designed.

[Insert footer here] 266 of 383 Student Health I prefer the book version no comment no comment Thank you for your comments, they Visitor have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

GP I'd like this I use print book on areas where I don't find areas where I don't find Thank you for your comments, they home visits, but rarely in the sufficient detail in BNF & cBNF sufficient detail in BNF & cBNF have been considered along with surgery. I would like NHS for me to safely prescribe, as a for me to safely prescribe, as a the other comments received in the prescribers' access to the BNF to GP palliative care prescribing in GP palliative care prescribing consultation, to inform the include on-line access to the pregnancy & breast feeding (I in pregnancy & breast feeding development of the enhanced BNF. PCF (Palliative Care Formulary) use MHRA & toxbase online) (I use MHRA & toxbase online) NICE acknowledges that digital too - currently cost prohibitive, I kidney impairment - common in kidney impairment - common infrastructure and access to really miss this, as I used it a lot older people. I don;t have in older people portable devices throughout the in the county where I used to access to the Renal Drug NHS is not fully developed. work, where local PCT library Handbook or Maudsley book for Distribution of print formats will purchased both PCF books and psychoactive prescribing continue in line with user later an online subscription requirements, subject to ongoing monitoring and review by the NICE Board.

Patient When it is, not, 'if', in existence The simplicity of the format in I am sure not overlooked, but, Thank you for your comments, they then I guess we will have which it is created. It must be the different platforms within have been considered along with reached Utopia in the prescribing user friendly above anything the website must be fully the other comments received in the field, but I have a feeling I will not else. If it is not, then it will be a tested before launch so that as consultation, to inform the see it. Please persevere to the failure and a danger to patients. few glitches as possible slip development of the enhanced BNF. goals envisaged. If it is not, it will undoubtedly be through. Once users are put NICE acknowledges that digital a source of litigation on the part off by problems within the site infrastructure and access to of patients with clinicians. As a it will not be trusted. portable devices throughout the

[Insert footer here] 267 of 383 patient I want to see the same Presumably full advantage of NHS is not fully developed. information my clinician will see, the experience of the issue of Distribution of print formats will not a simplified cut down the New Zealand on line continue in line with user version. A patient cannot be Formulary will be used. I note requirements, subject to ongoing expected to have the knowledge as well, in the plaudits in NZ, monitoring and review by the NICE to make decisions about his there are comments as to how Board. treatment without the FULL much the BNF book is clinical facts. One of the biggest missed. Access to the site problems I envisage for the MUST remain free and open to professionals when the BNF all in perpetuity. goes on line, is to become aware of the changes to the content which will happen every month. Take the case of NOACS currently evolving. There must be a way digital way of drawing attention to the updating and changes to text on a subject, as new or changed information becomes available. For example a different colour used in the presentation for a period of six months to show updating or changed text. The BNF cannot be withdrawn, if at all, until the NHS has got the hands on technology to enable everyone within it to have the necessary access to the site. Do the powers that be in NZ think they got it right and what would they have done differently in hind sight? e.g. Kept their formulary in book form still.

[Insert footer here] 268 of 383 Consultant in Excellent to have access to up to In my palliative medicine role it The links to local formularies Thank you for your comments, they Palliative date information - currently I do would be extremely helpful if are important as increasingly have been considered along with Medicine not use electronic access too there could be an automatic link our CCG is making specific the other comments received in the often but would if the BNF to the Palliative Care Formulary prescribing recommendations. consultation, to inform the developed as described. If it (PCF) - this is the main development of the enhanced BNF. links to the Palliative Care reference for medicines NICE acknowledges that digital Formulary then it would use it all information for palliative care infrastructure and access to the time. This gives detailed and professionals. It would be very portable devices throughout the up-to-date information about helpful for this to be funded NHS is not fully developed. medicines used in palliative care nationally (as it is in NHS Distribution of print formats will - currently the subscription to the Scotland) as I think other non- continue in line with user online version costs £50/year specialist prescribers would also requirements, subject to ongoing and so there are a limited find the information very helpful, monitoring and review by the NICE number of practitioners who and there would be greater Board. access the most up to date access amongst those specialist version. prescribers who can only afford the paper copies which rapidly become out-dated.

Consultant in You need to continue with paper Not sure - think you need to Please include the Palliative Thank you for your comments, they Plliative copies of the BNF. There are manitan paper versions as well Care Formulary written by Dr have been considered along with Medicine places and times where as online. Andrew Wilcock. It is a the other comments received in the computers are not available. fantastic resource for any consultation, to inform the health professional! development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. associate Would like the bnf in digital Bnf app should be available on Kindle app Thank you for your comments, they specialists old format with links within the app Kindle have been considered along with age the other comments received in the consultation, to inform the

[Insert footer here] 269 of 383 psychiatrist development of the enhanced BNF.

Locum Should make prescribing safer Suggested practice guidelines See above Thank you for your comments, they Consultant but unfortunately paper version for common drugs in each have been considered along with Palliative will be needed for sometime until specialty .. or links to specialty the other comments received in the Medicine more ward computers/tablets website prescribing guidelines consultation, to inform the available eg Palliativedrugs.com formulary development of the enhanced BNF. for palliative care drugs, many of NICE acknowledges that digital which are used off licence and in infrastructure and access to ways not coverd by BNF (I aman portable devices throughout the editor of this book) NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Community Whilst I appreciate the difficulties Current and up-to-date No Thank you for your comments, they Specialist and challenges of using the information and that it will be have been considered along with Palliative Care printed version of the BNF, in my cross referenced with the NICE the other comments received in the Nuse daily role, I do not always have guidance. consultation, to inform the access to the electronic version development of the enhanced BNF. of the BNF and without the NICE acknowledges that digital printed copy, would find it infrastructure and access to impossible to continue portable devices throughout the prescribing in the community as NHS is not fully developed. my prescribing is done in Distribution of print formats will patients' homes with handwritten continue in line with user prescriptions. If I did not have requirements, subject to ongoing access to a printed BNF, I feel it monitoring and review by the NICE would not be safe to continue my Board. prescribing.

Specialist Think it is a great idea To cover all topics throughly so I would like the BNF to link in Thank you for your comments, they Cancer that you only need to look in one with other resources such as have been considered along with resource - similiar to medciines Stockleys and the Pallative the other comments received in the

[Insert footer here] 270 of 383 Pharmacist complete but expanded Care Formulary (PCF) to save consultation, to inform the me having to perform several development of the enhanced BNF. searches for one drug. As I work in Pallative Care having to carry a paper version of the PCF (as our online account is limited to use in MI) this would be great for me.

Paediatric I think having an updated easily 'sounds like' search facility need some sort of back up if Thank you for your comments, they Advanced accessible BNF/BNFc will be 'condition' search easy there's intranet failure how have been considered along with Nurse beneficial for patients. Being interactions search - ie put 2 or much further advanced were the other comments received in the Practitioner able to search when you maybe more drugs into the computer NZ in their computerised consultation, to inform the don't know the exact spelling of a and ask it to tell you what can healthcare before they development of the enhanced BNF. drug (parents often have no and can't be given together, with removed paper copies? are we NICE acknowledges that digital idea!) and search more easily for maybe suggestions for near that yet across the whole infrastructure and access to drug interactions will be very alternative drugs that could be of the nhs services? - eg portable devices throughout the useful. I am concerned about used instead why sudden community practitioners with NHS is not fully developed. totally loosing the paper copy as changes to guidance or links to poor 3G/wifi while out visiting Distribution of print formats will we have significant issues with the underpinning research (eg patients or in remote clinics, continue in line with user accessing computers in a timely reasons as to why there has not able to get up to date requirements, subject to ongoing manner on the shop floor in a been a complete change on access. ?need ability to update monitoring and review by the NICE busy emergency department paracetamol + ibuprofen dosage devices on a daily basis + then Board. particularly if that is then going to advice for children) ability to link use offline? take sometime when the nursing with local formulary - eg in case staff need them to assess of antibiotic prescribing where patients/print notes etc. I have local resistance rates the apps on my phone but it is necessitate change from usual frowned on to be seen using guidance. phones openly in public/patient areas and the app is not yet as user friendly as I think it could be (this is recognised in the consultation document).

[Insert footer here] 271 of 383 Snr.technician The enhanced digital version/s Access via the internet would be Access to e-versions is not Thank you for your comments, they Medicines appear to be a good source of up my personal preferred option always available at all times in have been considered along with Information to date information but if users and the information must be many locations and old copies the other comments received in the cannot access them readily clear and easy to read. of the book will probably be consultation, to inform the (especially in hospitals where used. development of the enhanced BNF. internet access is limited - NICE acknowledges that digital especially on wards and in infrastructure and access to clinics) then potentially out of portable devices throughout the date paper copies of the book NHS is not fully developed. will be used - potential risk. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant in I think these are good aspirations Online access to regularly The Palliative Care Formulary Thank you for your comments, they Palliative for the BNF updated information Info on i(PCF) s an essential formulary have been considered along with Medicine interactions for all working in general and the other comments received in the specialist palliative care. It too consultation, to inform the has an online regular updated development of the enhanced BNF. version, alongside a paper version every 2 years. However it now requires an online subscription to keep it running and this has serious safety issues as some clinicians are unaware of significant updates. To have the PCF e linked with the BNF would be the way forward. community this is an idea that is in keeping access in every format possible from what i understand there Thank you for your comments, they Matron with the ever chaning need for to allow for trust who have will be increasing reliance on have been considered along with upto date information. limted asscess to wi fy and paper less serivce. so need to the other comments received in the techonology has been a vital those who relpy on a paperless consider places in extreme consultation, to inform the componant of the NHS to drive system. In keeping with the parts of country where remote development of the enhanced BNF. forward chagnes to meet carbon footprint asscess may be reduced. also NICE acknowledges that digital weather and user demand my infrastructure and access to

[Insert footer here] 272 of 383 increasing health care needs. slow process down at times so portable devices throughout the need multiply system back up. NHS is not fully developed. Will save have to carry book Distribution of print formats will around good for moving and continue in line with user handling. requirements, subject to ongoing monitoring and review by the NICE Board.

Epilepsy Conflicting advice could be an Up to date information available Community workers gaining a Thank you for your comments, they Specialist issue for practitioners signal to be able to access the have been considered along with Nurse Mobile/Community workers like document the other comments received in the myself do not always obtain a consultation, to inform the signal when out and about development of the enhanced BNF. Current practice allows ease to NICE acknowledges that digital obtain prescribing information infrastructure and access to within seconds by looking up in portable devices throughout the BNF also can flick between NHS is not fully developed. pages not so easy electronically Distribution of print formats will when sitting in someone's house continue in line with user Always having to ensure mobile requirements, subject to ongoing device is working battery monitoring and review by the NICE charged to obtain information I Board. do not feel hard copy of BNF should be discarded Enhanced BNF good idea for practitioner sitting in a surgery with guaranteed internet access looking up/comparing information will I believe take longer

Lead I very much support this. I like Access to more vital information. No Thank you for your comments, they Pharmacist; the idea of including common have been considered along with Education & medical devices being available. the other comments received in the Training, All of this if done properly will consultation, to inform the Research & make decision making alot development of the enhanced BNF. Development easier and quicker.

Managing Complete agreement except i The BNF is a good resource NO but ... The BNF has been Thank you for your comments, they

[Insert footer here] 273 of 383 Director question the real value of of the now but it needs to support e- revered for its advice and the have been considered along with Healthcare IT added purpose to provide prescribing and decision support that this has provided the other comments received in the Strategy "patient information". The support. This is essential. In to clinicians. Don't drop the consultation, to inform the Solutions reasons are as follows: (a) there addition an enhanced BNF advice. However, this advice development of the enhanced BNF. (previously is a lot of "good enough" should "Allow quick needs to be turned into smart, part of information already available - as comparisons of key information patient specific information that BMA/BMJ a patient I don't feel i'm lacking in on effectiveness, safety, patient is computable to help improve responsible for information, (b) the BNF should factors and resource decision making. NO BNF) maintain its purpose being for implications", It should support except... not all clinicians have clinical use, (c) products that some of the more complex the same level of experience seek to serve both patients and prescribing issues like co- and expertise. When writing clinicians get watered down and morbidities and poly pharmacy the enhanced BNF the "6- 8 then become useless to and should draw out (recognise) profiles of typical users (which clinicians and (d) to avoid the patient characteristics and probably needs updating)" dilution mentioned in (c) you'd develop medicines information needs to be kept in focus. need to build two separate which supports better products off the same base. prescribing and resulting in This is costly to build and fewer ADEs. Thus,in addition to maintain ( we did this with the comments above, for your CLinical Evidence and Best list in section 2, I'd prioritise: Practice (patient facing evidence Include high quality prescribing based medicine) when I was at information to help improve the BMJ. In a cash strapped patient outcomes by supporting NHS I don't see this as the most health professionals to choose effective use of the limited funds the right medicine, at the right available. time for the right patient, including patients with more than one medical condition Include information on drug interactions and unwanted effects including rating of their frequency and seriousness, to minimise the risk of harm Be searchable and browsable in multiple ways, such as by drug,condition and patient characteristic, so it can be easily accessed

[Insert footer here] 274 of 383 Prescribing Would welcome a BNF that Better interaction section with The investment needed in the Thank you for your comments, they specialits utilised technology better, the the kind of information Stockleys NHS for technology that have been considered along with mental health current interaction section for has. Updates occuring enables practitioners to take the other comments received in the pharmacist / example is very difficult to use frequently. Down loadable so it an electronic version with consultation, to inform the Joint course and prescribing students often can be carried into homes them. development of the enhanced BNF. leader non- struggle with this. I am without internet, fast to use. NICE acknowledges that digital medical concerned how community More detailed sections on infrastructure and access to prescribing based practitioners would be pregnancy and breast feeding. portable devices throughout the able to acces this, for example NHS is not fully developed. as a prescriber I visit people at Distribution of print formats will home, with no wifi connection continue in line with user and no access to hand held requirements, subject to ongoing devices. monitoring and review by the NICE Board.

Consultant in I think its a great idea to go on- almost everyone has access to no Thank you for your comments, they Palliative line and reduce reliance on print. internet and a smart phone now have been considered along with Medicine But you will have to make sure so I think rapid and easy access the other comments received in the that you have access available plus regular updates for me consultation, to inform the through a variety of means i.e. would be the most important development of the enhanced BNF. website, web-links through NICE, elements. NICE acknowledges that digital apps (apple,android). Please infrastructure and access to also consider producing a PDF portable devices throughout the version. NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant I would be happy to access the IT woudl be great to have a No that I can think of Thank you for your comments, they Ophthalmologi BNF soley by electronic means. I dose calculator linked witht he have been considered along with st was not aware of the app but BNF so that patient weight could the other comments received in the considering that the majority of be entered to calculated the consultation, to inform the doctors int he NHS have smart appropriate doseage particularly development of the enhanced BNF. phones this woudl eb a great for the childrend BNF way of accessing this

[Insert footer here] 275 of 383 information.

Medicines As a regular user of print/online The online version should The current need to find Thank you for your comments, they Information versions of the BNFs, I concentrate on its ability to funding for March 2014 Print have been considered along with Manager appreciate the benefit to using a integrate with any potential e- copies leaves budget holders the other comments received in the digital platform that can ensure prescribing systems. The in difficult financial positions consultation, to inform the the info is the most up-to-date, necessity for an Athens with little time to plan. development of the enhanced BNF. but there are definite situations password is a barrier to the Resource in the future will NICE acknowledges that digital where the print copy is still rapid access required for this obviously move towards IT infrastructure and access to necessary. I have concerns over information. Fluidity of development, but there portable devices throughout the the accessibilty of the online/app incorporation into formulary appears to be little NHS is not fully developed. version in areas with limited documents is something that consideration as to how this Distribution of print formats will access to IT resource. The lack would benefit our prescribing potential financial impact for continue in line with user of print resource may work practices locally. The decision resource management locally requirements, subject to ongoing against the proposed access to support tools proposed would be may affect patient care in the monitoring and review by the NICE information at the 'right place very useful in assisting joint interim. Reliance on personal Board. and right time'. I appreciate the decisions and should assist in mobile devices is not need for accreditation standards, bringing medicines adherence appropriate with the NHS. but I hope that in applying the and optimisation to the forefront Current financial restricitions at process that info is updated (to of prescribing decisons. The local level do not appear to reduce any confliction), but not BNF itself as a publication have been considered in this lost, in the re-formatting. Whilst needs to remain close to its proposed development. New the consultation paper indicates current format. Both versions Zealand has been provided as it will be high quality info to must be a reflection of each an example of a successful improve patient outcomes will be other to avoid confusion. NHS move to digital resource. The developed, further information on evidence search as a search health economy, scale and how this would be done would be platform has significant structure is not the same as useful, as if this simply a limitations in its functional ability the UK. A dedicated e- reflection of NICE pathways then to filter and narrow down learning package should be this may not be extensive searches. Other information devised that can be enough. There is the suggestion which has previously been incorporated into mandatory that this would be a single incorporated onto this site has training. The roll-out of authorative resource which is been 'lost' or extemely difficult to appropriate training for an ambitious. Whilst I think access find. Several collegaues essential resource on an of information in an accredited feedback that you have to know online platform is absolutely

[Insert footer here] 276 of 383 resource for the majority of HC what you are looking for in order necessary. Although the apps staff is useful ofr point of care to find it. The consultation paper can be used without internet access, other resources are still indicates the the BNF content connection(which can be necessary for more complex will be accessible/browsible in problematic and inconsistent), medicines enquiries. multiple ways but the the governance issues around information is limited on on how ensuring access of updates this would be be executed to has not been investigated. It is fully provide comment. not clear if, and how, CQC for example would monitor this, (particulary if there was a reliance on personal devices in the workplace)

GOVERNANCE supportive of proposals - links to continually updated Add access to Palliative care Thank you for your comments, they PHARMACIST palliative care formulary would formulary PCF document since have been considered along with also be advantageous specialise area of knowledge the other comments received in the Also explore other specialist consultation, to inform the areas of prescribing , development of the enhanced BNF. dispensing, administration and recording - hyperlinks to SPCs pharmacist very good Have links to evidence based not that i can think of Thank you for your comments, they guidance like how the NHS have been considered along with evidence website is now. Easier the other comments received in the to browse on mobile devices- consultation, to inform the but should assure the user that development of the enhanced BNF. there is no opportunity to miss any information in the BNF about medications

Chest Pain I feel well used to using the print I would be happy to use a Don't think so. Thank you for your comments, they Assessment version of the BNF - it is easy mobile device if one was have been considered along with Lead Nurse and portable. Using on-line provided by my employer for me the other comments received in the facilities is very dependent on to use - it would be good to consultation, to inform the computers being easily available, harness the use and power of development of the enhanced BNF. etc, which can make things very on-line methods of accessing NICE acknowledges that digital difficult. I also don't carry a information. infrastructure and access to tablet or mobile device with me portable devices throughout the

[Insert footer here] 277 of 383 at work, so accessing the BNF NHS is not fully developed. this way would be difficult. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. macmillan cns sounds fabulous but it MUST be palliative care information would there be a paper version Thank you for your comments, they user friendly and easy to contained in the new BNF would at all? have been considered along with navigate. help reduce the multiple sources the other comments received in the of information required to be consultation, to inform the accessed to gain appropriate development of the enhanced BNF. guidance. The palliative care NICE acknowledges that digital formulary being incorporated or infrastructure and access to as an addition would be very portable devices throughout the useful and as we move to NHS is not fully developed. national pal care guidelines it Distribution of print formats will will be easier to standardise the continue in line with user guidance. requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant A single source of accurate I want to see the BNF content Please note that it is not just Thank you for your comments, they Informaticist information is a vital; the BNF is available for use in active that prescribers that need to have been considered along with unique in having the JFC to decision support in clinical use the BNF (2.2); section 4.2 the other comments received in the assess and assure the systems throughout the NHS. says that much better. consultation, to inform the information it provides. This An enormous amount of work development of the enhanced BNF. information must be available was undertaken within the BNF seamlessly at the point of use - to lay the foundation for this but which is within systems. In has not been taken through to a primary care, the entire full production. This was an medication process is systems extremely sad outcome, and based; secondary care is behind indeed the BNF has now lost the curve but must catch up key staff that had the expertise soon. Consequently, the BNF to make that happen. I still see must be embedded within requests from clinicians on fora medicines use applications. In and the like for BNF-based

[Insert footer here] 278 of 383 order to minimise harm, the active decision support and I content must be active, not just know that the BNF has received passive as at present - see all numerous requests from system the evidence and discussion of suppliers over the years. investigators such as Bates et al Please, NICE, consider that for active clinical decision evidence! support. Being searchable and browsable in multiple ways is good, but it is by no means enough in today's world and definitely will not be enough for tomorrow's world. Patient focussed information may be useful, but it is not the BNF's core strength. The BNF should try to move properly into the 21st Century with the quality content that it has now rather than to try to branch out into other areas.

Consultant I whole heartedly agree with the Integration with guidelines, It assumes that everyone will Thank you for your comments, they concept but I still need access to evidence and current best eventually have digital access have been considered along with a book when I am out on home practice. Information on side and that this is practical to use the other comments received in the visits. I do not currently have effects and interactions in all situations. consultation, to inform the access to digital content outside development of the enhanced BNF. the hospital and even if I did it NICE acknowledges that digital would not be appropriate or infrastructure and access to practical in some situations. portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 279 of 383 Consultant I really like the new system No Thank you for your comments, they Psychiatrist although sometimes it depends have been considered along with Urgent Care on the network coverage (iPhone the other comments received in the app). I am also aware of the consultation, to inform the Athens access which maybe development of the enhanced BNF. could be coverted in a BNF NICE acknowledges that digital register with the creation of a infrastructure and access to personal account for prescribing portable devices throughout the practiotioners. NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

GP would be great to have on line I would like to do everything I no Thank you for your comments, they but it must be easy to search and can do with a paper version . have been considered along with quick and user friendly - we are mostly I wan t to be able to the other comments received in the in a remote area and internet search for a medicine quickly consultation, to inform the connection can be slow at times. either by brand name or generic development of the enhanced BNF. name. it would be good to be able to search by topic- eg migraine also . I need to be able to look up side effects and issues to do with pregnancy also .

Clinical senior Sounds good. Not really relevant for my Please ensure that you never Thank you for your comments, they lecturer practice. change the numbering of your have been considered along with subsections (except for adding the other comments received in the new sections with new consultation, to inform the numbers or new numbers if development of the enhanced BNF. splitting a section into two or more, eg if you wanted to divide lipid-lowering drugs into statins and others, or oral hypoglycaemic drugs by class). The Health Survey for

[Insert footer here] 280 of 383 England is one of a large number of ongoing research projects that uses the BNF as its coding frame for prescribed medications,

Clinical Nurse It's very useful as it is, so any Free and easy access to all Opportunity to link to the on- Thank you for your comments, they Specialist in enhancement will add to this and professionals who need to use line Palliative Care Formulary have been considered along with Palliative Care enable enhanced patient care, it. Up to date. (PCF) to the BNF, this would the other comments received in the symptom management, efficacy enhance the BNF. Free and consultation, to inform the and safety. up-to-date access to both BNF development of the enhanced BNF. and PCF would enable enhanced patient care, symptom management, efficacy and safety. Provision and free-access for UK health professionals of the BNF on- line and PCF on-line is a fundamental part of optimising safe and efficient prescribing. I have just completed the Non- Medical Prescribers course and am due to start prescribing in September 2014. In my specialist field of palliative care on-line free access to both PCF and BNF is vital in supporting safe and current prescribing practice.

[Insert footer here] 281 of 383 Sexual Health The benefits of an immediately Clear information pathways No Thank you for your comments, they Nurse available, frequently update BNF Timely updates have been considered along with are obvious when prescibing in a the other comments received in the busy clinical environment. consultation, to inform the Despite working in a specialist development of the enhanced BNF. area where you believe you keep up to date, one can be "caught out " by new advices introduced between clinical updates

Consultant in I think this is important and Interactions information could be No - I think this is an important Thank you for your comments, they Palliative necessary, to enable important streamlined - presumably an step and agree with the have been considered along with Medicine information to be accurate, up-to- electronic BNF would allow a proposal in the main. the other comments received in the date and readily accessible. The drug's potential interactions to consultation, to inform the key challenge would be to be presented by drug name, as development of the enhanced BNF. ensure that the local version can well as by drug class. (i.e, when be readily updated. To some looking up erythromycin, all extent, I already do something macrolide interactions could be similar by downloading NICE presented with the drug). guidance pdfs to a portable Currently, interactions are device. My main concern would checked against drug name and be people using an offline class to avoid missing anything version (such as saved to a important. Links to NICE tablet that is not regularly guidance for drugs such as updated) which would become abiraterone would be helpful if out of date. Perhaps a clear feasible. Adding access to other datestamp/review date or prompt related formularies would also to update would be useful. be important. For example, the PCF and the renal drug handbook.

[Insert footer here] 282 of 383 Senior The regular updating of the BNF The regular updates. There are occasions when a Thank you for your comments, they Pahrmacy is certainly a great thing. This branded medication may have been considered along with Technician ensures that I always have the appear in the printed BNF but the other comments received in the most up to date info available. cannot be found in the apps, i consultation, to inform the Also the ability to search by drug, think this needs addressing. development of the enhanced BNF. condition and patient Also I feel more differentiation characteristic will be of huge needs to be made between benefit when providing advice or search results in the app for answering specific questions. example I may search for Clopidogrel and get two results one will be for the actual entry and the other will be for the pack size and pricing information, but it is impossible to distinguish between the two on the search screen

CHIEF What are your views on the What do you think are the most Do you think we have Thank you for your comments, they PHARMACIST vision for an enhance BNF as important elements of an overlooked anything? A have been considered along with described? Better digital enhanced BNF? The complete and wholesale switch the other comments received in the platforms for the BNF offer the suggestion of providing new to digital only platforms for consultation, to inform the opportunity to provide significant functionality and improving the delivery of BNF content is development of the enhanced BNF. new functionality over and above BNF through updated and undoubtedly the right way NICE acknowledges that digital that currently available. As a first revitalised digital platforms is to forward. However, infrastructure and access to step, they might improve be welcomed. However, the achievability of this from a user portable devices throughout the integration of information, for BNF is a successful brand perspective needs to be given NHS is not fully developed. example improving linkages and because it is concise, some thought; in particular the Distribution of print formats will presentation between contextual authoritative, and accessible. barriers, both cultural and continue in line with user text, information in appendices, These core values must not be practical, to achieving such a requirements, subject to ongoing and information in individual threatened either by addition of switch need to be identified monitoring and review by the NICE monographs. In addition, they new functionality or by the work and understood. Board. could allow better control of involved in achieving them. It is Notwithstanding this, providing revisions and updates with therefore essential for the appropriate education and potentially positive impacts on success of this initiative that support is in place, a complete patient safety. They might also future digital platforms not only switch to digital only delivery enable embedding of BNF add functionality over and above within 5 years seems content in e-prescribing systems that available currently, but also potentially feasible. The as decision support directly, as present overall safer, easier to BNF book has a number of

[Insert footer here] 283 of 383 opposed to relying on current use, and more timely products useful spin offs, not least third-party solutions. However, than are currently available. The perhaps its distribution and whilst the overall vision is to be ability for continuous updating of use in the developing world welcomed, it should also be products on digital platforms is through the Pharmaid noted that a valued attribute of to be welcomed, and if such programme. The BNF also the BNF currently is its ability to platforms were the universal has an international reputation reflect both an assimilation of the access point to BNF information in other contexts. It would be evidence-base as well as in the future, this would a shame if this laudable practical and pragmatic clinical represent a real change with approach to spreading good wisdom. It would be a shame if patient safety benefits. Also practice, in particular through increased focus on the former particularly welcome is the the Pharmaid programme, precluded consideration of the suggestion that the BNF is were affected detrimentally by latter. Taken to its conclusion, an enhanced such that it is a the switch to digital only entirely evidence driven resource aimed not only at versions. approach would prevent the professionals but also at BNF’s useful function of patients. For the BNF to link to standardising licensed information that enables indications and adverse effect healthcare professionals and profiles for drugs in the same patients to reach decisions class. Similarly, the BNF has a together would be potentially potentially crucial role in hugely beneficial, particularly as operationalizing the evidence- healthcare professionals evolve driven recommendations of their approaches to thinking others: for example, providing about choices between guidance on appropriate treatment options. alternative courses of action where the regulator identifies safety concerns for an individual medici

[Insert footer here] 284 of 383 Lead Electronic access on wards in Improved electronic access in The decision to move to Thank you for your comments, they Pharmacist, NHS hospitals is variable and the NHS. A need to investigate annual paper copies has been have been considered along with Medicines very limited in some Infection Control issues over done without adequate the other comments received in the Information circumstances. There are in using personal Smartphones consultation with staff in the consultation, to inform the and Formulary addition issues around using Advice to Trusts and funding for front line. There are a number development of the enhanced BNF. personal Smartphones in clinical Tablets in clinical areas of clinical areas without NICE acknowledges that digital areas where there are Infection electronic access and staff infrastructure and access to Control Issues. Not everyone without Smartphones who will portable devices throughout the has Smartphones and nurses be unable to access the NHS is not fully developed. doing medication administration electronic BNF. Distribution of print formats will frequently refer to the BNF for continue in line with user information which would be requirements, subject to ongoing difficult without a paper copy or a monitoring and review by the NICE hand-held tablet. Issues over Board. Clinical Governance if an annual paper copy is issued as they will possibly remain in clinical areas longer than 6 months - are the CQC going to overlook expired information being present?

Advanced ok ok More work to align / work with Thank you for your comments, they Terminology existing terminology products, have been considered along with Specialist / such as SNOMED CT and the other comments received in the Pharmacy dm+d consultation, to inform the Quality Lead development of the enhanced BNF.

[Insert footer here] 285 of 383 Director Are all the features described in Improvements in searchability, Editorial or technical alignment Thank you for your comments, they Section 2 (e.g. interactions, cross referencing and with the NHS Drugs and have been considered along with linkages to conditions, unwanted browsability of the The Medicines Dictionary (dm+d) is the other comments received in the effect etc.) to be fully machine introduction of a standard not mentioned here. Given the consultation, to inform the readable i.e. actionable in active terminology/controlled latter is now a DoH mandate I development of the enhanced BNF. electronic prescribing decision vocabulary underlying the BNF had expected an explicit support systems? This is a is I assume already a part of statement on this. major technical and ontological these plans. Will this be challenge. The amount of input published? Links from BNF to required by knowledge workers relevant NICE guidance would is great - both initial setup and be welcome. Maintenance of maintenance. It also brings the these links and the level(s) / BNF into direct competition with kinds of data elements within the (and duplicates) major electronic BNF to which these links will drug databases like Cerner inhere is not however obvious. Multum, First DataBank Multilex. I question whether the time, skills and resources this would require are best spent on this endeavour even if they are available. specialist Agree with the principle of have Ease of use advanced search no Thank you for your comments, they nurse immediate information that is facility (eg search by drug, have been considered along with practitioner continually up-dated as required. contition, contr-indications etc) the other comments received in the consultation, to inform the development of the enhanced BNF.

Medical and I think their idea to have a more Thank you for your comments, they Dental digital & thus searchable & more have been considered along with easily updated BNF is good. the other comments received in the Important to keep it a consultation, to inform the manageable “size” so as not to development of the enhanced BNF. limit its useability day to day.

[Insert footer here] 286 of 383 Senior Having up to date information Being up to date The fact that on many wards Thank you for your comments, they Pharmacist, available digitally is of paramount there is not easy access to have been considered along with Medicines importance however I am aware electronic versions of the BNF the other comments received in the Information that my colleagues on the wards at present consultation, to inform the do not currently have easy development of the enhanced BNF. access to computers and do not NICE acknowledges that digital all have mobile phones which infrastructure and access to they can use on the wards. They portable devices throughout the therefore rely upon paper BNFs NHS is not fully developed. at present. Within Medicines Distribution of print formats will Information we do tend to use continue in line with user electronic versions of the BNF - requirements, subject to ongoing via Medicinescomplete primarily monitoring and review by the NICE however there are times, even in Board. this day and age, when internet access is not available and we then rely soley upon the paper BNF. We also still tend to flick through the paper version if we require a quick answer as it is still quicker than the internet on some occasions.

Advanced I completely support the vision A link to the guidance for the A concern on the robustness Thank you for your comments, they Practitioner for the enhanced BNF. Using medicines is an excellent of networks, ensuring that have been considered along with Sonographer electronic media will ensure that addition ensuring that access is always available. the other comments received in the the most up to date advice is prescribers can see the latest Whilst in most instances a consultation, to inform the available at all times. I currently guidance and where necessary delay in accessing the development of the enhanced BNF. find myself useing a book which look at the comparator and information may not be life NICE acknowledges that digital is more often than not out of alternative medicines within a threatening, it could certainly infrastructure and access to date. specific group. Also the link to be an inconvienience both for portable devices throughout the ensure that the interaction of prescribers and patients. NHS is not fully developed. medicines is clearly defined will Distribution of print formats will be an excellent addition leading continue in line with user to improved patient safety requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 287 of 383 Lead Oncology In theory it sounds very Enhanced features would be to Renal drug handbook can be Thank you for your comments, they Pharmacist interesting and would love to see link to other special sources linked in to provide better have been considered along with the developement of this , such as the palliative care dosing instructions , alond side the other comments received in the especially for an app which is formularly (PCF) which i with catogeries of drugs used consultation, to inform the freely available to healthcare extensivley use as the BNF in pregnancy or breast feeding development of the enhanced BNF. professionals, currently we are does not provide full info, maybe to simplify like ABCD etc Can provided with a hard copy of the for online applications the drugs the tablets be crushed is a bnf could be linked to their SPC common question or mixed from the emc site or your own with anything , taking into indivual database. Other account people with sources which were really swallowing difficulties . helpful in the past were medicines for children which does provide a lot of additonal information. Ambiguos terms and direction should be removed and linked to known sources which are used clinically like hte PCF or chemo protocols , or unlicesed doses.

Medical It is a very good vision. In my On-line as well as on an APPs. No. Thank you for your comments, they Director and opinion it is absolutely essential. Easily readable version effective have been considered along with Consultant in With the current changing book for a quick reference guide in the other comments received in the Palliative format, there is a danger that the midst of a busy working life consultation, to inform the Medicine professionals may not access and ward rounds etcetera. development of the enhanced BNF. the correct version and hence run the risk of prescribing inadvertently.

Consultant This sounds very appropriate Having a unified source of Paper copies need to be Thank you for your comments, they Paediatrician and useful. Having printed information and easy to use available as technology is not have been considered along with versions available is also helpful, fail safe and often more time the other comments received in the even if only annually updated. consuming. consultation, to inform the The majority of drugs we use development of the enhanced BNF. have standard doses that do not NICE acknowledges that digital change infrastructure and access to portable devices throughout the

[Insert footer here] 288 of 383 NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Medicines Digital platforms will provide The BNF is successful because Accessibility is fundamental to Thank you for your comments, they Information functionality over and above that it is pragmatic, authoritative, and the use of the BNF and the have been considered along with Pharmacist currently available. They will accessible. These are the most range of formats proposed is the other comments received in the improve integration of important elements of the BNF. welcomed. The reasons for consultation, to inform the information from different Many other resources provide the popularity of the print development of the enhanced BNF. sections similar to the way other evidence based information that version in this age of NICE acknowledges that digital resources do via use of support patient centred care. If technology must be explored infrastructure and access to hyperlinks. It would also allow the enhanced BNF can provide and understood to facilitate the portable devices throughout the better control of updates to the latter without detriment to widest accessibility. I note that NHS is not fully developed. facilitate assimilation of up-to- the former it will truly become a although the NZformulary is Distribution of print formats will date evidence into practice. first-line must have resource. only available in digital formats continue in line with user However, there can be a danger it can also be downloaded in e- requirements, subject to ongoing of information overload and lack book format and printed from monitoring and review by the NICE of focus as links are followed. pdf should that be preferable Board. The current strength of the BNF to the end user. Many lies in the pragmatic assimilation healthcare professionals are of the evidence, especially in the limited in their ability to do their text information that precedes job effectively by their lack of individual drug monographs. access to IT notably in patient This is easily lost in digital homes, community formats when search functions pharmacies and on hospital direct the user to specific drugs. wards. A wholesale switch to It is unarguable that for a digital formats without the resource to support safe and continued availability of a print effective use of medicines, version (even in cut down information needs to be up to form) that can be used as a date, accessible, evidence based ‘back up’ (healthcare and reliable. The vision for an professionals are aware of the enhanced BNF is laudable but I limitations of print versions but suspect overly optimistic in being they are better than nothing!) achievable, in particular the plan could be detrimental not only to allow quick comparisons of to patient care but also to the

[Insert footer here] 289 of 383 key information on effectiveness, aim of the BNF being a widely safety, patient factors and accessible respected resource. resource implications. However, I am pleased to see that information on drug interactions and unwanted effects will include a rating of their frequency and seriousness. This will facilitate patient discussions about therapy choice and will be an advantage over information in patient packs. I am also pleased to see that medical devices will be included; it would be helpful if these also included an evidence base of efficacy.

GP see below see below Apps available for too few Thank you for your comments, they tablet devices and phones - have been considered along with they need to be available for the other comments received in the ALL devices including kindle consultation, to inform the fire HD. I DON'T have a smart development of the enhanced BNF. phone and the only tablet device I have is a kindle. Also it would be best if the BNF was integrated into primary care prescribing software - i.e. Vision, EMIS, system 1, etc as too often the internet is too slow on the archaic N3 network to make it possible to look things up on the electronic BNF quick enough in a 10 minute consultation. Also GP registrars need to take a paper version on the BNF to the CSA as they are not allowed electronic devices or internet

[Insert footer here] 290 of 383 during the exam.

Senior I think if there are no paper No comment No comment Thank you for your comments, they Technician - copies of the BNF available for have been considered along with Medicines the medicines management the other comments received in the Management technicians it will be very difficult consultation, to inform the for the technicians to provide the development of the enhanced BNF. service to patients on the wards NICE acknowledges that digital that they currently undertake. As infrastructure and access to the ward based teams are not portable devices throughout the allowed to use mobile phones on NHS is not fully developed. the wards, they may not be able Distribution of print formats will to acces a computer on the continue in line with user ward, as usually the Dr's, requirements, subject to ongoing therapists and ward staff are monitoring and review by the NICE given priority as they are ward Board. based. As the technicians are not clinically trained, they are using the BNF to confirm doses, different strenghts of preparations available etc. Not being able to find this information out independantly will increase the pressure on the ward pharmacist, and make the technicians role in medicines management and medicine reconciliation more difficult. This would lead to a risk of more errors occuring.

[Insert footer here] 291 of 383 Pharmacist I think it sounds good I am just x x Thank you for your comments, they concerned about access for have been considered along with some healthcare professionals the other comments received in the who do not have internet access consultation, to inform the if the print version is stopped. development of the enhanced BNF. For example, I do cardiac rehab NICE acknowledges that digital talks with patients, and use the infrastructure and access to BNF for help if asked questions I portable devices throughout the cannot immediately answer. It NHS is not fully developed. would not be possible for me to Distribution of print formats will use the online BNF unless my continue in line with user hospital provides me with a requirements, subject to ongoing tablet, which seems unlikely. monitoring and review by the NICE Also, many community Board. pharmacists incredibly do not have internet access and so will be unable to access the BNF, which obviously will mean they will be unable to practice safely.

Associate Yes we need to move to online Nothing to add Implementation usability. Will Thank you for your comments, they Director East tablet based. Recently reviewed this work at the bedside? How have been considered along with Midlands uptodates CDS system which will patients feel if their doctor the other comments received in the health has worked well in the USA so is on the tablet in front of consultation, to inform the Innovation this should work here as we them? Will this reduce patients development of the enhanced BNF. Education become used to this style of confidence? These things Cluster working. need to be considers

[Insert footer here] 292 of 383 General I feel that the way forward is The enhanced BNF needs to be There are a number of other Thank you for your comments, they practitioner, through an enhanced BNF by the updated quickly and easily. The authoritative formularies have been considered along with medical use of information technology. pages should open within including the adult palliative the other comments received in the director of various devices in a clean care formulary and the children consultation, to inform the children's manner with out data or the Association of paediatric development of the enhanced BNF. hospice, dosages split across pages palliative medicine drug executive formulary. The BNF needs to member consider how it can integrate Association of the up-to-date evidence within paediatric these formularies or even to palliative take over the work for these medicine types of formularies. I'm sure that other specialities also have similar formularies e.g. the neonatal formulary. It may also be possible in the future to attach these other formularies as appendix to the BNF itself.

Advanced this new proposed format will current, up-to-date information. no Thank you for your comments, they Nurse allow frontline clinicians to no longer subject to out-of-date have been considered along with Practitioner prescribe both drugs and devices books that are always lurking in the other comments received in the with a feeling of safety. by the work environment. it will be consultation, to inform the allowing such an extensive an easily readable and development of the enhanced BNF. access to information, shareable format - prescriber considered and thoughtful and patient can view screen prescibing will be enhanced with together and make responsible the proposed information links choices quickly and with that will allow partnership confidence. working and meaningful discussion between prescriber and patient.

[Insert footer here] 293 of 383 Consultant in Fully support this approach, Inclusion of detailed evidence No Thank you for your comments, they palliative could use/be linked to suitable based guidelines for each have been considered along with medicine resources which already specialty. Easier to use the other comments received in the exist,such as: the Palliative Care information re drug interactions, consultation, to inform the Formulary grading of adverse effects. development of the enhanced BNF. (www.palliativedrugs.com), the Renal Handbook, the Maudsley Prescribing Guidelines.

Hospital In a busy ward area/pharmacy Ease of use is the most BNF is seen as an Thank you for your comments, they Pharmacist department it can be difficult and important factor so that the independent national resource have been considered along with timely to access the BNF online relevant information is easy and where as NICE is an the other comments received in the (due to lack of computer access quick to find and use. Obviously department of health English consultation, to inform the and time taken to log on to would want the information to be resource which may not be development of the enhanced BNF. computer- as each member of up to date, authoritative and relevant within Scotland and NICE acknowledges that digital staff is expected to log on/off relevant to clinical practice as Wales. infrastructure and access to each time they access a well. portable devices throughout the computer). Currently there is NHS is not fully developed. limited use of mobile devices Distribution of print formats will (due to cost). So having access continue in line with user to a print copy of the BNF is requirements, subject to ongoing essential to enable myself as a monitoring and review by the NICE pharmacist and independent Board. prescriber to carry out my job. By having a print copy of the BNF I save time ( i.e do not have to spend time moving around the ward to find a computer and then log on access the online BNF). Also some of the information on the online version of the BNF is difficult to use (interactions section in particular). With print version it is easier to read over a larger section of information to get an overview of a section, this is more difficult to achieve on the online version as less

[Insert footer here] 294 of 383 information is immediately available and can involve a lot of clicking on links and moving back and fore between screens. Sometimes you need an overview of a section to guide your clinical practice rather then just a particular detail (which is relatively easy to access either online or in print)

ST3 Paediatrics The use of digital technology to Digital access on NHS N/A Thank you for your comments, they help with BNFc access is long computers (i.e. not having to log have been considered along with overdue. on to the internet and log in) the other comments received in the Digital access on smartphone/ consultation, to inform the tablets Easy to use above development of the enhanced BNF. systems

Consultant I strongly agree. I'm keen to see Electronic version with tabs and No Thank you for your comments, they more easily browsable BNFc. easy manoeuvre have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF.

Consultant in Looks good Easier access Would be very useful to have Thank you for your comments, they palliative access to the palliative care have been considered along with medicine formulary on line or via app the other comments received in the nationally. Currently a consultation, to inform the subscription only service. This development of the enhanced BNF. would compliment the enhanced BNF.

Professor of With the majority of users still Clarity, brevity, most used The case for going digital is Thank you for your comments, they Clinical relying on print versions, information clearly visible at the made but the considerations have been considered along with Nursing optimising for digital formats is first attempt, not multiple layers for managing paper copy in the other comments received in the likley to herald unanticipated to access essential information that environment does not consultation, to inform the problems in use unless a full risk appear to have been so development of the enhanced BNF. assessment is completed and adesquatly described. NICE acknowledges that digital

[Insert footer here] 295 of 383 findings addressed infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Specialty It would offer a more rounded That it will be searchable using a Linking to NICE Guidance. Thank you for your comments, they Doctor service and guaranteed to be up number of criteria. Opportunity to develop have been considered along with Palliative to date. It is often difficult to national guidelines for the other comments received in the Medicine access the most recent BNF management of symptoms that consultation, to inform the book. aren't covered under NICE development of the enhanced BNF. Guidance and have these available online. It would be helpful if a patient has a serious side effect from a drug to be able to enter the patient's full list of drugs and be able to identify the likely culprit or whether the side effect is due to a combination of drugs or possibly an as yet unreported side effect. Linkage to 'yellow card' system for reporting side effects. Reminder that it would be appropriate to check certain blood parameters e.g. if prescribing methotrexate Link to eGFR calculator for those drugs where dose modification required in renal impairment/failure.

[Insert footer here] 296 of 383 Senior Practice Better digital platforms for the The suggestion of providing new A complete and wholesale Thank you for your comments, they Pharmacist BNF offer the opportunity to functionality and improving the switch to digital only platforms have been considered along with provide significant new BNF through updated and for delivery of BNF content is the other comments received in the functionality over and above that revitalised digital platforms is to undoubtedly the right way consultation, to inform the currently available. As a first be welcomed. However, the forward. However, development of the enhanced BNF. step, they might improve BNF is a successful brand achievability of this from a user NICE acknowledges that digital integration of information, for because it is concise, perspective needs to be given infrastructure and access to example improving linkages and authoritative, and accessible. some thought; in particular the portable devices throughout the presentation between contextual These core values must not be barriers, both cultural and NHS is not fully developed. text, information in appendices, threatened either by addition of practical, to achieving such a Distribution of print formats will and information in individual new functionality or by the work switch need to be identified continue in line with user monographs. In addition, they involved in achieving them. It is and understood. requirements, subject to ongoing could allow better control of therefore essential for the Notwithstanding this, providing monitoring and review by the NICE revisions and updates with success of this initiative that appropriate education and Board. potentially positive impacts on future digital platforms not only support is in place, a complete patient safety. They might also add functionality over and above switch to digital only delivery enable embedding of BNF that available currently, but also within 5 years seems content in e-prescribing systems present overall safer, easier to potentially feasible. The as decision support directly, as use, and more timely products BNF book has a number of opposed to relying on current than are currently available. The useful spin offs, not least third-party solutions. However, ability for continuous updating of perhaps its distribution and whilst the overall vision is to be products on digital platforms is use in the developing world welcomed, it should also be to be welcomed, and if such through the Pharmaid noted that a valued attribute of platforms were the universal programme. The BNF also the BNF currently is its ability to access point to BNF information has an international reputation reflect both an assimilation of the in the future, this would in other contexts. It would be evidence-base as well as represent a real change with a shame if this laudable practical and pragmatic clinical patient safety benefits. Also approach to spreading good wisdom. It would be a shame if particularly welcome is the practice, in particular through increased focus on the former suggestion that the BNF is the Pharmaid programme, precluded consideration of the enhanced such that it is a were affected detrimentally by latter. Taken to its conclusion, an resource aimed not only at the switch to digital only entirely evidence driven professionals but also at versions. approach would prevent the patients. For the BNF to link to BNF’s useful function of information that enables standardising licensed healthcare professionals and indications and adverse effect patients to reach decisions profiles for drugs in the same together would be potentially

[Insert footer here] 297 of 383 class. Similarly, the BNF has a hugely beneficial, particularly as potentially crucial role in healthcare professionals evolve operationalizing the evidence- their approaches to thinking driven recommendations of about choices between others. The BNF must consult treatment options. more on how content not driven solely by published evidence is derived, but conversely this function should not be overlooked in the move to digital platforms.

Consultant The enhanced BNF offers some The live updating function would It isn't clear from the Thank you for your comments, they Psychiatrist minor advantages in the be useful. Other functions are consultation paper whether have been considered along with proposed format however it well served by the current access to the print format will the other comments received in the should not replace the hard copy format. be maintained. Access to an e- consultation, to inform the that clinicains currently use. version requires hardware (eg development of the enhanced BNF. Access to internet based a smart phone) and internet NICE acknowledges that digital resources is severely limited in access. In this region internet infrastructure and access to my region by slow 3G networks access is not available in rural portable devices throughout the and patchy coverage. To remove areas where many patients are NHS is not fully developed. access to the hard copy would seen, due to poor 3G coverage Distribution of print formats will mean that clinicians would have and connectivity. continue in line with user to make prescribing decisions requirements, subject to ongoing without access to appropriate monitoring and review by the NICE prescribing information and this Board. would put patients at risk.

CT3 LAS To be specifc, detailed, not clear, specific and full dosing To recommend physical health Thank you for your comments, they Psychiatry giving too much repeatitive details in one page not in checks about some have been considered along with generic information. e.g some of different places. treatements before during or the other comments received in the the basic inforamtion about drug after the course. Or be in tune consultation, to inform the category is repeated in each with NICE guidleines.e.g to development of the enhanced BNF. chapter but there is not enough suggest requirements before inforamtion about the "dosing". clozapine initiation; things like ECG, blood tests and phyisical examiantions

[Insert footer here] 298 of 383 Pharmacist I think the BNF currently plays a Medical devices would be really Not enough emphasis on the Thank you for your comments, they vital role in medicines useful and maybe some of the IT issues and the fact that have been considered along with management and the available commonly used herbal several settings do not have the other comments received in the information is key to all remedies. More information on adequate access. Secondary consultation, to inform the prescribers. Updated quality commonly used off label care staff are often sharing development of the enhanced BNF. information on drugs is key.It will medicines will allow Gp's etc terminals which are used for NICE acknowledges that digital be useful to have a more easily more information about these many other uses. Timely infrastructure and access to updatable referance source and medicines and give them the access to information is key to portable devices throughout the if you can search in multiple confidence to take over clinical avoid delay in the prescribing NHS is not fully developed. ways, such as by drug, condition prescribing. process and guesswork may Distribution of print formats will and patient characteristic, this take over. continue in line with user will be better still. It will also be requirements, subject to ongoing useful in this format to assist in monitoring and review by the NICE electronic prescribing in the Board. future and overlaying information onto local formularies. However they key issue will be availability particulary in a secondary care setting when terminals are at a premium.

Research I think it would be very Easy to access, easy to use, OTC drugs and use with POM Thank you for your comments, they Pharmacist problematic to introduce an access to info on OTC drugs, medication. If, for example a have been considered along with online only BNF, nice as it would side effects search server went down as does the other comments received in the be. Having recently come out of happen, how dangerous would consultation, to inform the community pharmacy where I it be for a pharmacy to development of the enhanced BNF. was for 15 years, I have never potentially be without NICE acknowledges that digital worked in a pharmacy that had access?? infrastructure and access to adequate internet access. This portable devices throughout the may be in capability (speed, poor NHS is not fully developed. internet connection) or in that it is Distribution of print formats will not always possible to access a continue in line with user terminal when you want to look requirements, subject to ongoing something up. In a busy monitoring and review by the NICE pharmacy, quite often all Board. terminals are in use with labelling. Also, many consulting rooms do not have internet

[Insert footer here] 299 of 383 access. I think having more info on frequencies of side effects (more like Medicines Compendium) would be useful.

Locum Great idea in principle - allows Clear, concise information as above Thank you for your comments, they Consultant for information to be up to date Would be useful to have it linked have been considered along with Palliative Care and accurate with the palliative care formulary the other comments received in the especially for our field of work consultation, to inform the development of the enhanced BNF.

Specialist I think it relies on having Ease of use and accessibility Yes computer access. Thank you for your comments, they Renal adequate access to computers have been considered along with Pharmacist for all users. At present within my the other comments received in the organisation we do struggle for consultation, to inform the computer access therefore if development of the enhanced BNF. everything is electronic finding NICE acknowledges that digital answers to questions will not be infrastructure and access to as simple and fast as it once was portable devices throughout the before. Also i feel people will NHS is not fully developed. continue to use out of date Distribution of print formats will copies which will leave us open continue in line with user to errors. requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 300 of 383 professor of I am concerned about nurses I think that many will not be able Yes the poor staff and their Thank you for your comments, they prescribing working in rural communities with to access the online version, patients who don't have have been considered along with and medicines no access to the internet, also and that phasing this change in access to the internet and will the other comments received in the management staff nurses on wards where the over a period of time is what is be at risk, and who employers consultation, to inform the BNF papercopy is the only required. I also have concerns wont provide the required development of the enhanced BNF. mobile source of information. about staff using mobile phones hardware to. Getting a BNF NICE acknowledges that digital Many employers don't have the on wards or when they are with can be a challenge, getting a infrastructure and access to hardware or the IT systems with patients. The Nursing profession tablet or laptop will be almost portable devices throughout the internet access available to all has had many unhappy patients impossible in cash strapped NHS is not fully developed. staff. This reduction in printed in recent years and the NHS organisations! Distribution of print formats will copies needs to be phased in to accusation that they aren't continue in line with user allow employers to get their caring, if staff are looking the requirements, subject to ongoing systems in place. Reducing to BNF up on their smart phones, monitoring and review by the NICE one paper copy per year will will public perception be that Board. mean that this is the only source they are answering texts or of information some practitioners going onto social media sites, or will have access to. This risks that they are using this as a patient safety considerably, as clinical tool! I believe that it with around 60,000 report could be very harmful to how all medication incidents per year medical and allied staff are (and this being the tip of the viewed. iceberg) giving only one paper copy (when there are on average 4 significant changes per month) when many don't have access to internet is irresponsible. senior Lecturer pleased to see that evidence greater calrity fo side effects NPF to inclde interactions Thank you for your comments, they base is being considerd furtye to section to aid prescribers using have been considered along with enhance decison making this formulary the other comments received in the consultation, to inform the development of the enhanced BNF.

[Insert footer here] 301 of 383 Consultant in I would welcome an enhanced 1 Easy access in a variety of Direct links from the BNF to Thank you for your comments, they Palliative BNF and feel now would be settings 2 Continuous updating the on line Palliative Care have been considered along with Medicine timely as our hospice is moving including supply alerts 3 Formulary (PCF), opioid the other comments received in the from a paper system to using Highlighting interaction/side conversion tools and syringe consultation, to inform the Crosscare. Electronic prescribing effects 4 Reliability and speedy pump compatibilities would development of the enhanced BNF. would be aided by an enhanced resolution of potentially also be very useful. BNF. Information on interactions conflicting advice from other and side effects at the time of sources. prescribing would be advantageous. The ability to highlight any current issues e.g. supply problems would be valuable. More detailed advice on prescribing in hepatic and renal failure could be included or hyperlinks could permit access to existing resources.

Macmillan Lead Would welcome ready, free access to PCF no Thank you for your comments, they Cancer Nurse access to PCF have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF.

CT1 Psychiatry Print BNF are still essential I think it would be helpful to have More information would be Thank you for your comments, they especially with multiple home more of an understanding of the good on renal/liver prescribing. have been considered along with visits in order to ensure safe frequency and severity of Possibly icons regarding safe the other comments received in the prescribing. The BNF app interactions. in pregnancy/renal consultation, to inform the frequently updates itself and then disease/liver disease. development of the enhanced BNF. requires a memory of the NHS NICE acknowledges that digital athens password which infrastructure and access to frequently is changed/easy to portable devices throughout the forget with multiple passwords NHS is not fully developed. for other purposes. Without the Distribution of print formats will print edition i will have little ability continue in line with user to check the BNF so will have to requirements, subject to ongoing see a patient, go to the office monitoring and review by the NICE and then go back to see the

[Insert footer here] 302 of 383 patient and provide the Board. prescription once i have accessed the BNF where i am unfamiliar with the medication. This may delay prescriptions by 2-5 days.

GP seems fine Linking to prescribing support I think every ccg is ring to Thank you for your comments, they and evidence bases is good. i repicate the BNF in part as a have been considered along with use CKS as easiest to use. local formulary - all doing this the other comments received in the Unifying the best practice and individually and sourcing IT consultation, to inform the prescribing seems good. Build in support and web hosting to do development of the enhanced BNF. calculators -eg this. Why not have an ability to chadsvasc/hasbled "skin" the bnf according to local need incorporating local guidelines. 212 ccgs each spending lets say £5000 annually to maintain a formulary- £1m annually nationally

Consultant in Although it will be challenging for I would want the enhanced BNF No Thank you for your comments, they Palliative me to get used to using an online to be linked to the online version have been considered along with Medicine version rather than the print one I of the Palliative Care Formulary the other comments received in the am used to, I think it will be & Electronic Medicines consultation, to inform the beneficial to be confident that the Compendium, both of which I development of the enhanced BNF. information I am accessing is up use regularly. to date & linked to other sources of prescribing info,

[Insert footer here] 303 of 383 Surgical Care The BNF should move away I would like to see a BNF that is Linking to NICE guidance and Thank you for your comments, they Practitioner from a model that is based on up to date at all times. The clinical trials. For example, have been considered along with the paper version. digital link between the BNF and under ACE inhibitor the BNF the other comments received in the supporting evidence form other will provide prescribing consultation, to inform the sources is what would be most information for ACE inhibitor development of the enhanced BNF. beneficial to myself. following MI. This could be enhanced with linkage to NICE guidance and significant published trails.

Clinical Nurse I agree with the vision of the I would want this to be linked to links to an upto date electronic Thank you for your comments, they Specialist enhanced BNF in that it is based the electronic rescribing, as version of the palliaitve care have been considered along with MAlignant on exploiting the advantages suggested be searchable and formulary (PCF) which the other comments received in the Bone offered by digital media to browsable in multiple ways, comprises of drug consultation, to inform the provide the right information, in such as by drug, condition and momographs and more development of the enhanced BNF. the right format, in the right patient characteristic, so it can general medical topics would NICE acknowledges that digital place, at the right time. however be easily accessed. Include high enhance prescribing for infrastructure and access to total reliance on IT and internet quality prescribing information to patients with life limiting portable devices throughout the access at present does not help improve patient outcomes conditions or for patients NHS is not fully developed. support this use in the acute by supporting health requiring symptom Distribution of print formats will setting. access to trust WI-FI professionals to choose the right management as part of their continue in line with user from devices other than PC's medicine, at the right time for cancer treatment requirements, subject to ongoing need to be considered. the right patient, including monitoring and review by the NICE patients with more than one Board. medical condition.

[Insert footer here] 304 of 383 Consultant in I agree that it is a sensible and I think having the ability to keep No I think you have covered Thank you for your comments, they Palliative appropriate approach. the document updated and the main points. have been considered along with Medicine linking to other sources of the other comments received in the prescribing evidence is very consultation, to inform the helpful. In particular I was development of the enhanced BNF. interested in the links to other NICE acknowledges that digital sources of information. As a infrastructure and access to specialist in palliative care I portable devices throughout the would value a link to the NHS is not fully developed. Palliative Care Formularly 4 (or Distribution of print formats will future updated versions). As well continue in line with user as a being a full time clinician requirements, subject to ongoing prescribing for patients with monitoring and review by the NICE palliative care needs I am also Board. the co chair of the Scottish Palliative Care Guidelines Steering group. We have been fortunate in Scotland to have had the PCF4 available as an online resource via the NES Knowledge Network. As you will be aware the PCF4 is a core text and source of evidence for prescribing in palliative care and we plan to have links from our electronic guidelines to this site. I also regulary use it clinically as it conatins more information on specfic drugs that we use in palltive care than the BNF could carry in a paper format. I also find it a very useful teaching resource especially when using medications that generalist clininians may have littel experience of and can direct fellow clinicains to it when required.

[Insert footer here] 305 of 383 Macmillan Lead I would be happy to support all I would be keen to see linking to No. Thank you for the Thank you for your comments, they Principal the principles described in the additional core texts/resources I opportunity to comment. have been considered along with Clinical consultation document. routinely use. In particular I the other comments received in the Pharmacist would like to see linking to the consultation, to inform the (Palliative on line Palliative Care Formulary development of the enhanced BNF. Care) (PCF) which I use in my own practice and as an aid in advising other clincians.

Pharmacist Broadly supportive, but feel it Recommending (with No. Thank you for your comments, they may be too ambitious. For BNF- references) doses that are have been considered along with C in particular, the main use is in perhaps not licensed, but where the other comments received in the finding out what dose to use, a strong body of published consultation, to inform the rather than choice of therapy. evidence exists to suggest a development of the enhanced BNF. Indeed choice often comes down different dose should be used. to local factors which may or may not include appraisal of NICE guidance, and it may take quite a change of practice before people start using BNF to help them decide what to prescribe. I would find referencing of dose recommendations useful to help decide whether to follow them e.g. the recent change of co- amoxiclav frequency from 8 to 12 hourly in children under 3 months seems largely to have been driven by SPC changes that were being harmonised across Europe rather than being based on any sound evidence. Since co-amoxiclav is safe when given 8 hourly to children > 7days old, is a time dependent agent, and we live in a time of increasing antimicrobial resistance, it is tempting to

[Insert footer here] 306 of 383 ignore BNF-c dosing on this.

Senior I am for the enhanced BNF if Up to date information at your No Thank you for your comments, they Pharmacy access to network can be finger tips. have been considered along with Technician maintained at all times and Trust the other comments received in the IT can provide the resources consultation, to inform the needed for mobile phone or development of the enhanced BNF. ipads apps to accessible. Every area of hospital need access to network - currently staff are fighting for access to PCs There has to be drive to train or all staff to use technology rather than papercopies (which should be removed from all locations). Need to have more user friendly navigation system

Consultant in Will improve the usefulness of Include the Palliative Care The BNF should remove its Thank you for your comments, they Palliative Care information. Formulary (see below) sections on palliative care and have been considered along with Medicine adopt the Palliative Care the other comments received in the Formulary which is a far consultation, to inform the superior source of information development of the enhanced BNF. on palliative care prescribing. As many conditions become more life limiting than life threatening the need for high quality information on palliative care prescribing will become increasingly important.

Medical Officer Sounds good Easy, up to date access Please link PCF (Palliative Thank you for your comments, they in Palliative care formulary) to BNF as this have been considered along with Medicine would enhance the service the other comments received in the consultation, to inform the development of the enhanced BNF.

[Insert footer here] 307 of 383 Specialist Good idea as always the most Constant updating Easy to use Just concerned for those Thank you for your comments, they Medicines up to date version available. online without digital access. We are have been considered along with Management Worry about staff not having not supplied with smart pones / the other comments received in the Technician access to digital version eg when iphones so not everyone can consultation, to inform the out on visits or in places with no access the BNF if no paper development of the enhanced BNF. signal for internet copy available. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. medical Positive step forward and reflects Easily accessible and easy to No Thank you for your comments, they secretary modern thinking and ways of navigate have been considered along with working the other comments received in the consultation, to inform the development of the enhanced BNF.

Medicines I agree with the general aims, Accessible Easy to read format Not that I can see. Thank you for your comments, they Management however I find the current BNF for all information have been considered along with Pharmacist online is not formatted in a way the other comments received in the which is easily read. It is best consultation, to inform the used for specific questions, such development of the enhanced BNF. as the dose of a particular NICE acknowledges that digital medicine. The notes on infrastructure and access to prescribing in each section of the portable devices throughout the BNF are extremely useful in my NHS is not fully developed. work and these are not as easily Distribution of print formats will accessed or as obvious in the continue in line with user online version. There is a risk requirements, subject to ongoing that prescribers looking for a monitoring and review by the NICE particular piece of information Board. will neglect to read them entirely. While electronic resources are becoming more and more

[Insert footer here] 308 of 383 important, my hospital does not yet have sufficient computer terminals on wards to facilitate regular access to an online BNF. This is further complicated by the fact that the wards do not have access to the external internet, and ward staff are not permitted to carry smartphones while on the ward.

Community I believe it is a good idea to #NAME? No I feel it has a Thank you for your comments, they Heart Failure move towards the digital comprehensive consultation have been considered along with Specialist approach of delivering the BNF which is appropriate given the the other comments received in the Nurse and updating information on a times we work in; however I consultation, to inform the regular basis. Having access to a would like a print version to be development of the enhanced BNF. laptop, as we move to mobile maintained for those times NICE acknowledges that digital working in the next month and a when remote access or IT infrastructure and access to blackberry to download any systems break down! portable devices throughout the Apps, I am happy to dispense NHS is not fully developed. with my print edition. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Pharmacy As long as access is restricted to more updated details rather than no Thank you for your comments, they Manager healthcare professionsals as only every 6 months have been considered along with patients will end up demanding the other comments received in the certain things or scaring consultation, to inform the themselves development of the enhanced BNF.

Associate Would be helpful. I would Up to date evidence based As above Thank you for your comments, they Specialist particularly value inclusion/link to information have been considered along with Palliative the PCF ( Palliative care the other comments received in the Medicine formulary) an invaluable consultation, to inform the palliative care resource that I development of the enhanced BNF. frequently use.

[Insert footer here] 309 of 383 Improvement We are very supportive of this Improved safety and speed of We have made the following Thank you for your comments, they Manager proposal and can see the access to searchable data. This assumptions: - the e BNF will have been considered along with benefits of improved safety and proposal has potential to link be embedded within GP the other comments received in the the linkages with NHS England with digital care plans that will systems for ease of access to consultation, to inform the vision for all people with long allow patients to access drug information. - e BNF will be development of the enhanced BNF. term conditions to have access information. free - users will be updated of NICE acknowledges that digital to digital care plan by 2015. changes via e bulletins/alerts infrastructure and access to - consideration will be given to portable devices throughout the people living or working in NHS is not fully developed. areas with poor signals - Distribution of print formats will recognition of the hardware continue in line with user and software costs for requirements, subject to ongoing organisations have been taken monitoring and review by the NICE into account. Board.

Medical Library It seems inevitable that the BNF Offline usage You need to include the Thank you for your comments, they Manager has to progress to online only Channel Islands in the deal - have been considered along with and use existing / emerging we cannot access any NHS the other comments received in the technologies ATHENS resources and are consultation, to inform the extremely disadvantaged in development of the enhanced BNF. this respect. We have a fair sized hosptial as well as over 100 GPs, and everyone relies on the print version, which is not really viable anymore, especially when compared to the app. To purchase online access is too expensive as it stands. Though it is free online on registration, offline handheld accesss is really what is needed. We are especially stretched financially as we have to create a bespoke collection of online databases, books and journals to try and provide parity with NHS Evidence, which is quite

[Insert footer here] 310 of 383 a tall order, given a small library budget occasional contributions from other department. Please help us! pharmacist It's all well and good having an That it be user friendly, eg allow Don't know. Thank you for your comments, they on-line version, and the updates two or more tabs to be open if have been considered along with in between printed editions are looking up related things. the other comments received in the useful,, but I don't think it can consultation, to inform the replace the usefulness of having development of the enhanced BNF. a printed book. In a busy NICE acknowledges that digital community pharmacy it is easier infrastructure and access to to look up what we need more portable devices throughout the information on in a book so that NHS is not fully developed. the computer can still be used for Distribution of print formats will other procedures. Perhaps the continue in line with user on-line version is more pertinent requirements, subject to ongoing to hospital pharmacy. monitoring and review by the NICE Board.

Academic The BNF is widely considered to Ability to access content via Full integration into existing Thank you for your comments, they Pharmacist be the authoritative quick tablet, smart phone and other electronic prescribing (primary have been considered along with reference guide to medicines handheld devices. Ability to and secondary care) and PMR the other comments received in the and as such should be the single easily search by multiple routes / software. Inclusion of detailed consultation, to inform the recommended resource used by search terms / categories as guidance to guide not only development of the enhanced BNF. front-line NHS services. It is stated. Web links to further safe and efficacious, but also widely used by many healthcare information e.g. NICE guidance cost-effective choice of disciplines involved with and electronic Medicines medicines. electronic medicines and and contains Compendium (SmPC) A patient- compliance monitoring e.g. relevant additional information, centred version providing links push new guidance / updates guidance and support e.g. to PILs and relevant information to user and requires them to introductory sections / on medicines and general digitally sign to say they have appendices. As such the vision advice. Ability to open this read, understood and will to make this even more widely content within App or browser comply with this. available, accessible and screen, without having to access authoritative is welcomed. I an external site. would hope that this would reduce the excessive printing

[Insert footer here] 311 of 383 and distribution costs. The BNF is widely used as a teaching aid within undergraduate and postgraduate education of healthcare staff involved with medicines.

Chief Need to ensure that everything Easy to use; links to other People still like hard copy for Thank you for your comments, they Pharmacist matches and that information authoritative guidance easily; easy reference and to browse. have been considered along with provided is accurate and up to includes up to date prices; Need to consider whether like the other comments received in the date. In terms of medicines, includes medicines optimisation the drug tariff you have a pdf consultation, to inform the need to highlight in the BNF advice supporting concordance version which you can down development of the enhanced BNF. products which are referred to before automatically escalating. load if you wish-not NICE acknowledges that digital generically but which are necessarily to print out but infrastructure and access to unlicensed 'specials' from a sometimes easier to use in this portable devices throughout the primary care point of vie useful format. Access to electronic NHS is not fully developed. to inlcude NICE agreed version availalbe to all NHS Distribution of print formats will pathways within the BNF to staff.... continue in line with user support optimisation of requirements, subject to ongoing treatments. monitoring and review by the NICE Board.

Retired Good idea, but the project needs Addressing the point you raised As above: do not Thank you for your comments, they pharmacist to be done very gradually and about the sometimes conflicting underestimate how long all this have been considered along with piloted to a wide range of user advice from NICE and that in the will take to do. Ensure the the other comments received in the groups and refined thoroughly BNF. Get this right in the print expertise and knowledge of consultation, to inform the several times before being version first, for BNF users to the current BNF team are fully development of the enhanced BNF. launched. Examples of the see what it's all about, then used throughout the project, as NICE acknowledges that digital proposed links between NICE move to digital. the changeover from the infrastructure and access to guidance and BNF would be existing digital format for print portable devices throughout the good to see. With no single to the new format will no doubt NHS is not fully developed. computer system in the NHS, throw up all sorts of problems Distribution of print formats will getting everything to work on all which will need to be solved on continue in line with user the UK's primary and secondary the spot by experienced requirements, subject to ongoing care systems will take a great production staff who also know monitoring and review by the NICE deal of time and effort in testing how the BNF is used in Board. before launch. Please a) learn practice. Make sure that plenty NICE will undertake extensive user from the originators AND the of 'detail people' are involved testing on any enhancements made

[Insert footer here] 312 of 383 users of the New Zealand at all stages - the BNF to the BNF. changeover about what did/didn't chooses every word with great work/what they would do care because of the differently if they were doing it importance of its information. again b) do NOT get rid of the Yes, you will need planners print version until everything is and people who can see the working smoothly with digital. I big picture, but the success of have seen chaos caused by this project will stand or fall on people insisting on sticking to detail. Users must have easy unrealistic project deadlines, and reliable access to the new rather than taking a bit more time format by whatever means for thorough testing of new they use, and attention to technology. Users rely on the detail will be the means to BNF to be there, in whatever ensure this happens first time, format, for quick reference in every time. busy clinical situations. This must not be forgotten by any of the advocates for change, it and must be top priority for the teams creating the enhanced version.

GP The print format is so useful for Speed and ease of access To be able to add one's own Thank you for your comments, they the majority of times needed. If notes eg on using a particular have been considered along with there are recent, urgent meds with a particular patient, the other comments received in the changes, these can be sent via would be good as can be done consultation, to inform the email/text. BNF via Kindle, or with pen in the print form development of the enhanced BNF. SMART phone would bridge the NICE acknowledges that digital gap for those carrying them. As infrastructure and access to for print BNF vs Kindle portable devices throughout the equivalent, you can't write in the NHS is not fully developed. margin as you can with the book Distribution of print formats will version. BNF in book format is a continue in line with user vital bit of kit in Third World of requirements, subject to ongoing course. monitoring and review by the NICE Board.

[Insert footer here] 313 of 383 Macmillan Excellent idea we need to checking odes, medications, and no Thank you for your comments, they Palliative Care emabrace new ideas, but may contraindiactions have been considered along with Clinical nusre also need fall back on access to the other comments received in the specialist hard copies. We are going wi fi consultation, to inform the here at our trust but we do not development of the enhanced BNF. always have the hard ware to NICE acknowledges that digital access on wards infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 314 of 383 Lead Surgical Although I find the print format The same information as in the Although using medication in Thank you for your comments, they Pharmacist easy to use, a good digital print version should be such a way is outside of have been considered along with source is as accessible, and available, but take advantage of product licenses, and evidence the other comments received in the more up to date. Sadly, the BNF the extra opportunities that is largely anecdotal, could it consultation, to inform the and BNFc apps are not even digital media offers - the chance look at how to administer development of the enhanced BNF. remotely good digital sources; to hotlink to other sections within medication to patients via PEG NICE acknowledges that digital I've found downloads and the BNF, or even to advice from tubes, ng tubes, which infrastructure and access to updates to fail on a regular basis, other sources, where that has medications can be crushed or portable devices throughout the and the information within it been the basis of what the BNF disersed in water, etc? This is NHS is not fully developed. seem less than within the print says, allowing users to go something that arises on an Distribution of print formats will book, meaning when I can straight to the original source extremely common basis on continue in line with user access it, I don't entirely trust material. Linking to SPCs and wards, and although there are requirements, subject to ongoing what I find there. The apps PILs, where available, via the some useful books out there monitoring and review by the NICE should, at the very least, contain eMC, makes a great deal of (we use the NEWT Guidelines Board. everything the print version does. sense and would be a great help in my Trust, though we have As it is, after using them for a to prescribers when looking at others available), but if we are while, I deleted them as not drugs. Making it easy to access going to make easily being worthwhile. Access via a and widely available is also of accessible digital media, then computer is useful, but often on vital importance, as on a ward, being able to answer these a ward or dispensary setting is doctors and nurses are likely to questions in such a format actually more time consuming refer to a print version (even if would be greatly useful to than using a print version, old) because of simplicity - any doctors, nurses and because of the need to find a digital media needs to be as pharmacists on an almost daily free computer to use. In the simple and easy for them to use, basis. The problem, of course, absence of the print versions, I and as widely known, or people would be finding evidence in would use them more often, will default to what they have such a manner that it would however, as the content is better always done in the past. satisy NICE. than the apps.

[Insert footer here] 315 of 383 Lecturer in While agreeing with the vision Important and useful elements Just to repeat the need to Thank you for your comments, they Clinical and that it isn't possible to of an enhanced BNF/BNFc consider access to the digital have been considered along with Pharmacy & maintain the absolute currency of would include: easy search tool; format, whether on-line or via the other comments received in the Pharmacy the material in the paper format, links to related material such as an App, in terms of who has consultation, to inform the Practice access to the digital format NICE guidance, MHRA access and what is to be done development of the enhanced BNF. would need to be carefully information, key evidence; more in areas of the country where NICE acknowledges that digital thought through. At present only portable; compatibility with network and broadband infrastructure and access to NHS staff may access the App decision-making tools; access is poor. portable devices throughout the therefore excluding all pharmacy signposting to safety information NHS is not fully developed. students and all community such as pre-treatment tests and Distribution of print formats will pharmacists. The on-line version on-going monitoring continue in line with user is less easy to use and has less recommendations; requirements, subject to ongoing functionality if this could be monitoring and review by the NICE addressed or allowing wider Board. access to the App then many of the disadvantages of going away from the paper format would be resolved. If it was on-line or App only what would happen in areas where network coverage and broadband access is poor e.g. rural parts of the country?

[Insert footer here] 316 of 383 Senior Lecturer Whilst I think the vision from the The most important element is See comments above Thank you for your comments, they in Clinical prosepctive of keeping up to date being up to date with the latest have been considered along with Pharmacy and with the most current changes information. It allows things such the other comments received in the Pharmacy and advice is essential, I am as MHRA alerts, NICE guideline consultation, to inform the Practice concerned that for everyone changes and other information development of the enhanced BNF. online access is not always ideal. to be actioned immediately, NICE acknowledges that digital From a teaching perspective it is keeping clinical governance high infrastructure and access to vital a student can 'use' a book on the agenda and putting our portable devices throughout the correctly and not simply really on patients first. NHS is not fully developed. a search online bringing up an Distribution of print formats will answer for them. Using a book continue in line with user such as the BNF I believe is an requirements, subject to ongoing essential skill that must be learnt. monitoring and review by the NICE Also some students still don't Board. have access to smart phones and IT outside of the university as we see a widening in participation in Higher Education and so this should be kept in mind. Also when IT fails, EPSr2 being a key example, we can find oursleves in difficult positions if we rely to heavily on IT alone for day to day practice. I am not against electronic versions, simple feel there needs to remain a dual approach.

[Insert footer here] 317 of 383 Prescribing I think this is a positive I find it more difficult to find the No Thank you for your comments, they Adviser development relevant part of the BNF when have been considered along with using the App & online access. the other comments received in the Only limited text is displayed. I consultation, to inform the can navigate around the paper development of the enhanced BNF. BNF to find the information I require more easily. I hope the enhanced BNF search facility would rectify this problem. If conflicting information from sources coudl be rectified as part of the process then that is important - common conflicts are between 'consensus best practice' and 'maunfacturers authorised doses / indications' etc.

Director of I am supportive of the concept as Robust evidence informed Digital delivery needs to be Thank you for your comments, they Quality and it means timely update of decision making as evidence of phased as need to take into have been considered along with Clinical effectiveness and safety data effectiveness and safety is account e-prescribing system the other comments received in the Effectiveness with its respective advantages continuously updated should availability in the various consultation, to inform the for clinicians and patients. improve patient outcomes. locations where healthcare is development of the enhanced BNF. Improving accessibility via provided. BNF is used not just enhanced digital access provides by clinicians with prescribing timely decision making rights, but also by other information. healthcare professionals, and digital access may not always be available.

[Insert footer here] 318 of 383 Consultant in I agree that the BNF should be From the palliative care Please include free access to Thank you for your comments, they palliative available to professionals via perspective, I think it is essential the palliative care formulary for have been considered along with Medicine electronic media and should be that medical and nursing staff those who have access to the the other comments received in the the primary source of drug caring for patients in the last BNF It may be useful to consultation, to inform the information for prescribing in the year of life have free access to include links to the not-for- development of the enhanced BNF. UK the latest online version of the profit emcMedicines website, Palliative care Formulary that would allow users to (currentlhy available on access the SPCs and PILs for subscription via drugs they are considering palliativedrugs.com) There are prescribing, so that they can compelling reasons for this: - decide - in partnership with most patients towards the end of patients - whether or not to life receive primary and prescribe drugs, having been secondary care, but a minority able to access information on receives specialist palliative care the frequency of various side (the group that generally invests effects etc in access to this either via the website or as a book), and therefore many patients do not have the benefit of their caring professionals accessing that resource - many of the professionals who do access the PCF at a cost currently, work for hospices which are largely charitably funded, and would greatly benefit from free access to the PCF online as part of the BNF - it is rigorously researched, and clearly states sources of evidence for recommendations (making it easy to see the level of evidence that has prompted the advice).

[Insert footer here] 319 of 383 GP Registrar Good idea. Local formulary annotations. I want to be able to make my Thank you for your comments, they own notes, and have these have been considered along with sync across devices, please. I the other comments received in the think you should consider consultation, to inform the merging the BNF and the BNF development of the enhanced BNF. for children. More intelligent ordering of search results in the apps / website.

Paediatric I fully support such an initiative. A digital format capable of Childrens BNF should also Thank you for your comments, they Consultant For long I have been using interacting and being in apps have an enhanced interface have been considered along with american systems for which can integrate with other with drug interactions as well the other comments received in the interactions etc but these are systems would fall in line with a as integration with medical consultation, to inform the frustrating as it does not vision of single point of access calculaters development of the enhanced BNF. integrate with anything here. and ability to connect with other software systems.

GP Please do not get rid of the print I think it would be useful to have no Thank you for your comments, they version. Our computers are guidance in one place but that have been considered along with unreliable and internet access is should not be only on line or the other comments received in the slow. It would seriously impact downloaded version.Until IT consultation, to inform the on consultation time if I had to improves in rural locations the development of the enhanced BNF. rely on internet access. print version is essential. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

GP Please do not get rid of the that there is a paper copy too No but I am concerned that Thank you for your comments, they paper version , vital to be able to those that do not have easy have been considered along with glance through , takes seconds access to the internet are the other comments received in the rather than minutes. Our internet overlooked consultation, to inform the is so slow here, as is the mobile development of the enhanced BNF. NICE acknowledges that digital

[Insert footer here] 320 of 383 network service infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Core Trainee in This is much needed. Linking to evidence about each No Thank you for your comments. Psychiatry drug.

CNS It is an excellent suggestion and Again a very useful document to Not from what I can see. Thank you for your comments, they will be a welcome change which have while on the community, have been considered along with will give added benefit for the and in areas where sometimes the other comments received in the patients we see. the mobile phone signal is poor. consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Clinical In principle the planned vision Comprehensive information Martindale is a fantastic Thank you for your comments, they pharmacist- sounds good but might be irrespective of cost implications. resource for diseases and have been considered along with critical care difficult to complete in practice. The BNF differs from NICE as it treatment options with the the other comments received in the By stating the resource will be a states the information rather reference sources available. consultation, to inform the single authoritive source there than apply pharmacoeconomic The enhanced BNF should development of the enhanced BNF. has to be acknowledgement of principles- the integrated NICE acknowledge primary and Distribution of print formats will all the unlicensed and off label information should be separate secondary research and continue in line with user uses of medicines which to the BNF information (links to include links where appropriate requirements, subject to ongoing currently the BNF does not the NICE guidelines on a to this information so that monitoring and review by the NICE provide information about. I separate website would be fine healthcare professionals can work in a critical care area with though). Unlicensed see the evidence base for

[Insert footer here] 321 of 383 access to a clinical information medications need to be treatments recommendations. Board. system and having a link to the acknowledged as well as off- The medicines compendium is online BNF is good but there is label use of medicines. The off- also a good resource and also the understanding it is not label use of medicines is having links to manufacturers the only resource available and contentious but also used literature would enable HCP all healthcare professionals regularly in all areas of the NHS. make correct decisions. More should have access to multiple information about resources to ensure appropriate pharmacodynamic effects of treatment options are used. medications and the Having an enhanced BNF with pharmacokinetics of links to NICE guidelines, primary medicines. Having easy evidence, UKMI resources, access to the half-life of SPCs, Martindale, Stockley etc. medications or how a drug is would a very valuable resource. metabolised would be a great Often there can be conflicting help. From a pharmacist point information from reliable of view- the BNF is used as a resources, the enhanced BNF resource available when taking would have to acknowledge this the pre-registration exam. If conflict rather than pick one the book ceases to exist how definitive option to recommend would this be accomodated in as there is not always just one this exam? answer. I agree that the hard copies of the BNF are now out dated and therefore an electronic only format is more appropriate. Continued links to CSM and MHRA safety updates and tables of equivalence (steroids) which are very useful.

Consultant The BNF already has the Easier onlie access. The apps Nothing apart from above. Thank you for your comments, they Psychiatrist characteristics that the document need to be easier to operate. have been considered along with aspires to. I think BNF should the other comments received in the remain a source of information consultation, to inform the for drugs and therapeutics. Whist development of the enhanced BNF. it is informative to refer to the guidelines fromNICE the source of information should remain

[Insert footer here] 322 of 383 independent of NICE.

Medical Please could you link the BNF to Accessibility for all, multiple No Thank you for your comments, they director the current Palliative Care formats including paper and have been considered along with Formulary to provide evidence online, regular updates the other comments received in the based prescribing for specialists consultation, to inform the and non- specialists in end of life development of the enhanced BNF. and palliative care? This online NICE acknowledges that digital service was free until recently infrastructure and access to and an electronic version free to portable devices throughout the all professionals like in Scotland NHS is not fully developed. would be great Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Consutlant in Palliative Care Formulary is Range of practice Palliative Care Formulary is Thank you for your comments, they Palliative essential for my work and would essential for my work and have been considered along with Medicine be an excellent resource for all would be an excellent resource the other comments received in the clinicians to be able to access. for all clinicians to be able to consultation, to inform the access. development of the enhanced BNF.

Consultant Very much welcome the move Real time updates Apps & No Thank you for your comments, they Respiratory towards enhanced content and immediate/anywhere have been considered along with Physician utlisability. More immediate accessibility the other comments received in the access via apps & with up to consultation, to inform the date changes will be great. I was development of the enhanced BNF. not aware that apps were available to NHS staff for free. Would definitely use this, if so.

[Insert footer here] 323 of 383 Macmillan It is a good rescourse, as it is It gives sound advice about Off license prescribing for Thank you for your comments, they Palliative care updated regularly. prescribing, prices of medicines palliative care. have been considered along with nurse and alternative, less expensive the other comments received in the specialist products. consultation, to inform the development of the enhanced BNF.

Advanced having discussed this with non Accurate and up to date Just to please bear in mind Thank you for your comments, they Nurse medical prescriber colleagues, information. Abilility to access that asscess to have been considered along with Practitioner/No we feel it meets the needs of information re drug interactions. computers/smart phones the other comments received in the n Medical modern healthcare. It enhances Links with local formularies. cannot be assumed to be consultation, to inform the Prescribing patient safety as up to date and universal. development of the enhanced BNF. Lead with the additional interactions help. Gives evidence based guidance. For those of us who are working in the community it will very much enhance our practice to be able to access digitally vai apps etc. 2 main concerns: If digital only some areas will then struggle, I am thinking of places like care homes where there may be no computer access when admin staff have gone home. Also relies on good consistent internet connections and needs to be user friendly as not everyone is technologically competent.

Clinical The points set out in Section 2 Access on line and via hand- Yes - you have completely Thank you for your comments, they Pharmacologis are commonsense and digital held devices - which most failed to take a 'global good' have been considered along with t access is already important for prescribers use daily. The latter view. Just because other the other comments received in the many users. Overall though, are something of an insurance institutions take a narrow user- consultation, to inform the this is a narrow NHS- and NICE- when online fails - as it does pays view does not mean that development of the enhanced BNF. centric vision for the BNF. If all often in hospital - or is just so the BNF/ NICE have to follow NICE’s remit is to provide access to this is going to be done, then it slow that people skip it. suit. Through my links with the BNF and BNFC in the UK. might as well be shared widely. However, whatever is said, it is other countries, I am led to Why limit the BNF - and the skills often useful to have a plain old believe that NICE has NICE International operates on a

[Insert footer here] 324 of 383 used to create it - like this? It is paper copy - especially when expensive consultancies strict non-profit fee-for-service basis also a rather selfish approach. several people are discussing whereby it 'assists' others in and follows Her Majesty's Treasury For many years, prescribers in something. Also, it's easier to healthcare issues. For once, regulations on commercial activities much poorer regions than the UK flip between pages in the paper taking a global good by public sector organisations. have used the BNF as a version. perspective and making prescribing standard - while access available, ideally freely Costs for all international activity access was often by handed-on or certainly cheaply, for have to be fully recovered. Further copies, there is an opportunity example through WHO, would information is available here: right now to share the benefits be a real service - and I am but it is not evident in this rather sure DFID could use some of http://www.nice.org.uk/About/What- selfish vision the resources it uses not so we-do/NICE-International/About- well in some areas to assist NICE-International here.

Advanced I am broadly in favour of Its clear that an electronic Yes two very important areas Thank you for your comments, they Nurse developing the BNFc into a platform has many advantages are; 1. Drug dosing in have been considered along with Practitioner, single sources of reliable over paper copies but much obesity, which is an increasing the other comments received in the Paediatric evidence as long as a number of effort needs to be invested in problem in children, partially consultation, to inform the Critical Care issues are taken into account. ensuring these systems are with regards to when to development of the enhanced BNF. Unit, Sheffield These are; 1. Poor high level constantly available. I currently change doses. 2. Clear NICE acknowledges that digital Children's evidence dose not mean there is have the BNFc app on my I- guidance in BNFc about when infrastructure and access to Hospital a lack clinical of knowledge in phone which is accessible about to start using adult dosing, this portable devices throughout the that drug in children. There is a 50% of the time. This because is a source of considerable NHS is not fully developed. porosity of evidence in many of signal problems rather than confusion in Paediatric Distribution of print formats will agents used in children App problems. Currently poor practise especially as there continue in line with user particulate in the older agents. 3G coverage makes anphone few Nurses left who have an requirements, subject to ongoing However a body of clinically App difficult to use and the book adult background so have no monitoring and review by the NICE based evidence has developed is resorted to every day. This is “feel” for standard adult doses. Board. over time because by necessity inside a children’s hospital in a Since they work offline, a drugs have been used. These major city, the community use of has been crystallised into the the App is currently next to connection to the internet is not best available information which impossible. A whole NHS required once the BNF and BNFC is in the BNFc. Before BNFc strategy is required to sort the apps are downloaded onto a mobile some drugs information was technology issues out. device. available in RCPCH medicines for children, this was very useful but contained a limited no of drugs and before that references from single centres were used.

[Insert footer here] 325 of 383 This lead to wide variety of clinical practise across the UK. It may be that the best evidence is through professional consensus guidelines and as long as that’s acknowledged this has to be an acceptable bases for decision making in Paediatric drug use if no other evidence is available. 2. Evidence from outside of the UK is taken in context. In the resent guidance on the use of Codeine in children concerns were raised in America because of the deaths of a number of children after ENT surgery. This obviously should be avoided at costs but the American situation was just not comparable to that the UK with a totally different surgical technique, no use of non steroidal and very high doses of Codeine. In short the use of the dru consultant Sounds like a good idea. A Easy access to dosage, Mentioned but not clear about Thank you for your comments, they resource that is regularly pharmacological action and side how-I would really like a have been considered along with updated and is transparent is effects. Ability to search for patient resource that I could the other comments received in the obviously key. If we can compare interactions. The advantage of print off in clinic to give to my consultation, to inform the drug effectiveness this would any electronic resource is space patients. development of the enhanced BNF. also be very useful. References so an enhanced version could to the relevant NICE document be a useful tool to link to or Cochrane review would be evidence base. useful.

Clinical Strongly disagree. Although it searchable. Robust. Uptodate. Current online version is Thank you for your comments, they pharmacist sounds sensible it may actually High quality difficult to navigate and lacks have been considered along with increase ther risk of harm to much of the info that is the other comments received in the

[Insert footer here] 326 of 383 patients. Junior & inexperienced contained in the print BNF. consultation, to inform the staff may use the information to Now your abandoning print, development of the enhanced BNF. make clinical decisions without the online version needs to be NICE acknowledges that digital referring to experts or specialists. fit for purpose infrastructure and access to Obviously, professional portable devices throughout the judgement is required by the NHS is not fully developed. users but on night shifts etc, I Distribution of print formats will fear patient cae may continue in line with user inadvertantly be compromised requirements, subject to ongoing monitoring and review by the NICE Board.

Clinical See overlooking comments See overlooking comments Idea is good. People generally Thank you for your comments, they Pharmacist and have smartphones, but will have been considered along with Medicine they wish to use them on the the other comments received in the Information wards for work purposes. consultation, to inform the Manager Access to ward computers is development of the enhanced BNF. difficult enough (lack of PCs, NICE acknowledges that digital COWs) and erratic generic infrastructure and access to internet access. Clinical staff portable devices throughout the on wards need a book NHS is not fully developed. reference on their drug Distribution of print formats will trolleys, to check medicines, continue in line with user doses, etc - it is impractical to requirements, subject to ongoing leave to try to access the monitoring and review by the NICE computor. Those Trusts in Board. financial difficulties or very large teaching Trusts, will be viable to purchase a large number of BNFs for Trust use? The Trust will have to weigh the clinical risk of not buying the new BNFs and leave the old BNFs on the ward for prescribers/nurses, etc to use. A number of BNFs go missing. It is not good ethos to see many healthcare professionals on their phones (work or social

[Insert footer here] 327 of 383 purposes?). We are considering not to buy BNFs and leave the old ones in the clinical areas for use and its subsequent risks. There is also concern this is part of a long-term plan for NICE to stop distributing BNFs. Smartphones can get lost, need constantly charging and will not be able to carried at all times on the wards, where a BNF hardcopy is available for all to use on the ward - despite its small risk of being slightly out of date compared to the eversion - if you can get generic access to a computer and are trained to use the eBNF efficiently.

Practice nurse I believe it is the way forward. keeping information updated. No Thank you for your comments, they and non All clinicans in primary care have the ability to quickly obtain have been considered along with medical assess to the online version. it is medicines advice, information the other comments received in the prescriber more up todate and fairly easy to for pts to make an informed consultation, to inform the use. Having a 'one stop shop' for decision and gold standard development of the enhanced BNF. medicines information would be evidence in one place. extremely useful. Paper copies are quickly outdated and should be phased out. The ystem would need to be easy to use.I am in full agreement with the vision.

Practice Pro online and digital media. Updated live, one stop shop, if its online, could incporporate Thank you for your comments, they pharmacist Only issue is when needs to be other media types e.g. photos, have been considered along with used in the classroom for graphs etc. the other comments received in the students work, not every class consultation, to inform the has a online access or BNF app. development of the enhanced BNF.

[Insert footer here] 328 of 383 PRACTICE Good idea, everythig is easier to Having accurate up to dat no, but i do not use medicines Thank you for your comments, they EXCELLENCE access electronically, as long as information as much as I have in previous have been considered along with LEAD there is a plan for if the IT roles the other comments received in the systems are inaccessible, it may consultation, to inform the not wokrk well for staff that work development of the enhanced BNF. without IT access as a normal NICE acknowledges that digital part of their role infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

GP and Sounds like a good idea . I think Up to date Easy to access I think the NHS should be Thank you for your comments, they Prescribing it important to maintain paper Browsable Link with key firmer about what is best have been considered along with lead for South option as well as online we are evidence option for prescribing and the the other comments received in the eastern Hants all aware that it can get out of BNF is best way of consultation, to inform the CCG date but not always possible to communicating this development of the enhanced BNF. access online when visiting NICE acknowledges that digital patients at home infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Pharmacist - The BNF is used by more than Facilitation of ease of access - - really like the idea of it being Thank you for your comments, they prescribers yet all your vision is see above interfacing and a portal to medicines info - but have been considered along with designed only for prescribers; I contextualising of info with local the current NICE portal (that the other comments received in the may become a NMP in the future EPMA systems - there are has been bolted onto the front consultation, to inform the but I'm not sure that will change relatively few EPMA providers in of the old Athens page, that development of the enhanced BNF. the way I need to use the BNF - I the UK - agree a core set and did work!) doesn't work for me make de facto prescribing work with them to achieve this - I can never ever find what I interface centrally so individual need - ease provide a more

[Insert footer here] 329 of 383 decisions every day of the week trusts don't have to fund and explicit delvier this - it is such a pointless duplication of work & expense accessing the eBNF must be as easy as accessing the book - you're taking the book away and irrespective of the risks of using OOD editions, it remains the easiest point of access - having to log in and wait for the profile to wake up is too slow - realise this is a local IT problem rather than a NICE problem but you are overlooking these constraints really like the idea of PDAs being inlcuded in the BNF but some are already in development by non specialists and this work needs to be coordinated: (www.england.nhs.uk/ourwork/p e/sdm/tools-sdm/option-grids/ or optiongrids or choiceandmedication or www.england.nhs.uk/ourwork/pe /sdm/tools-sdm/brief-decision- aids/ or sdm.rightcare.nhs.uk/pda) Smartphones and iPads are a great idea for easy access but are not readily available in clinical settings where decision aids are provided, contextualise those with non-drug treatments

[Insert footer here] 330 of 383 Consultant I think this is exactly the right The enhanced BNF must No Thank you for your comments, they Pharmacist in vision for the future. The paper however not loose its place as have been considered along with Medicine & BNF is destined for the history the authoritative guide for UK the other comments received in the Medication books The enhanced BNF must Health professionals on consultation, to inform the Safety however not loose its place as medicines. In particular it needs development of the enhanced BNF. the authoritative guide for UK to maintain its practical and Health professionals on pragmatic advice for example medicines. In particular it needs about classes of medicines and to maintain its practical and guidance on prescribing in renal pragmatic advice for example impairment or how to give about classes of medicines and injectable medcines etc. This guidance on prescribing in renal type of advice will never be impairment or how to give covered by NICE guidance but injectable medcines etc. This the BNF would not be the BNF if type of advice will never be it was only allowed to present covered by NICE guidance but information about medication the BNF would not be the BNF if that had grade 1A evidence it was only allowed to present base. Its strength is it is information about medication intended for use to in real that had grade 1A evidence patients not just "ideal" clincal base. Its strength is it is intended trial patients for use to in real patients not just "ideal" clincal trial patients

[Insert footer here] 331 of 383 student health I think it is beneficial to be able to New information clearly seen so Access to computers etc has Thank you for your comments, they visitor access it quicky through an app perhaps online site or app could been considered. have been considered along with as this would help to inform alert u to any changes in some the other comments received in the practice in the now and allow for way. Esay to find what u r consultation, to inform the better decision making regarding looking for. Logically presented. development of the enhanced BNF. medicines for patients. As a information such as what drug is student health visitor I am for, side effects etc. saftey currently undertaking the alerts. Npf section for prescribing module. Once I community staff to access. qualify I know I will need to gain confidence in prescribing and by having access to the bnf in an app this would provide me with valuable knowledge to aid my prescribing. I also agree that by having it on line etc updates can be added as they happen which is benefical to being up to date and evidenced based. Having an app may also he useful in that would not matter if you did not have an npf or bnf to hand such as in a clients home as would allow u to access the required information allowing u to compete a prescription there and then.

Interface lead I am supportive of the digital As above, search function lists Link to NICE guidance Thank you for your comments, they Pharmacist format of the BNF and BNFc, possible option thus making it available offline via the NICE have been considered along with very user friendly, very easy to easier to pick what is required, app as well (so if you have the the other comments received in the get information. Can be used off very easy to use, quick to NICE app and the BNF app on consultation, to inform the line, but if access required to download, regular updates your device they will link thus development of the enhanced BNF. links this is not possible in areas access to the NICE information NICE acknowledges that digital where there is no wifi/inernet is available and visa versa. infrastructure and access to signal. portable devices throughout the NHS is not fully developed. Distribution of print formats will

[Insert footer here] 332 of 383 continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

NMP Lead This would work in acute trusts I think it is premature to go Yes, prescribers working in Thank you for your comments, they however in primary care you are ahead and withdraw access to primary care and undertaking have been considered along with assuming a level of digital hard copies to staff working care in patient's homes do not the other comments received in the technology that does not yet within primary care undertaking have access to the technology consultation, to inform the exist home visits as yet development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 333 of 383 Policy Advisor, I support the vision but would The points mentioned above The points mentioned above Thank you for your comments, they Transparency advocate that the underlying about open data. about open data. have been considered along with Team standards, schemas and codes the other comments received in the that are used and referenced consultation, to inform the with the BNF are published as development of the enhanced BNF. open data. This does not mean to say that the content should be published as open data (although it would be good to consider which elements might be), but if the codes etc are published then it will result in benefits as seen in other domains (including parts of the health space), such as: More joined up systems with more consistent data; and A more competitive market as provides will be able to build tools/apps outside of procurement processes. Consideration should be given to the terms underwhich the content is licenced too. community Good intention. Important to dosage, side effects, no Thank you for your comments, they pharmacist have up to date information. contraindications, drug have been considered along with However working at a busy interactions the other comments received in the pharmacy, it is more convenient consultation, to inform the to have a bnf book on hand. development of the enhanced BNF. Referring on line can prove NICE acknowledges that digital difficult because of the number of infrastructure and access to staff sharing the computers. portable devices throughout the Hence I prefer to have bnf book NHS is not fully developed. published twice a year. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 334 of 383 NICE distributes print BNFs free of charge each September. Copies of the March editions are available for purchase here: http://www.pharmpress.com/

Community Sounds like a good plan. I'm searchability and browsability, can't think of anything Thank you for your comments, they Matron keen to utilise BNF in digital accurate information quickly, have been considered along with format. knowing that all info is up to date the other comments received in the consultation, to inform the development of the enhanced BNF. nurse whilst i appreciate that things are having bnf linked to systems in no. lots of extensive Thank you for your comments, they practitioner changing and we are a much gp surgerys would be useful. we information. have been considered along with more computer/technology already have some prescribing the other comments received in the reliant age I VERY much like my support tools and I think it is consultation, to inform the paper copy of the bnf and bnfc I poss to get the bnf info linked development of the enhanced BNF. would be very lost without these. but for me this kind of thing NICE acknowledges that digital Not everyone has access to needs to be simple and easy to infrastructure and access to tablets etc. my use of the online use and well publicised. there portable devices throughout the bnf so far has not been seems to be a lot that I am just NHS is not fully developed. extensive. we need to have not aware of with regard to Distribution of print formats will provision for power cuts and online prescribing support. continue in line with user areas of poor internet requirements, subject to ongoing accessibility. monitoring and review by the NICE Board.

[Insert footer here] 335 of 383 Consultant in sounds like a perfect world I don't have access to apps but no Thank you for your comments, they Palliative know that many colleagues and have been considered along with Medicine my inpatient hospice unit would the other comments received in the make use of comparisons and consultation, to inform the links to primary sources, development of the enhanced BNF. algorithms for safe practice, for example dose modification in renal failure links to specialist formularies - eg palliative care formulary, renal failure prescribing guidelines would be very useful I would personally access all these things on line on my desktop if they were available

Associate Good idea Currently use mims More information where What are costs of the BNF Thank you for your comments, they specialist in app a lot Still good to have differences between nice and apps going to be ? Currently have been considered along with palliative some print copies while in the bnf Advice on patients with clinicians are not obliged to the other comments received in the medicine transition phase multi morbidity and frailty buy their own print copies . consultation, to inform the Ability to link to PCF. Palliative development of the enhanced BNF. care formulary which gives The NICE BNF and BNFC apps are advice where medications are available free of charge to NHS used to manage symptoms , employees. We expect them to continue to be free of charge. More information on how to access the apps is here: http://www.nice.org.uk/About/What- we-do/NICE-apps-for-smartphones- and-tablets consultant agree with everything proposed no need to check other no Thank you for your comments, they palliative literature, its all there. Palliative have been considered along with medicine care section in BNF is poor and the other comments received in the including pall care formulary consultation, to inform the

[Insert footer here] 336 of 383 within BNF would be ideal development of the enhanced BNF. salaried GP Consistency of advice has to be current advice palliative care prescribing Thank you for your comments, they a good way forward advice in line with have been considered along with palliativedrugs.com formulary. the other comments received in the This would be useful as some consultation, to inform the palliative care prescribing is off development of the enhanced BNF. licence or anecdotal so advice from experts in the field would be incredibly helpful.

Pharmacist A very good and useful idea for From the POV of a pharmacist, No, this looks like a very good Thank you for your comments, they Manager community pharmacy. It would medication usages, directions, approach to making have been considered along with be more up to date than using a side effects, cautions and other prescribing and medicines the other comments received in the text version which is published aspects relating to the use of the delivery safer and quicker. I consultation, to inform the twice yearly and will give medication must be substantially think this will be a massive development of the enhanced BNF. information much quicker on clear and quick to access. The step forward for medicines medication queries through current online BNF does not do formularies. digital search functions. this as well as the hard copy However, it would be useful to book version and makes it have this fully integrated for difficult to use day to day. A FREE in pharmacy dispensing more interactive and detailed programs (e.g. proscript) and version of the eBNF would be access to all areas of the eBNF required to go forward. should be FREE on and off site for pharmacy managers.

Clinical Offering electronic access to It must be updated more Any electronic version must Thank you for your comments, they Pharmacist prescribing information must be frequently and be as usable as harness the full benefits of have been considered along with done in such a way as to keep the print version in daily use and electronic delivery while still the other comments received in the the content accessible and user in remote locations - away from remaining as portable, useable consultation, to inform the friendly. Paper copies will never connections to the internet. and reliable as the print development of the enhanced BNF. be prone to computer glitches. version. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user

[Insert footer here] 337 of 383 requirements, subject to ongoing monitoring and review by the NICE Board.

Medicines a good idea to move towards a easy access from all devices. poor internet and phone Thank you for your comments, they Management system that enables users to Better searching facilities, signals in many rural areas have been considered along with Adviser access the most up to date info including ability to flick between the other comments received in the at all times. However, as several pages at the same time. consultation, to inform the mentioned, access to suitable IT Links to NICE guidance, doh development of the enhanced BNF. hardware for all healthcare staff guidance, green book. Ability to NICE acknowledges that digital and reliable access to the add local notes for local users? infrastructure and access to internet via phone line or wifi in portable devices throughout the all care settings may be a NHS is not fully developed. challenge e.g. in patients homes. Distribution of print formats will Enabling links to key documents continue in line with user such as NICE or local formulary requirements, subject to ongoing would be great. Using NICE monitoring and review by the NICE accreditation criteria is a concern Board. as much of the most useful info NICE Accreditation assesses in the BNF is from specialist processes used to develop opinion and common practice, guidance such as the BNF, rather and may not have a robust than appraising specific medicines. evidence base that would satisfy The inclusion of recommendations NICE. Experience of NELM/ which are not formed from a robust NPSA/ NPC having been evidence base is acceptable, as incorporated into NICE is that the long as the reasoning for inclusion quality of these services and the is made clear. accessibility to the info on the NICE website has deteriorated. The current online BNF is not good to access / search - you need to be able to flick between several pages at the same time, as you often need to do in the paper version.

[Insert footer here] 338 of 383 Senior I think this is a very good idea. In enhancing the BNF, it is I can't think of anything at Thank you for your comments, they Pharmacist for However, I think the online important that it doesnt become present. As mentioned in the have been considered along with Patient Safety version of the BNF needs to be too complicated to use for basic box above, one thing that may the other comments received in the & Clinical more user friendly & easier to information required. In order to have been overlooked is the consultation, to inform the Governance navigate through. help prescribers & pharmacists use of available calculators development of the enhanced BNF. alike, I think it would also be that can be integrated into the useful to have integrated BNF online. calculators e.g. Cockroft gault equation, how to calculate BSA, BMI, Immunoglobulin doses.

Consultant I would be very wary of It has to be functional and easy No. Thank you for your comments, they Paediatric enhancing it too much. The to use i.e. the structure is just as have been considered along with Anaesthetist success of electronic apps is that important as the content. It the other comments received in the they are functional and not needs to be comprehensive consultation, to inform the clunky. It is a balancing act certainly, and with a good development of the enhanced BNF. getting enough info without search facility. As stated above, affecting the ease of use and I think the balance is good at the accessing that info. I personally moment. feel that the balance is good at present, and that whilst it is important to maintain the eveidence base for the BNFc, i would rather see links and notes to access greater infor in the papaer version rather than in the app. As someone who has developed electronic app for anaesthesia too much isnt always a good thing.

Pharmacist This would be more useful and I I hope it would become a more No comment Thank you for your comments, they might refer to the BNF more complete and useful reference have been considered along with often. I work in areas where the source the other comments received in the BNF is not of any use and consultation, to inform the normally find myself jumping development of the enhanced BNF. straight to other reference sources which are more

[Insert footer here] 339 of 383 informative as I know that the BNF has no useful input.

Locum Would be a great opportunity to I currently use the book form Links to other helpful Thank you for your comments, they Consultant make information in BNF more most frequently as I am most resources have been considered along with Palliative accessible and keep up to date. familiary with it and therefore the other comments received in the Medicine Would provide opportunities to can look things up quickly. I find consultation, to inform the link with other helpful resources, the online version does not development of the enhanced BNF. e.g. palliative care formulary replicate it well. Therefore I which I also frequently use. would suggest that a clear site is the most important element to use as easily as the book.

Senior Pain Although I agree with the vision Interactions, side effects and conversion tables would be Thank you for your comments, they Nurse for the BNF,I would like to point NICE related documents useful have been considered along with Specialist out that in secondary care the other comments received in the access to digital resources consultation, to inform the cannot be somewhat delayed. If development of the enhanced BNF. you are working in a clinical area NICE acknowledges that digital with limited computers, then it is infrastructure and access to far easier to look at a paper copy portable devices throughout the of the BNF rather than waiting to NHS is not fully developed. access it online. Also we cannot Distribution of print formats will utilise APPS as this is quite rude continue in line with user and offputting in a clinical area requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 340 of 383 Registered Very admirable, appreciate the Search terms facility on line No not really, any on line Thank you for your comments, they nurse need to make the formulary which will enable quick links to formats just have to be have been considered along with available through digital media, information you are searching incredibly user friendly to the other comments received in the however will not have access to for, specific drugs or groups of compete with printed versions consultation, to inform the a computer/ipad on a drug round drugs that may be helpful for of the formulary that most will development of the enhanced BNF. so printed formularies still vital managing specific complaints i.e feel more comfortable using. NICE acknowledges that digital for nurses dispensing drugs for prescribing advice for insulin infrastructure and access to quick referencing. They can stay regimes in diabetes as well as portable devices throughout the in the drawer of the drug trolley! being able to search for a single NHS is not fully developed. Computer access on wards is drug. Quick reference guides for Distribution of print formats will also an issue and the time it will dose conversions for use in continue in line with user take to access the information palliative care, maximum dose requirements, subject to ongoing you require. Again in the clinical ranges/regimes for medications monitoring and review by the NICE environment you may need to in renal failure. Having the Board. find information quickly so any enhanced BNF as a resource apps, on line formularies need to with latest supporting evidence be easy to use and intuitive. and links to that information Passwords and usernames will slow clinicians down as well as the speed of the internet. It's easier to grab a printed version which may be out of date. Links to further information to support prescribing advice i.e. research, evidence base for meds etc would be great. A specialist palliative care formulary would also be a key asset as currently practitioners like myself are having to pay for the benefits of an up to date palliative care formulary on line through the palliative drugs site. NICE supporting this as well as the general formulary would be a great reassurance for those of us who work in a palliative care environment also.

[Insert footer here] 341 of 383 Retired. Very pleased that the BNF is The BNF content will become Not enough thought on non- Thank you for your comments, they Emeritus going to get a new lease of life more widely available - which is medical prescribers and those have been considered along with Orofessor of making use of enhanced good. The worry is that Nice will who need to know about the the other comments received in the Clinical technology. I hope its reputation push the move to mainly drugs their patients are on eg consultation, to inform the Pharmacology, will be maintained in the new electronic too fast. Some dentists, optometrists. Taking development of the enhanced BNF. Birmingham. era. students, nursing homes, district this opportunity ( the new era ) NICE acknowledges that digital Senior Medical nurses, and other non-medical to enhance the role of the BNF infrastructure and access to Advisor to the prescribers will not have the as a key educational tool - portable devices throughout the BNF 2000 - necessary access and/or skills. undergrads in medicine, NHS is not fully developed. 2012. pharmacy and non-medical Distribution of print formats will prescribers and for postgrads continue in line with user as part of CPD. Do not requirements, subject to ongoing overestimate the need for monitoring and review by the NICE rapid updates ( allow time to Board. digest and read the criticisms ) or for keeping the paper and electronic exactly the same ( a warning note may suffice )

Specialist I understand the vision Efficiency, easy access in clinics Please look at appropraite Thank you for your comments, they Nurse completely and it seems to be and reliability. We cannot use training and or online advice to have been considered along with the direction most service mobile phones in clinic settings compliment any changes as the other comments received in the applications are going in, either from a trust point of view time delays in clinic with consultation, to inform the however reservations for relaince yet also they are a distraction patients are rarely appreciated. development of the enhanced BNF. upon more and more and this shouldn't be overly NICE acknowledges that digital 'technology' does concern me as encouraged is an opinion infrastructure and access to frequently its this technology that amongst some of my portable devices throughout the can let us down. I also feel we colleagues. NHS is not fully developed. spend so long in front of a Distribution of print formats will computer, completing forms etc continue in line with user that our patients will increasingly requirements, subject to ongoing feel like they talk to the side of monitoring and review by the NICE our heads! that being said, i can Board. see the practical advantages of this, the updates will be more frequent and i suspect the overall cost will be cheaper and more environmentally friendly.

[Insert footer here] 342 of 383 Hospice Ease of accessis crucial. With I would like it to be linked in with Not that I can identify Thank you for your comments, they Community the reduction in frequency of the Palliative Care Formulary as have been considered along with Nurse paper copies being printed from this is as relevant to my practice the other comments received in the Specialist 6 monthly to annual, the phone as the BNF consultation, to inform the Team Manager apps become more important in development of the enhanced BNF. community prescribing to ensure NICE acknowledges that digital information is up to date infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. NICE distributes print BNFs free of charge each September. Copies of the March editions are available for purchase here: http://www.pharmpress.com/

Senior I welcome digital development of Early communication of NPF - as above. The timing of Thank you for your comments, they Medicines the BNF and am impressed with developments with organisations this development coincides have been considered along with Optimisation the way in which the app has / stakeholders Fully accessible with the integration agenda, the other comments received in the Pharmacist / been developed. However, I offline Concise of itself with which is moving more consultation, to inform the Non-Medical have some reservations: - cost of optional links to associated apps specialist care away from development of the enhanced BNF. Prescribing providing hard copy March 2014 (rather than internet resources) traditional healthcare locations NICE acknowledges that digital Lead BNFs has been passed to as far as possible Supported by and will increase reliance on infrastructure and access to organisations with little notice of appropriate training Additional mobile digital devices, which is portable devices throughout the change; need more notice of NPF app or functionality within an opportunity, but also NHS is not fully developed. future changes to allow BNF app to provide more than represents a financial, Distribution of print formats will organisations to plan just a list for Community governance and training continue in line with user infrastructure changes to support Practitioner Nurse Prescribers challenge for organisations. requirements, subject to ongoing these developments, especially Although organisations retain monitoring and review by the NICE in view of massive cost savings much of the responsibility for Board. being demanded within NHS - strategy to manage this it may what functionality / safeguards be more appropriate for some

[Insert footer here] 343 of 383 will be put in place to support of the governance and training organisations to ensure that issues to be dealt with at users update resources national level. Monthly update appropriately? - what can be of the BNF is an excellent done to improve the download concept, but only if staff speed for the updates (app update the app promptly. suggests 10 minutes to Organisations need to have download, but regularly longer some way of assuring this is than half an hour on fast the case, e.g. might the app broadband wifi)? - linking to itself have functionality to other resources is a great option, support 'feedback' to the but need to keep BNF itseld parent organisation. A manageable as a first-line nationally commissioned e- resource - must avoid issues learning package would such as those with NICE ensure a common high guidelines app that requires link standard. to internet to access algorithms, rather than them being available offline within the app - NPF isn't mentioned, although reference is made to inclusion of appliances - need clarification of plans for NPF - although many uses will be IT literate there a large number of professional staff who haven't 'grown up' with computers and will require training to utilise digital versions, even in the basic sense; will NICE make provision for this? e.g. extension of CPPE training package

[Insert footer here] 344 of 383 Advanced I view the vision of the enhanced Availability of access to non- Depending on scope as Thank you for your comments, they Clinical BNF as positive as this will NHS staff e.g care mentioned above there is also have been considered along with Pharmacist ensure that the latest evidence is homes/Hospices/Charities/ a need to make information the other comments received in the available for clinical staff when Homecare including care timely which is the reason for consultation, to inform the making decisions. I however agencies, nursing and AHPs. going electronic. Updates to development of the enhanced BNF. have reservations in access and Links to other peer-reviewed information e.g. product NICE acknowledges that digital competence in using the sources of evidence e.g. recalls/safety information must infrastructure and access to technology especially for nurses palliative drugs.com for palliative be within 24 hours which will portable devices throughout the doing drug rounds where it is far care, renal handbook for drugs mean providing a 7 day NHS is not fully developed. easier to reach for a book on the in dialysis, administration via service (like the NHS!) There Distribution of print formats will top of a drug trolley to provide enteral tubes, stockleys, SPCs will be other functions that can continue in line with user information rather than to leave etc One-stop shop for all info wait longer but hopefully not as requirements, subject to ongoing the drug trolley to find a e.g. how to administer, long as it takes to go through a monitoring and review by the NICE computer, log into this and find interactions, dose in renal, NICE review. What product Board. the information they need. The monitoring, special precautions, licensing requirements and time delay in accessing the if there is a drug/device recall on costs will be involved. I am information electronically taken the product, simple information thinking that for a Hospice away from caring for patients on pharmacology would be good (non-NHS) or care home to and "doing the drugs" means for doctors as medical students make one paper copy of the that is hard to imagine nurses don't seem to cover this much BNF available to its staff is not ever doing this. I would therefore now, link to yellow card reporting a huge financial outlay. To have reservations about stopping on each page, links to social arrange multiple access to an a print version of such media (may already be on app?) electronic version will cost a lot information and would wish this and maybe financially to continue annually until a time prohibitive. Will this be when such access and accessible through athens if competence has been they can get NHS athens addressed and there is no access? Again there are negative impact on patient care. I issues around competency in also have reservations about the accessing and using the evidence based content. I work information for nursing staff in palliative care where there is some of who do not access limited good quality evidence on email or the internet regularly. effectiveness in our specific If print copies were to be patient population. This no doubt stopped this may have a leads to inherent variations in financial impact on the practices which is why local publishers if such non-NHS palliative care formularies are in organisations choose not to

[Insert footer here] 345 of 383 existence. Guidelines can vary buy into the electronic version locally depending on the setting especially if staff are unlikely to the patient is in e.g. Hospice, use it. community or hospital and the use of off-label and unlicensed medication. This presumably will affect the scope of the enhanced BNF. Maybe the enhanced BNF can link to other peer-reviewed guidelines already in existence? practice As a PN this looks as if it would It would provide a very useful up This is reliant on all health care Thank you for your comments, they nurse/senior be a very useful service but to date and extensive resource professionals being computer have been considered along with lecturer could duplicate what is already which should ensure safe literate and having the the other comments received in the used in practice unless it were to prescribing. appropriate devices which is consultation, to inform the replace that. As a senior lecturer not currently the case. It will development of the enhanced BNF. this would almost impossible to not be possible to undertake NICE acknowledges that digital utilise within the classroom the case scenarios which I infrastructure and access to situation. currently use with the portable devices throughout the classroom setting unless all NHS is not fully developed. students have access to the Distribution of print formats will most up to date version of the continue in line with user BNF/BNFc either electronically requirements, subject to ongoing but ideally in paper formatt. monitoring and review by the NICE Board.

Student health A single source to go to for up to Up to date Accessible from Not that I can think of. Thank you for your comments, they visitor date evidence will be fantastic. computer or app Public aware have been considered along with Electronic sources very useful. the other comments received in the Transparent service is ideal consultation, to inform the development of the enhanced BNF.

Deputy I agree with the principle of I think the most important It is always a surprise to Thank you for your comments, they Director of harnessing technology in various element is navigation. This is myself and colleagues that the have been considered along with Pharmacy, ways to enhance the BNF. This currently very poorly executed. BNF does not include the other comments received in the Clinical is long overdue and will improve Other than getting navigation information on products such consultation, to inform the Services usability and accessibility. With right, I believe that the following as contrast agents which are development of the enhanced BNF. the progress in electronic are the most important functions used medicinally and are NICE acknowledges that digital

[Insert footer here] 346 of 383 prescribing, online and pc - searching in multiple ways, under the responsibility of infrastructure and access to access are arguably more dose calculators, risk pharmacy departments, even if portable devices throughout the important than the access via calculators, transparency of they are not strictly speaking, NHS is not fully developed. apps, especially on wards and in evidence, links to SPCs, PILs, medicines. Understanding, the Distribution of print formats will clinics. The online version is not NICE guidelines, standards and restrictions of the paper BNF, it continue in line with user user-friendly in the slightest, I TAs, more detail on drug would be very helpful if digital requirements, subject to ongoing believe it needs a complete interactions and contra versions could include monitoring and review by the NICE refresh. The paper copy indications. information on agents such as Board. however is still invaluable, even these. in my organisation which has electronic prescribing and electronic access to the BNF. The advantages of the portability and low-tech nature of the paper version should not be underestimated. Also, pre- registration pharmacists and other HCPs use the BNF in exams and assessments - this currently has to be a book. The paper BNF is also used extensively overseas and depriving developing and other countries of this excellent resource would be a huge shame. Therefore, I would like to stress that continued development of the paper BNF will always need to continue, even though it will not be as up to date as digital versions.

[Insert footer here] 347 of 383 Practice I have a clinical role and A useable search engine that As above registration Thank you for your comments, they Educator therefore do use the BNF on-line does not require exact data but asssesments for pharmacists have been considered along with Pharmacist, as a first resort but do not find it will offer a choice of entries. using open book techniques. the other comments received in the Pre-registration as helpful as the paper copy consultation, to inform the Pharmacy when relating to multiple drug development of the enhanced BNF. Trainee Tutor therapy, interactions are NICE acknowledges that digital particularly annoying as each infrastructure and access to monograph has to be checked portable devices throughout the individulally instead of looking at NHS is not fully developed. one entry in an appendix. I have Distribution of print formats will a major concern with regard to continue in line with user the pre-registration trainee requirements, subject to ongoing pharmacists. The GPhC in its monitoring and review by the NICE wisdom has recently decided Board. that the registration assessments held annually in June will use the paper copy BNF issued in March of that year; if there is not to be a paper copy some consultation with the GPhC needs to occur!

Medicines Useful to have all medicines Key thing will be simplicity of Not currently Thank you for your comments, they Management information in the one use.... Majority of current have been considered along with Adviser place....with links to different graduates will be competent with the other comments received in the sources of information. It would various digitial media but still a consultation, to inform the be important to keep the significant proportion of development of the enhanced BNF. information about drug prescribers who are not interactions and unwanted confident using digital media effects and if this could include routinely as part of their working the frequency with which these day.... Addressing areas of occur (as the SPCs state) then conflicting advice will be helpful this would be useful. Searching in having discussions locally by patient characteristic is an with clinicians about decisions interesting novel approach....not being made sure practically what this would look like but could be beneficial Links to patient information would also be helpful

[Insert footer here] 348 of 383 Haematology I think the idea of an integrated I would use it at ward level, in no Thank you for your comments, they Pharmacist service with NICE and BNF is Ward rounds and when writing have been considered along with really good. The difficulty is guidance for hospital policiesl. the other comments received in the access for eg I have access to The proposal of guidance when consultation, to inform the my own paper BNF at work faced with conflicting advice via development of the enhanced BNF. however if I want the app or to the BNF and NICE would be NICE acknowledges that digital access online I have to pay how really useful. infrastructure and access to will this be addressed if it was to portable devices throughout the become digital would NHS is not fully developed. Pharmacists automatically get Distribution of print formats will access continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. The NICE BNF and BNFC apps, and online content are freely available to all staff who work for the NHS, or for a service commissioned by the NHS. Check http://www.nice.org.uk/mpc/BritishN ationalFormulary.jsp for information on how to access the BNF content digitally.

Health visitor I think it is appropriate to keep Up to date information with links As a health visitor it is crucial Thank you for your comments, they abreast of change by introducing to management of conditions to have right the tools to do the have been considered along with computerisation of the BNF with ..like map of medicine Easy job. In the community we the other comments received in the links to aid decision making in accessibility Patient information would need access to a laptop consultation, to inform the holistic management on drugs to be able to make decisions development of the enhanced BNF. on prescribing and also to give NICE acknowledges that digital patients information. Even infrastructure and access to when drugs have been portable devices throughout the prescribed by other NHS is not fully developed. professionals patients are Distribution of print formats will asking questions about usage continue in line with user and interactions....particularly requirements, subject to ongoing with infants and breast feeding monitoring and review by the NICE mothers. Board.

[Insert footer here] 349 of 383 Specialist The BNF is more often than not, That it's a single point of entry in no Thank you for your comments, they Psychiatric my starting point for accessing to a wide variety of sources of have been considered along with Pharmacist medication and prescribing information. the other comments received in the information. To be able to access consultation, to inform the further references from the BNF development of the enhanced BNF. would be both efficient and have the potential to reveal sources of information that may not otherwise have been considered or known to be available. On-line access ensures data is up to date.

Pharmacist Always a concern that Ability to use on ANY tablet Demonstration videos for Thank you for your comments, they information we are using is up to device with reliable search medical devices? have been considered along with date and is based on practical function would made for useful the other comments received in the application would be useful to practical tool consultation, to inform the have reasons for change in development of the enhanced BNF. policy or access to same

CONSULTANT Very important to make best use Thank you for your comments, they OLD AGE of electronic communication have been considered along with PSYCHIATRIST methods and for patients to be the other comments received in the able to access information consultation, to inform the development of the enhanced BNF.

Triage Nurse It sounds like a good idea, but I It needs to be very easy to use The user who is likely to Thank you for your comments, they am worried I will not be able to and if there are special ways to struggle with using the internet have been considered along with use an online system effectively access information it either has after 20 years of looking in a the other comments received in the and most importantly quickly in a to be completely self book for the answer. Users consultation, to inform the 10 minute consultation. explanatory, even to people who need to be sure that they have development of the enhanced BNF. have no natural affinity with the accessed all the appropriate NICE acknowledges that digital internet, or there needs to be information if using an online infrastructure and access to clear guidance to help the user. system, so they can have portable devices throughout the confidence that they have not NHS is not fully developed. missed something important Distribution of print formats will because they did not use the continue in line with user requirements, subject to ongoing

[Insert footer here] 350 of 383 right search. monitoring and review by the NICE Board.

general this all seems sensible for a usability- so people dont think can the electronic version be Thank you for your comments, they practioner "formulary" document - i am so twice before using it- accessed through andriod have been considered along with familiar withe bnf as a reference accessibility and ease of use. phones( which are in use the other comments received in the book- and i would nt like to loose An electronic version can be across our local trust) consultation, to inform the this - as an aid to prescribing kept up to date more easily than development of the enhanced BNF. within a consultation the BNF is a paper version NICE acknowledges that digital hard to beat- if i need more infrastructure and access to complicated advice, i would find portable devices throughout the the references after. NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board. The NICE BNF and BNFC apps are available for Android phones, you can find more information on how to access them at http://www.nice.org.uk/aboutnice/nic ewebsitedevelopment/NICEApps.js p#X-201206111614351 consultant It is very important to keep more choices no Thank you for your comments, they printed versions at least once a have been considered along with year. Not everybody has access the other comments received in the to apps and the internet in the consultation, to inform the trusat very slow slow and development of the enhanced BNF. sometimes not accessible. NICE acknowledges that digital infrastructure and access to portable devices throughout the

[Insert footer here] 351 of 383 NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Pharmacist I am very concerned of the move Allow integration with elecrontic The Joint Formulary Thank you for your comments, they from the Joint Formulary prescribing systems and local Committee for the BNF has have been considered along with Committee for the development formularies so that the right always produced a high the other comments received in the of the BNF to a NICE accredited information is available at the quality, reputable and consultation, to inform the process. My experience of NICE point of prescribing Include links comprehensive product. In my development of the enhanced BNF. guideline development is that to Patient Information/Decision opinion the NICE acknowledges that digital pragmatic advice has to be aids development/committee infrastructure and access to omitted because there is weak or arrangements do not need to portable devices throughout the no evidence base. Whereas the be changed to allow the NHS is not fully developed. BNF is a very comprehensive proposed and worthy vision of Distribution of print formats will and useful tool for prescribers expoiting digital media to continue in line with user because the committee has a enhance the electronic BNF requirements, subject to ongoing strong background of using product. monitoring and review by the NICE expert opinion when reliable Board. evidence is lacking. I fully support the vision for an enhanced BNF which exploits the use of electronic media to improve accessibility to the product . I have experience of working in community services where non-medical prescribers do not have access to technologies that would allow them to make good use of eBNF etc. There will need to be double running of both paper and electronic formularies until there is comprehensive use of electronic prescribing across all healthcare settings, including in

[Insert footer here] 352 of 383 patients own homes.

Honorary The rationale for an enhanced I think a format designed for Please don't remove the print Thank you for your comments, they Secretary digital format is sound in today's mobile devices is probably best. one just yet. have been considered along with RCPSG digital age. Nevertheless, it can Tablets will be coming to wards the other comments received in the be quicker to open the book to in future and the rest of the time consultation, to inform the find what is needed in clinics and we will most likely use our development of the enhanced BNF. on busy wards than to find an phones as they are faster. I'd NICE acknowledges that digital available computer, the website like to be able to type in quickly infrastructure and access to and search through it for the right a drug -ideally with text portable devices throughout the page. I appreciate the added recognition prompts to help with NHS is not fully developed. benefit of an online version but the more complex names. I'd Distribution of print formats will we are not quite in an era of then like to choose if I want to continue in line with user tablet ward rounds or e- see all the information or to requirements, subject to ongoing prescribing yet. I wonder if it is a focus on sections such as monitoring and review by the NICE bit early to remove the paper indications, complications, Board. format. interactions, dosage. If I go to a a section or a hyperlinked additional page, I'd like to be able to click a menu icon to access the bread-crumb trail I have used to find where I was before quickly.

GP Partner Lots of really interesting See prior section. Drug I'm concerned at the phasing Thank you for your comments, they suggestions, however it's a interactions/ contraindications/ out of the Print BNF entirely.I have been considered along with fantastic resource as it is. One of unwanted effects : more agree it ' important to ensure the other comments received in the it's great strengths is the fact that nuanced information such as that transition to digital from consultation, to inform the it is so compact , indications of thresholds of print format is timed development of the enhanced BNF. comprehensive and portable. I concern in cases of impaired appropriately and does not NICE acknowledges that digital would find it frustrating if it renal & liver function, relative or preclude access to any users' infrastructure and access to became difficult to sort out the absolute contraindications ( however is also should not portable devices throughout the core information from all the add such as the UK MEC guidance preclude any circumstance NHS is not fully developed. ons. It's crucial there is a top in Contraception) Comparative either. What is the evidence Distribution of print formats will level summary interface of Cost of Drugs Dressings etc : that the 4 or so significant continue in line with user

[Insert footer here] 353 of 383 information, akin to current Print how many of a given item are in changes per month have a requirements, subject to ongoing Version, though hyperlinks to a pack or box ( which is how significant or adverse impact monitoring and review by the NICE other resources and sources of patients/ district nurses etc often on patient care , or one which Board. data that could be dipped into on submit requests!) is more than the risk of not a need to know basis would be being able to access the helpful. . There has be clarity electronic BNF at all because about the over arching structure of IT problems? These occur and it must be very clear and on a weekly if not daily basis in evident at what level / tier one is Primary Care! GP IT systems in , if delving into greater detail. are often run slow, we have In reality I think a busy GP is numerous software interfaces not likely to source much more to deal with in consultations , information than is currently it is genuinely often much available in the Print BNF, during quicker to check something a consultation / busy surgery in quickly in the print version. real time. The level of detail Electronic / digital sources of required must differ between information have some different specialisms - eg : I can advantages, but speed of appreciate that links to more access / use is NOT inherently detail and evidence may be one of them. . Also the whole extremely valuable in oncology IT system crashes rarely , but or HIV medicine etc, but is far it does occur- what happens less so for many other drug / then ? What happens when medcation groups. There is a there are wide spread power great danger that it becomes too cuts eg: during these recent unweildy to be user friendly. storms etc? The print version is very useful for home visits. Searching for info on the small screen of a smart phone is not necessarily very user friendly and what about people working in rural & remote areas with patchy internet connection/ broad band coverage....

[Insert footer here] 354 of 383 Consultant in sounds excellent as long as this easily accessible and constantly yes the unreliability and slow Thank you for your comments, they Palliative is additional to a hard copy and updated easily searchable and speed of nhs technology its a have been considered along with medicine / is produced in an app form that being able to see where you are very exciting prospect and I the other comments received in the Hospice is truly quick and easy until nhs in the whole thing which can love technology - but ...... consultation, to inform the Medical & technology catches up with sometimes be hard not at work! development of the enhanced BNF. Education 'apple' there's no chance of it NICE acknowledges that digital Director working sufficiently reliably to be infrastructure and access to of use at the speed that doctors portable devices throughout the have to work If it takes longer NHS is not fully developed. than it takes to look it up in a Distribution of print formats will hard copy it will not be used. continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Student school Love the idea of being able to Having open access to an online Remove Athens account Thank you for your comments, they nurse v100 access bnf on a mobile device, or offline copy will aid requirement to aid access. have been considered along with but aware this is currently prescribing as a V100, as it will the other comments received in the dependant on network coverage make it possible to access the consultation, to inform the and the need for an Athens NPF and enable the prescriber development of the enhanced BNF. account. For it to be accessible to ascertain that what is being for all in the right place at the prescribed is the best option in right time, I think that this the circumstances, as an NPF restriction needs to be removed can in theory be up to two years to help move this forward as an old, it is not up to date enough to innovative idea. make what is consider as out of date and not necessarily what NICE guidelines promote.

[Insert footer here] 355 of 383 Medicines The BNF and BNF-C are both Users would wish to have ready The main issue with moving Thank you for your comments, they Management difficult to read on-line, and access to an up-to-date towards a single annual paper have been considered along with and Utilisation errors can result from an inability document, I am not sure that edition is that users will need the other comments received in the Pharmacist to see the full page. I welcome this new development will to use the on-line version in consultation, to inform the the move towards a bespoke deliver this to users in areas order to access current development of the enhanced BNF. screen based BNF, however I delivering patient care. information. I can foresee the NICE acknowledges that digital feel that this has been a long following problems: Users are infrastructure and access to time coming, and we could have not always computer literate portable devices throughout the been provided with this facitly Users do not always have NHS is not fully developed. some years ago. access to a computer, as they Distribution of print formats will are more often than not in use continue in line with user by other users, and access requirements, subject to ongoing can be difficult. Users rarely monitoring and review by the NICE have a computer close to the Board. location in which they wish to use the BNF. Most Wards are not equipped with a screen at each bedside. Having to lock a medicines trolley in order to access current BNF information will inevitably lead to a reduction in patient safety. associate I would like for the bnf app to be Thank you for your comments, they specialists old available on Kindle. have been considered along with age the other comments received in the psychiatrist consultation, to inform the development of the enhanced BNF.

[Insert footer here] 356 of 383 Health Visitor The reliance on digital An enhanced service would No Thank you for your comments, they information depends upon the mean easier access to have been considered along with technology being available at the BNF/BNFc (currently working the other comments received in the point of need, it also needs to be without information technology consultation, to inform the fully functional. It has the and only NPF) in community, development of the enhanced BNF. potential to enhance the assuming appropriate NICE acknowledges that digital information available; however it technology to support this infrastructure and access to also has the potential to leave becomes available. portable devices throughout the prescribers without resource NHS is not fully developed. should the systems supporting it Distribution of print formats will fail. Problems recently in continue in line with user banking should be used to learn requirements, subject to ongoing lessons to ensure those who monitoring and review by the NICE prescribe can access information Board. through a 'Plan B' route should 'Plan A' fail. It is also reliant on prescribers being provided with equipment to access these resources.

Critical care I don't see how in day to day As with the current online The paper version is the most Thank you for your comments, they doctor practice it would add much to the version, it will have new useful, as it does not depend have been considered along with current status quo with paper medications as soon as they are on a creaking IT infrastructure, the other comments received in the and online versions licensed. However by definition, power, or the ability to access consultation, to inform the these will be used only by a a computer or the internet. development of the enhanced BNF. minority initially. Comparison of Many hospitals have frequent NICE acknowledges that digital side effects, such as currently problems with wifi (as infrastructure and access to be done most easily with a evidenced by wifi phones portable devices throughout the paper copy, will likely be the cutting in and out), and NHS is not fully developed. most useful computers are in very short Distribution of print formats will supply. IT systems are less continue in line with user accessible and take much requirements, subject to ongoing longer to access than the monitoring and review by the NICE paper version. While I have Board. accessde the BNF online while working remotely (such as at sea) for non-UK based companies, again, this was

[Insert footer here] 357 of 383 dependent on internet access. A paper copy was much missed and I was frequently requested by other staff of multiple nationalities to leave copies behind when I left. The publication is highly regarded, perhaps even more so by those from outside the UK who have nothing similar.

Commissionin The ideas proposed within the The ability to be able to No. The success of this project Thank you for your comments, they g Pharmacist consultation document are very download this to local will rely on good promotion have been considered along with good, especially the ability to formularies. Accesability for and some thought should be the other comments received in the have a facility which can be patients. given to this. consultation, to inform the downloaded to local formularies. development of the enhanced BNF. Every NHS trust in the country has to have an online formulary that is clear and easily accessible to patients. NHS trusts use valuable resources maintaining these formularies, usually bought in at a one-off cost but often requiring annual maintainance fees. NICE and the BNF could be doing more to support trusts with this DH initiative and an enhanced BNF is one way of achieving this.

Nurse Fine Better precision, less fuzziness Merge bnf and bnfc Thank you for your comments, they have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF.

[Insert footer here] 358 of 383 Prescribing I support the delivery of more up Provision of high quality up to The BNF has been an Thank you for your comments, they Studies to date advice and links to other date drug information with links excellent and essential have been considered along with Programme reference sources using digital to national guidance. Excellent reference source for many the other comments received in the Manager media but I am concerned about search engines for drug years. Be careful that in trying consultation, to inform the the loss of the paper BNF. I interactions detailed information to enhance what it can deliver development of the enhanced BNF. regularly use a range of about side effects interactions that you do not take away the NICE acknowledges that digital reference sources via the etc. essential function of providing infrastructure and access to internet so am very familiar with reliable information about portable devices throughout the this medium. I do occasionally drugs and all that entails. NHS is not fully developed. use the BNF through Medicines Distribution of print formats will Complete but I would sorely miss continue in line with user my paper copy that I can flick requirements, subject to ongoing through. i regret the decision to monitoring and review by the NICE go to an annual print only. I am Board. concerned that having a digital copy only would increase the risk of missing important drug information that could affect patient safety.

Clinical nurse I believe utilising digital The comparison of effectiveness No - it was clear and well Thank you for your comments, they Specialist applications is obviously the way would be really helpful. And the thought out. Yearly BNF's have been considered along with forward - but due to cahs ability to browse in different would seem sufficient as we the other comments received in the strapped NHS systems - not ways - via PC or tablet helpful - have other emans for checking consultation, to inform the really supported in reality. I use please keep the app as simple accuracy. I do beleive we will development of the enhanced BNF. my BNF app all the time and find to use a possible - because if it require some printable NICE acknowledges that digital it really useful. I rarely cannot becomes too complicated it will versions for ward areas etc infrastructure and access to find the info I am lookign for - but take too much time when who cannot keep accessing portable devices throughout the if this happens I will use the book prescribing in the patients home. digital data - at least in the NHS is not fully developed. as a reference - but I can use the forseeable future. Distribution of print formats will app because I have a personal continue in line with user phone that supports this practice. requirements, subject to ongoing the NHS nokia would not. I have monitoring and review by the NICE foudn the monthly update Board. supportive - and probably take more notice of them now as they come in "bitesize" bits of info.

[Insert footer here] 359 of 383 GP Also CCG I really like what I have read. I Timely Single authoritative Nothing that I am aware of Thank you for your comments, they Chief Clinical have used previous electronic source Integration with other have been considered along with Officer versions of the BNF but over systems to be sngle source High the other comments received in the recent years the web version has quality prescribing info consultation, to inform the been slow & I have reverted to a Accessible for patients development of the enhanced BNF. paper copy. I am aware of other NICE acknowledges that digital colleagues who may be less infrastructure and access to welcoming. I like the fat that it portable devices throughout the will be continually updated and NHS is not fully developed. recognised as the authority Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

GP Principal Very positive IF user friendly Software operates rapidly in real No Thank you for your comments, they enough. time (to be used during have been considered along with consultations) the other comments received in the consultation, to inform the development of the enhanced BNF. cluster matron this is an excellent move in Better links with clinical not clear Thank you for your comments, they keeping with modern technology. information such as disease have been considered along with However not all phones will specific prescribing and local the other comments received in the suppport and app and this will fomulary consultation, to inform the need to addressed to ensure that development of the enhanced BNF. all clinicians has access to the BNF app

Value & Access Good Updating Yes Thank you for your comments, they Director have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF.

[Insert footer here] 360 of 383 Senior Dental Sounds good. -so long as the up to date easy to access drug not that I have noticed Thank you for your comments, they Officer computer doesn't go down! interactions, side effects, etc. have been considered along with ability to look up condition and the other comments received in the find the drugs actual prescribing consultation, to inform the of these drugs is probably nnot development of the enhanced BNF. impt to me as a dentist but it so often happens that patients can only tell what the drugs for what it starts with and that it's pink! ideally what the drug preparation looks like. full prescribing information

Consultant will be helpful I will still need the continuing to provide the paper some of us do not have smart Thank you for your comments, they Dermatologist paper copy of the BNF to refer to issues phones so cannot use apps have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Clinical An excellent initiative - but time See above See above Thank you for your comments, they Pharmacy and thought must be given to the have been considered along with Manager realiability of access / means of the other comments received in the access available across NHS consultation, to inform the premises and the current development of the enhanced BNF. restrictions on use of OWN NICE acknowledges that digital devices and lack of consistent infrastructure and access to funding and support for cross- portable devices throughout the organisation devices. NHS is not fully developed. Distribution of print formats will

[Insert footer here] 361 of 383 continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Principal I welcome the moves to develop Continuous updating, Easy to Not that I can think of Thank you for your comments, they Lecturer in the online / e-sources but believe use interface. have been considered along with Pharmacy strongly that print editions should the other comments received in the Practice not become the poor relation in consultation, to inform the this initiative. Print editions are development of the enhanced BNF. key for several reasons: - in NICE acknowledges that digital education (and therefore infrastructure and access to assessment) access to these portable devices throughout the resources are vital to ensure a NHS is not fully developed. robust assessment of future Distribution of print formats will professionals' competence in continue in line with user using the resource - in some requirements, subject to ongoing community pharmacies, for monitoring and review by the NICE example, access to the web is Board. not easy so the print edition needs to remain available and authoritative. A similar issue exists in domiciliary visits.

Consultant in Sounds really good! An app would be great, as well No, great ideas! Thank you for your comments, they Palliative as a website - for me it would have been considered along with Medicine be great to have a link to the the other comments received in the PALLIATIVE CARE consultation, to inform the FORMULARY for detailed development of the enhanced BNF. monographs on medications I would use, and especially for syringe driver compatibilities/ diluents.

[Insert footer here] 362 of 383 Locum It would be useful if this was also Ease of access in different The accessibility of the BNF to Thank you for your comments, they Pharmacist linked to the on-line Palliative formats: information at one's all healthcare professionals is have been considered along with Care Formulary so that there is fingertips. Information current of paramount importance. the other comments received in the up-to-date detailed information and rapidly updated to take into consultation, to inform the available to pharmacists account changes in evidence development of the enhanced BNF. supporting Palliative Care and guidance, although it is Teams, patients and carers in important to remember that the community. It is important to guidance may lag behind current include items which may be evidence. designated appliances, but may also appear to be medicinal products.

Dr would be useful prefer an online version none Thank you for your comments, they have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF.

Specialist I have linited access to The BNF gives all information I feel that the printed copy for Thank you for your comments, they Nurse and computers in my clinics and find essential to maintain good primary care staff who do not have been considered along with Team Leader that the print BNF is essential to practice and standards and have access to computers the other comments received in the my practice. allows my professional within a clinic is a essential consultation, to inform the development to be supported. development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

[Insert footer here] 363 of 383 GP An online,easily navigated Struggled to access the The wide variability in IT Thank you for your comments, they resource would enhance consultation document using accessibility have been considered along with consultations in my room but a existing NHS IT-that's the barrier the other comments received in the paper BNF still provides to a purely web based service consultation, to inform the accessibility for the development of the enhanced BNF. housebound/residential patients NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Senior hospice Good idea to go digital - PCF4 Links to other sources eg. pcf4 No Thank you for your comments, they physician gets updated regularly this way. for palliative medicine have been considered along with However main problem is then the other comments received in the accessing it in different locations consultation, to inform the especially if lack of computers in development of the enhanced BNF. ward office. Still need paper NICE acknowledges that digital version for home visits. infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Pre-registration I think the visions are really good Ensuring that all the information No. Thank you for your comments, they pharmacist and would be appropriate since currently available on the printed have been considered along with most people/healthcare versions are still in the the other comments received in the professionals are tech-savvy enhanced BNF. consultation, to inform the now. It would make access to development of the enhanced BNF. BNF and BNFC really easy, thus saving time.

[Insert footer here] 364 of 383 Library I applaud the idea of an Integration of NICE Older versions of BNF are Thank you for your comments, they Services integrated BNF, containing recommendations and BNFc, sometimes used in court cases have been considered along with Manager commonly-prescribed medical BNF and NPF with the facility to to demonstrate the other comments received in the devices, drug interactions, limit searches to any one or recommendations and consultation, to inform the patient information, NICE combination of these categories. dosages in use on a certain development of the enhanced BNF. guidelines, etc, that is continually A vastly improved search engine date. If BNF is constantly NICE acknowledges that digital updated and easy to search. and better display. The current updated how will this be infrastructure and access to However, increased reliance on digital version is not as user- achieved in future? Will there portable devices throughout the electronic resources leaves friendly as the paper version be an online archive? NHS is not fully developed. clinicians extremely vulnerable in where it is easy to flip to see Distribution of print formats will the event of network or power similar drugs, contraindications, continue in line with user failure. It is important that access etc without losing one's place. requirements, subject to ongoing to paper copies is still available With a paper copy it is easy to monitoring and review by the NICE as backup. Also, we have visiting keep one's finger in a certain Board. consultants in this Trust who page whilst flipping to read other prefer to flick through a paper pages. This is not true of the copy rather than log on to a current digital version. specific website to check a drug.

Clinical I am writing on behalf of the To be searchable in a number of It's great for this to be digital Thank you for your comments, they Specialty Lead prescribing group of different ways - by patient but access can be difficult in have been considered along with Physiotherapis physiotherapists as working in condition, etc Integrate NICE some hospital settings and the other comments received in the t CF The suggestions for creating guidelines Include drug also in the community Tablets consultation, to inform the a more digital system are interactions, unwanted side are very helpful development of the enhanced BNF. excellent and there is an appetite effects NICE acknowledges that digital for an up to date BNF to be infrastructure and access to accessed. It should be portable devices throughout the mandatory for this to be NHS is not fully developed. accessed easily from trust Distribution of print formats will intranet systems and for drugs to continue in line with user be searched based on patient requirements, subject to ongoing condition and infection. It would monitoring and review by the NICE be great if you could link to key Board. pieces of evidence for that medicine and patient group.

[Insert footer here] 365 of 383 clinical More clarity on why Thank you for your comments, they pharmacist recommendations made: have been considered along with the other comments received in the consultation, to inform the development of the enhanced BNF.

Nurse I agrreet with this strongly the For it to be open to flexible Need to llink in effectively with Thank you for your comments, they consultant app at the moment is not fit for interrogation of information, to specialist formularies in my have been considered along with Palliative Care purpose, it is slow and buggy. flag interactions automatically. context the Palliative Care the other comments received in the Formulary. consultation, to inform the development of the enhanced BNF.

Dental Surgeon Potentially a good idea and I The ability to be As noted not all dentists have Thank you for your comments, they would use it personally. There searchable/browsable in multiple computer/internet access in have been considered along with might potentially be access ways. Dentists do not have surgeries, therefore the option the other comments received in the difficulties within dentistry, access to patients medical of a paper copy needs to be consultation, to inform the regrettably not all dental records, frequently patients retained. development of the enhanced BNF. practices are computerized present without knowing exactly NICE acknowledges that digital witness the Dental; Services which drugs they are taking it infrastructure and access to Division of the NHS BSA which then becomes almost a game of portable devices throughout the recently wanted to make all charades trying to identify a NHS is not fully developed. dental payment schedules patients medication from details Distribution of print formats will available online only by such as medical condition, the continue in line with user withdrawing paper schedules, initial letter, colour of the tablet requirements, subject to ongoing this plan had to be scrapped and doseage a a multi-seach monitoring and review by the NICE because a significant number of online version of the BNF would Board. dental practices did not have help to narrow the options. The computer access. Equally real time updates so that we can practices would need to be be sure the most current advice provided with free of charge is available access rights to an enhanced online BNF i.e. login and password authorization.

[Insert footer here] 366 of 383 nurse I think we need to progress up to date and evidence based a Ensure that interactions Thank you for your comments, they practitioner forward and the needs to ensure must. continue with meds as i use have been considered along with we need up to date information, this daily the other comments received in the although i really like having the consultation, to inform the BNF book at hand. development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant in I support this but it would require A good search tool Cross- See above Thank you for your comments, they Palliative two further things to be fully referencing have been considered along with Medicine functional for me: 1. My the other comments received in the employer providing a suitable consultation, to inform the portable phone/tablet as I travel development of the enhanced BNF. around the community on foot 2. Inclusion of the Palliative Care Formulary

Specialist I think the print version, although Frequent updates will be very Print copies are used by Thank you for your comments, they clinical able to go out of date quickly still useful, and remove the need for students during open book have been considered along with pharmacist has a valuable role. It is largely issuing errata. Unlike the current examinations - reduced the other comments received in the unaffected by powercuts and app it would be very useful if the availability of print copies may consultation, to inform the internet outages, and does not updates ran silently and quickly cause logistical problems, and development of the enhanced BNF. run out of power and is hugely in the background so the user allowing students access to NICE acknowledges that digital portable. In healthcare there can still access the information. electronic copies may not help infrastructure and access to seems to be the thought that as they may be able to access portable devices throughout the computers will solve all the too much information, or NHS is not fully developed. problems but we seem to have content on the electronic Distribution of print formats will entered the age where the media may have changed continue in line with user converse is true. Systems that between the time the exam requirements, subject to ongoing do not talk to each other and was set and sat which may monitoring and review by the NICE poor user interfaces are complicate marking / fairness.

[Insert footer here] 367 of 383 frequently slowing down Medicines information Board. professionals at work. Coupled departments often keep back with this should be remembered copies of the BNF because that, by trying to move everything some information removed onto computers you increase the between versions may still be need for access to computers useful for a large number of hugely. The NHS is currently in a reasons. How will superceded dire state for affording and information be kept available maintaining computers, both for those that need it? Local financially and spatially, so when copies on intranets need to be you have nurses, doctors, available for when internet pharmacists etc all needing a PC access is lost. The interface for accessing the BNF, drug needs to be easy to use, and charts, electronic discharge, x- stable (the current version has rays, patient notes, electronic problems) rostering etc but you only have 2 PCs available on the ward you put patients at huge risk of something not being done. Immense care needs to be taken to ensure infrastructure can cope before adding another PC-based aspect to work.

[Insert footer here] 368 of 383 Medicines Although an enhanced BNF, To have all the necessary The fact that electronic access Thank you for your comments, they Information which would include access to prescribing information under to the BNF is currently have been considered along with Manager guidelines is in principle an one umbrella, including links to insufficient in many NHS the other comments received in the excellent idea, before NICE guidance, CKS, MHRA Trusts has been overlooked consultation, to inform the implementation, particularly in safety advice. It would be useful and this must be addressed development of the enhanced BNF. secondary care, it is important to have more detailed before distribution of the paper NICE acknowledges that digital that a robust electronic solution information regarding the use of copies is reduced. Sudden infrastructure and access to is in place. Currently there are drugs in pregnancy and breast reduction in the supply paper portable devices throughout the insufficient PCs on the wards feeding with links to UKTIS copies will pose clinical risks NHS is not fully developed. and no personal access to the reviews and UKMI Q and A 's. and may result in out of date Distribution of print formats will Trust's wifi, making use of the Compatibility information relating copies of the BNF being used. continue in line with user app on mobile phones to iv drugs would be useful, as requirements, subject to ongoing difficult.There are also areas of this is currently not available via monitoring and review by the NICE the hospital where use of mobile the BNF. Board. phones is not permitted. We are therefore disappointed that paper copies of BNFs are only being supplied annually, as this will pose a clinical risk due to insufficient access to the electronic source in clinical areas. This needs to be addressed nationally before a reduction in the supply of paper copies occurs.

GP Regularly updated version as Able to access electronically Including a link to the palliative Thank you for your comments, they app would be idea with limited or slow data care formulary would be useful have been considered along with downloading the other comments received in the consultation, to inform the development of the enhanced BNF.

[Insert footer here] 369 of 383 Pharmacist I support its development into a Access to other resources. Availability of medications - Thank you for your comments, they more responsive resource. Link Improved functionality. - To Supply problems More have been considered along with into work undertaken by include a navigation bar - The information about unlicensed the other comments received in the organisations such as UKMi. ability to expand more than one medicines in common usage / consultation, to inform the section within a monograph (e.g. dosages - restricted to development of the enhanced BNF. if looking at ferrous sulfate - to Healthcare professionals? etc. have the ability to open up the Access to risk assessments section for ferrous sulphate and tools to support the aswell as Ironorm drops). implementation of medications /

Head of Central Vision seems sensible giving the Most important :- integrity, Not all uses want to 'step into Thank you for your comments, they Data increased use of technology and accurate content, accessibility the BNF' in its entirety. have been considered along with the growing need for information and interoperability. Not all uses Organisations also need to be the other comments received in the at the point of care. It would be want to 'step into the BNF' in its able to link to relevant consultation, to inform the helpful to include interoperability entirety. Organisations also chapters and content, so that development of the enhanced BNF. clearly within the vision, need to be able to link to the right content is accessible supporting even greater access relevant chapters and content, within our own systems eg. to to wider audience. Not all uses so that the right content is support labelling of dispensed want to 'step into the BNF' in its accessible within our own medicines with BNF cautionary entirety. Organisations also need systems eg. to support labelling labels. to be able to link to relevant of dispensed medicines with chapters and content, so that the BNF cautionary labels. right content is accessible within our own systems eg. to support labelling of dispensed medicines with BNF cautionary labels.

AIMD The electonic versions will be Ensuring access to the most up No Thank you for your comments, they pharmacist good to ensure up to date to date version of the have been considered along with access, but relies on access to BNF/BNFC the other comments received in the electronic devices, which can be consultation, to inform the problematic on the wards. development of the enhanced BNF.

[Insert footer here] 370 of 383 Podiatrist All good points. A link to MHRA Ease of navigation around the Summary of product Thank you for your comments, they would be great too. However, to site. No broken links. Clear and characterises and patient have been considered along with be quite honest having simple site. information leaflet for each the other comments received in the researched products that are item. Include herbal, consultation, to inform the listed in the antimicrobial homeopathic, and medical development of the enhanced BNF. dressings section I have become devices quite disillusioned by what I thought would be high quality clinical trial data to support the marketing authorisation achievement by some of the listed products. In fact, some of the traditional herbal medicinal products have more high quality research to support their use and they don't even need that evidence of efficacy. So when the BNF posts an answer to 'Why are there no listings of homeopathic and herbal products in the BNF?' as being 'because we like to stick to what we are good at'. I find it snobbish and a bit like 'burying the head in the sand' type reaction. Therefore, I would recommend a stronger link to the MHRA for these products so we can advise our patients accordingly, because they are using them whether we like it or not.

[Insert footer here] 371 of 383 HR & LEgal This is good idea but not when ensure patient safety and also yes as above also we feel Thank you for your comments, they Manager - you are in a busy practice pharmacist and staff can access PHARMACIES who use the have been considered along with Regional dispensing presecriptions and without problems such as BNF a lot have been the other comments received in the Manager - being on the phone using an potential distraction if app is on overlooked and not consulted consultation, to inform the SENIOR apps will appear to the patient phone - pre reg students cannot on the first incorrect decision development of the enhanced BNF. Pharmacy you are not dispensing. Also this take this into an examination NICE have made of sending NICE acknowledges that digital Dispenser may lead to false accusations of the September BNF and not infrastructure and access to using mobiles during work and in the March. Why were we not portable devices throughout the particular if there was an error informed or notified as a NHS is not fully developed. how can one prove they were on stakeholder and also as one of Distribution of print formats will the BNF and not texting or the main primary care user of continue in line with user calling. Pre registration the BNF requirements, subject to ongoing pharmacy students cannot use monitoring and review by the NICE an apps in the examination. Board. NICE distributes print BNFs free of charge each September. Copies of the March editions are available for purchase here: http://www.pharmpress.com/

Medicines I like that information is updated Would not want to lose useful, It would also be useful is the Thank you for your comments, they Information more regularly using e-versions. practical information from the sections on have been considered along with Pharmacist However, I have concerns with current BNF versions, pregnancy/lactation were more the other comments received in the relying on downloading apps on particularly from the BNFc which sensible - based on a range of consultation, to inform the a monthly basis. I tried to use my is sometimes based on historical specialist information rather development of the enhanced BNF. amrt phone app in a location with use rather than from trial than just 'the manufacturers' NICE acknowledges that digital little/no 3G and it spent evidence. Would not want the advise to avoid' infrastructure and access to 30minutes attempting to 'conflicting advice' that you refer portable devices throughout the download the March update and to to mean that advice not in line NHS is not fully developed. I was unable to access the with NICE guidance is lost. Distribution of print formats will information I wanted. This is not Sometimes NICE guidance does continue in line with user suitable for making decisions at not apply (it is guidance rather requirements, subject to ongoing the bedside! The NHS would than policy after all). Sometimes monitoring and review by the NICE need to invest a lot in their to apply to a particular patient Board. We recommend using a WiFi infrastructure to enable access to you need to follow information connection to download monthly

[Insert footer here] 372 of 383 apps before this is really a from other authorities than updates to the NICE BNF and feasible option. NICE. BNFC apps.

CASH nurse I believe that this is a retrograde instanateous access is the best yes ther needs to be an Thank you for your comments, they step to reduce the frequeny of feature as long as this is interaction section added to have been considered along with production of BNF to annually as accessible in a variaety of the NPF to aid community the other comments received in the many community staff like myself formats formualry prescribers decision consultation, to inform the dont have access to electronic making development of the enhanced BNF. resources or devices that NICE acknowledges that digital support apps for use in peoples' infrastructure and access to homes or may well not have portable devices throughout the internet access making NHS is not fully developed. prescribig devsions without a Distribution of print formats will hard copy resources wouls be continue in line with user risky and unsafe requirements, subject to ongoing monitoring and review by the NICE Board.

Consultant It is appleaing but in Gibraltar we I would use it regularly Font size & colour Thank you for your comments, they Obstetrcian & I am concerned if we would be depending on font size, but have been considered along with Gynaecologist allowed access as now most history teach me that access is the other comments received in the St Bernard things is reliant on @nhs.net slower than using a book consultation, to inform the Hospital account which we do not have development of the enhanced BNF. Gibraltar

[Insert footer here] 373 of 383 Consultant I am concerned about the access Access is really important and I have nothing to add here Thank you for your comments, they forensic to the electronic version that will making it user friendly have been considered along with psychiatrist be possible in community the other comments received in the settings. consultation, to inform the development of the enhanced BNF. NICE acknowledges that digital infrastructure and access to portable devices throughout the NHS is not fully developed. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Acute I think an enhanced BNF would There needs to be consideration Pricing needs to be addressed, Thank you for your comments, they Oncology be a very helpful addition to of the palliative care formulary, I in a world of tight financial have been considered along with Clinical Nurse supporting my practice. have found that this is an area of restrictions within the NHS the the other comments received in the Specialist medicine management that individual practitioner is consultation, to inform the worries dr's and nurses and the looking for applications, development of the enhanced BNF. formulary gives clear guidelines reasonably priced, to inform and rationales on prescribing their practice as quite often up outside the usual guidelines to date hard copies of the BNF can not be found in clinical areas.

Consultant in I like the idea of the enhanced Having all the cross-referenced I regularly access the Palliative Thank you for your comments, they Palliative version to be kept more up-to- guidance, and I presume, most Care Formulary (PCF4) in my have been considered along with Medicine date. I suppose I have some recent formal guidelines will be a practice, and I would hope that the other comments received in the anxieties as to the complete big advantage. It will hopefully the detailed information consultation, to inform the absence of a paper version: for follow the same format as the included in that would also be development of the enhanced BNF. those of us over 50 (myself paper BNF (like the App does). included in an enhanced BNF; NICE acknowledges that digital included) it is quicker to just pick there may be other specialities infrastructure and access to it up. I appreciate that more and with similar needs. portable devices throughout the more clinicians are more savvy NHS is not fully developed. with technology, but what if Distribution of print formats will access is down? continue in line with user requirements, subject to ongoing

[Insert footer here] 374 of 383 monitoring and review by the NICE Board.

Consultant in It sounds like an excellent idea to I would strongly favour having Need to ensure that all staff Thank you for your comments, they Palliative have authoritative information the Palliative Care Formulary have access to electronic have been considered along with Medicine readily and freely available to (PCF4 currently, currently being information- many doctors the other comments received in the relevant staff. revised) as this is frequently have smart phones, but not all; consultation, to inform the used by palliative care staff many ward staff may not. development of the enhanced BNF. throughout the country. There is Being able to access the NICE acknowledges that digital no serious rival to the PCF for information off line (eg via app) infrastructure and access to use in palliative care, and it is very appealing. portable devices throughout the contains much information that NHS is not fully developed. the BNF does not. Distribution of print formats will continue in line with user requirements, subject to ongoing monitoring and review by the NICE Board.

Palliative I particularly agree with the I think having paper and digital As a Palliative Medicine Thank you for your comments, they Medicine proposal to try enhance access access should be a priority. doctor, I use the Palliative have been considered along with Specialist through digital means as people Digital copies could be updated Care Formulary over the BNF the other comments received in the Registrar often have better access to the as soon as a new drug in in most situations. I purchase consultation, to inform the internet than a BNF paper copy licensed. I would also suggest the PCF personally at a cost of development of the enhanced BNF. in some situations. That said, I that having links to pictures of £49 and appreciate that this NICE acknowledges that digital don't think the digital version the tablets would be really expense means that it may not infrastructure and access to should completely replace paper, helpful for commoner drugs. be feasible to provide paper portable devices throughout the as I would tend to use the paper copies for all wards but I feel NHS is not fully developed. copy over digital in an strongly that NICE should Distribution of print formats will emergency situation. consider funding the online continue in line with user PCF for all healthcare requirements, subject to ongoing professionals to access. Not monitoring and review by the NICE only does the PCF give Board. syringe driver compatibilites

[Insert footer here] 375 of 383 that are unavailable in the BNF, it also has doses that are more appropriate for patients at the end of life.

Senior Clinical I can see the reasoning for an Ease and speed of use, It would be extremely useful to Thank you for your comments, they Pharmacist enhanced BNF, and think that it accessability, reliability. have the BNF linked with the have been considered along with is a good idea. However, access Palliative Care Formulary - a the other comments received in the to an electronic version whilst I formulary which I have to use consultation, to inform the am working on the wards often to obtain further reliable development of the enhanced BNF. concerns me - at best there are 3 information that isn't contained NICE acknowledges that digital computers on the ward, and in the BNF on palliative care. infrastructure and access to many other healthcare portable devices throughout the professionals needing access to NHS is not fully developed. these at the same time that I Distribution of print formats will would. At least with a paper continue in line with user copy, I can take this with me to requirements, subject to ongoing each bay as I assess the drug monitoring and review by the NICE charts - with the financial state Board. that the NHS is currently in, we won't be given individual electronic devices to access the eBNF on the ward so if the paper copy is discontinued, I will be wasting a lot of my time fighting for access to a computer to check interactions, etc!

[Insert footer here] 376 of 383 Palliative Care Would be an excellent resource, It might help to reduce Will it link into the palliative Thank you for your comments, they Nurse to have constantly updated polyphamacy. It would be care formulary have been considered along with Specialist information. If it was able to have educational. Typically we see the other comments received in the the ability to show interactions new patients on upwards of 10 consultation, to inform the etc medications so if it made it development of the enhanced BNF. easier to eliminate unnecessary and prevent potentially harmful interactions.

Clinical nurse Excellent idea Integrated with palliative care See above Thank you for your comments, they specialist in formulary - lots of errors out of have been considered along with palliative care , hours with prescribing for end of the other comments received in the non-medical life care and I do,not think the consultation, to inform the prescriber , Bna contains enough guidance development of the enhanced BNF. lecturer on eg titration opioids, emergency symptom management

1. Coordinate Excellent, the most logical best That it will draw from combined No it looks great Thank you for your comments, they my care clinical forward move clinical and research findings to have been considered along with facilitator the obtain the most up to date the other comments received in the Royal Marsden information and guidance e.g. consultation, to inform the 2. Lecturer integrating the palliative care development of the enhanced BNF. Peninsula drugs wealth of experience Medical through linking to the on-line School, 3. NHS PCF IMAS interim

Associate NICE and the BNF need Needs to replicate the paper Other formularies, like the Thank you for your comments, they Professor in consider how to link with version as closely as possible. Palliative Care Formulary, have been considered along with Clinical guidance produced by Royal complement the BNF and it the other comments received in the Pharmacy Colleges and other professional would be beneficial to be able consultation, to inform the Practice bodies and the standards that to link to them from the BNF development of the enhanced BNF. must be met for them to portal. included. The process for ensuring this needs to be transparent.

[Insert footer here] 377 of 383 GP The main reason for using BNF 1) Concise easily available Computer failure with loss of Thank you for your comments, they remains looking up adverse information on doses, cost, access to e(phemeral)- have been considered along with effects and/or interactions of effects, adverse effects and information. Hard copy back the other comments received in the drugs. I have no problems with interactions of drugs IN ONE up remains essential. consultation, to inform the BNF being designed mainly for PLACE. There is no time during development of the enhanced BNF. online use, but the paper version the consultation to follow links to NICE acknowledges that digital remains quicker and easier to evidence. 2) This may be infrastructure and access to read. It is also occasionally usefully followed up at a late, portable devices throughout the pleasant (and good education) to quieter time, but is seldom NHS is not fully developed. read some of the advice appropriate at the time of using Distribution of print formats will accompanying each chapter and BNF. Authoritative guidance at continue in line with user I still prefer to do this in hard the turn of a page (not 2-4 clicks requirements, subject to ongoing copy form at leisure. of a mouse) would be pleasant. monitoring and review by the NICE 3) A font size that is not Board. prejudicial to aging eyes would also be helpful. 4) A useful size for browsing - i.e. tablet access or a small, bound volume as at present (NOT a loose leaf folder)

Señor I would like to suggest that No comment Yes PCF Thank you for your comments, they sister/ward linking to the on-line PCF would have been considered along with manager of enhance the BNF. I work in the other comments received in the inpatient unit - palliative card and currently have consultation, to inform the hospice to pay for a copy of PCF . I development of the enhanced BNF. consult this formulary on a daily bases, currently my colleagues in Scotland do not have to pay to receive this vital resource.

HTA & EBM MSD is in agreement with the MSD is in agreement with the MSD believes that a Thank you for your comments, they Manager ABPI response. ABPI response. consultation with stakeholders have been considered along with to discuss the sources of the other comments received in the evidence to be considered for consultation, to inform the inclusion in the enhanced BNF development of the enhanced BNF. and the methods by which any conflicting guidance will be

[Insert footer here] 378 of 383 aggregated is essential to ensure that the BNF remains a robust source of information.

GP Sounds great, but I am wary of Mostly I use the digital BNF as Speed is of the essence. Thank you for your comments, they grand IT schemes. Also, you part of the EMIS prescribing Choose and Book is still too have been considered along with can have too much information. package, integrated into the clunky and slow, and I try not the other comments received in the One of the problems with the patient record it also gives me to use it for that reason (locally consultation, to inform the NICE guidance is its sprawling warnings about possible we had a better system for development of the enhanced BNF. nature. One of the great things interactions with other meds that referrals to the local hospital, NICE acknowledges that digital about the BNF is that it is patient is on, or conditions the which was closed when C&B infrastructure and access to constrained to fit into a finite patient may have. This is very came along). Talk to people portable devices throughout the book, and is CONCISE AND TO useful - though having too many like EMIS. All the information NHS is not fully developed. THE POINT. In a consultation I warnings leads to one ignoring should be on webpages: there Distribution of print formats will do not have time to read essays, them. It has the same general is not time to download PDFs continue in line with user nor exhortations to be nice to my format as the book (eg cautions, etc. Fonts need to be large requirements, subject to ongoing patient. So I am strongly in contraindications), which makes and clear. Links need to go to monitoring and review by the NICE favour of keeping the style of the it quick to navigate. Drawbacks pages which exist. It must not Board. current BNF. are the difficulty accessing the crash. We will still need some more general overview or advice paper versions eg when our sections, and lack of information computers go down/go slow. on whether a medication is We already have a version of a prescription only. Dressings, local formulary (Scriptswitch). equipment etc are more difficult. Are you talking to the MHRA? Links to oteh rguidance would Our local pharmacists put be useful, aso long as tey work, MHRA advice into our are robust. Decision aids would Scriptswitch (eg when be good to add in. guidance on generic prescribing of antiepileptics changed). Anything new needs to be an improvement on what we already have. Best to introduce a skeleton system, then build on it, while getting feedback on what works; do not go for too grand a scheme to begin with.

[Insert footer here] 379 of 383 Clinical It is hoped that the proposed One of the most important Within the consultation Thank you for your comments, they Solutions vision for an enhanced BNF will elements for an enhanced BNF document there is no mention have been considered along with Director also mean there is greater scope would be to allow access to the of possible platforms for the other comments received in the for embedding the data into third core data in such a way that it delivery of a datafeed/API, as consultation, to inform the party products, thus making BNF can be embedded in 3rd party previously mentioned in development of the enhanced BNF. information more readily products to be delivered to NHS response to the earlier accessible to NHS end-users end users alongside other questions. Would being who are also using third party clinical information and evidence 'searchable and browsable in information resources in the as a trusted source of drug data. multiple ways’ be limited to a course of their clinical workflow As a leading provider of clinical search index based on BNF activities. This would also information resources and online data alone? Since the range provide an alternative access skills solutions to the NHS and of evidence and information route for those users who do not wider UK healthcare market, the used in clinical decision- have ready access to the printed ability to receive a regular feed making in the UK also draws copy or NICE/BNF online of the BNF data as an API that on non-UK sources about platform. Enabling greater could be pulled automatically specific integration will be directly into third party products would drugs/conditions/patient beneficial to NHS end users by improve the user experience for characteristics, the ability to making it easier for them to both healthcare professionals search via international drug access disparate information and and students. This would lend names/spellings would enable evidence sources in support of itself to the consultation greater discoverability of BNF clinical decision-making, proposal item - 'Be searchable content in that international contributing to improvements in and browsable in multiple ways, context. For example, where the quality of care and ultimately such as by drug, condition and a UK clinician is using a better patient outcomes. patient characteristic, so it can journal article about the use of Making BNF data readily be easily accessed'. End users a particular drug in a US available beyond the confines of could both view BNF data for context to inform the course of the NICE platform will help to specific drugs/conditions/patient treatment for a patient, it would drive up usage and build on the characteristics independently be beneficial if the clinician BNF’s already valued position as within the NICE application, and could easily check the an aid to prescribing and clinical also by corresponding BNF data for decision-making. searching/browsing/linking in the that drug. This could be broader context of third party achieved if a search for the US authoritative sources of name would resolve to the information relating to those correct BNF monograph for dugs/conditions/patient that drug in the UK. characteristics. If such a datafeed could also be real time

[Insert footer here] 380 of 383 or updated on a regular basis so the information is as accurate and up to date as possible, this would further increase the quality and value of the data to end-users.

Pharmacist Although I currently prefer to use As above, it is often not the Suggest looking at opportunity Thank you for your comments, they the print version, I agree there monographs but the other bits to link with wider range of keys have been considered along with are significant benefits to moving and pieces which I turn to the reference texts (which may the other comments received in the to a 'designed for digital' BNF for - these need to be require consideration of consultation, to inform the publication. It is essential that the retained. Suitability for national subscriptions) - these development of the enhanced BNF. non-drug specific information is phone/tablet is also a key issue valuable resources could accesible and easy to find e.g. and making it easy to download include Palliative Care list of manufacturers, palliative / update. Also size is an issue as Formulary, Bradman & White's care advice, appendices. don't want to fill my personal medications via enteral feeding phone with a work related tubes book, Stockley's drug product - keep images, colour interactions and Martindale. etc to a minimum to reduce size Also, a trsutworthy source on of mobile app. herbal medicines would be a useful addition.

Community In examination and OSCE Thank you for your comments, they Pharmacist conditions for pharmacists, pre- have been considered along with registration pharmacists, the other comments received in the technicians, medics, dentists, consultation, to inform the nurses, opticians and many other development of the enhanced BNF. healthcare practitioners, the BNF NICE acknowledges that digital is the standard reference infrastructure and access to resource for the examination. portable devices throughout the How will this large cohort of NHS is not fully developed. healthcare practitioners access Distribution of print formats will electronic copies of the resource continue in line with user in a controlled manner in test or requirements, subject to ongoing examination conditions never monitoring and review by the NICE mind its invaluable roll in their Board. day to day working lives.

[Insert footer here] 381 of 383 Head of This is an important part of Opening up the API of the BNF Thank you for your comments, they Service providing patients with the tools to make it available to other have been considered along with Development - to look after themselves and systems to use the content the other comments received in the Pharmacy support concordance with would help and support other consultation, to inform the

treatment once they have system developments for development of the enhanced BNF. reached a decision to take a decision support, prescribing medicine. The information and dispensing. provided as part of the NHS Choices website would be a sensible link so that accredited information sources can be linked without any commercial ties or prejudice. The current Medicines Guides content provided by DataPharm would be a credible source although it could be improved in some areas in terms of scope and complexity of information. The information is however, already linked to disease and condition information and so lends itself to coding the BNF information to the content to provide useful links for patients. A joint development with NHS Choices would optimise the resources available to the NHS for supporting trusted information that can be accredited and aligned with NICE standards fro information development. NHS Direct experience of working with patients across multiple digital channels and providing patient facing web material supports this piece of work.

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