BNF publications are unique in bringing together authoritative, independent guidance on best practice with clinically validated drug information, enabling healthcare professionals to select safe and effective medicines for individual patients.
Information in BNF publications has been validated against emerging evidence, best-practice guidelines, and advice from a network of clinical experts.
Hundreds of changes are made between print editions, and are published monthly online. The most clinically significant changes are listed at the front of each print edition and under Changes online.
Editorial team
BNF clinical writers have all worked as pharmacists and have a sound understanding of how drugs are used in clinical practice. Each clinical writer is responsible for editing, maintaining, and updating specific chapters of the BNF and BNFC. During the publication cycle the clinical writers review information in these publications against a variety of sources (see below).Amendments to the text are drafted when the clinical writers are satisfied that any new information is reliable and relevant. The draft amendments are passed to expert advisers for comment and then presented to the Joint Formulary Committee and/or the Paediatric Formulary Committee for consideration. Additionally, sections are regularly chosen from every chapter for thorough review. These planned reviews aim to verify all the information in the selected sections and to draft any amendments to reflect the current best practice.
Clinical writers prepare the text for publication and undertake a number of checks on the knowledge at various stages of the production.
Joint Formulary Committee
The Joint Formulary Committee (JFC) is responsible for the content of the BNF. The JFC includes doctors appointed by the BMJ Group, pharmacists appointed by the Royal Pharmaceutical Society, and representatives from the Medicines and Healthcare products Regulatory Agency (MHRA), the UK Health Departments, and a national guideline producer. The JFC decides on matters of policy and reviews amendments to the BNF in the light of new evidence and expert advice.Paediatric Formulary Committee
The Paediatric Formulary Committee (PFC) is responsible for the content of BNFC. The PFC includes a neonatologist and paediatricians appointed by the Royal College of Paediatrics and Child Health, paediatric pharmacists appointed by the Royal Pharmaceutical Society and the Neonatal and Paediatric Pharmacists Group, doctors appointed by the BMJ Group, a GP appointed by the Royal College of General Practitioners, and representatives from the Medicines and Healthcare products Regulatory Agency (MHRA) and the Department of Health for England. The PFC decides on matters of policy and reviews amendments to BNFC in the light of new evidence and expert advice.Dental Advisory Group
The Dental Advisory Group oversees the preparation of advice on the drug management of dental and oral conditions; the group includes representatives from the British Dental Association and a representative from the UK Health Departments.Expert advisers
BNF publications use over 100 expert clinical advisers (including doctors, pharmacists, nurses, and dentists) throughout the UK to help with the clinical content. The role of these expert advisers is to review existing text and to comment on amendments drafted by the clinical writers. These clinical experts help to ensure that BNF publications remain reliable by:- commenting on the relevance of the text in the context of best clinical practice in the UK;
- checking draft amendments for appropriate interpretation of any new evidence;
- providing expert opinion in areas of controversy or when reliable evidence is lacking;
- advising on areas where BNF publications diverge from summaries of product characteristics;
- providing independent advice on drug interactions, prescribing in hepatic impairment, renal impairment, pregnancy, breast-feeding, children, the elderly, palliative care, and the emergency treatment of poisoning.
The BNF also works closely with a number of expert bodies that produce clinical guidelines. Drafts or pre-publication copies of guidelines are routinely received for comment and for assimilation into BNF publications.
Sources of BNF information
The BNF uses a variety of sources for its information; the main ones are shown below.Summaries of product characteristics. BNF publications receive summaries of product characteristics (SPCs) of all new products as well as revised SPCs for existing products. The SPCs are the principal source of product information and are carefully processed, despite the ever-increasing volume of information being issued by the pharmaceutical industry. Such processing involves:
- verifying the approved names of all relevant ingredients including ‘non-active’ ingredients (the BNF is committed to using approved names and descriptions as laid down by the Human Medicines Regulations 2012);
- comparing the indications, cautions, contra-indications, and side-effects with similar existing drugs. Where these are different from the expected pattern, justification is sought for their inclusion or exclusion;
- seeking independent data on the use of drugs in pregnancy and breast-feeding;
- incorporating the information into BNF publications using established criteria for the presentation and inclusion of the data;
- checking interpretation of the information by a second clinical writer before submitting to a lead editor; changes relating to doses receive an extra check;
- identifying potential clinical problems or omissions and seeking further information from manufacturers or from expert advisers;
- careful validation of any areas of divergence of BNF publications from the SPC before discussion by the Committee (in the light of supporting evidence);
- constructing, with the help of expert advisers, a comment on the role of the drug in the context of similar drugs.
Expert advisers. The role of expert clinical advisers in providing the appropriate clinical context for all BNF information is discussed above.
Literature. Clinical writers monitor core medical and pharmaceutical journals. Research papers and reviews relating to drug therapy are carefully processed. When a difference between the advice in the BNF or BNFC and the paper is noted, the new information is assessed for reliability and relevance to UK clinical practice. If necessary, new text is drafted and discussed with expert advisers and the Joint Formulary Committee and/or the Paediatric Formulary Committee. The BNF enjoys a close working relationship with a number of national information providers.
Systematic reviews. BNF Publications has access to various databases of systematic reviews (including the Cochrane Library and various web-based resources). These are used for answering specific queries, for reviewing existing text, and for constructing new text. Clinical writers receive training in critical appraisal, literature evaluation, and search strategies. Reviews published in Clinical Evidence are used to validate BNF advice.
Consensus guidelines. The advice in BNF publications is checked against consensus guidelines produced by expert bodies. A number of bodies make drafts or pre-publication copies of the guidelines available to the BNF; it is therefore possible to ensure that a consistent message is disseminated. The BNF editorial team routinely processes guidelines from the National Institute for Health and Care Excellence (NICE), the Scottish Medicines Consortium (SMC), and the Scottish Intercollegiate Guidelines Network (SIGN).
Reference sources. Textbooks and reference sources are used to provide background information for the review of existing text or for the construction of new text. The BNF team works closely with the editorial team that produces Martindale: The Complete Drug Reference. BNF Publications has access to Martindale information resources and each team keeps the other informed of significant developments and shifts in the trends of drug usage.
Statutory information. The BNF routinely processes relevant information from various Government bodies including Statutory Instruments and regulations affecting the Prescription only Medicines Order. Official compendia such as the British Pharmacopoeia and its addenda are processed routinely to ensure that the BNF complies with the relevant sections of the Human Medicines Regulations 2012.
BNF Publications maintains close links with the Home Office (in relation to controlled drug regulations) and the Medicines and Healthcare products Regulatory Agency (including the British Pharmacopoeia Commission). Safety warnings issued by the Commission on Human Medicines (CHM) and guidelines on drug use issued by the UK health departments are processed as a matter of routine.
Relevant professional statements issued by the Royal Pharmaceutical Society are included in BNF publications as are guidelines from bodies such as the Royal College of General Practitioners.
BNF publications reflect information from the Drug Tariff, the Scottish Drug Tariff, and the Northern Ireland Drug Tariff.
Pricing information. The prices of medicinal products and appliances in BNF publications are based on information provided by the NHS Prescription Services (from the NHS Business Services Authority).
Comments from readers. Readers of BNF publications are invited to send in comments. Numerous letters and emails are received by the BNF team. Such feedback helps to ensure that BNF publications provide practical and clinically relevant information. Many changes in the presentation and scope of BNF publications have resulted from comments sent in by users.
Comments from industry. Close scrutiny of BNF publications by the manufacturers provides an additional check and allows them an opportunity to raise issues about the BNF and BNFC’s presentation of the role of various drugs; this is yet another check on the balance of the BNF publications' advice. All comments are looked at with care and, where necessary, additional information and expert advice are sought.
Virtual user groups. BNF Publications has set up virtual user groups across various healthcare professions (e.g. doctors, pharmacists, nurses, dentists). The aim of these groups will be to provide feedback to the editors and publishers to ensure that BNF publications continue to serve the needs of its users.
Market research. Market research is conducted at regular intervals to gather feedback on specific areas of development, such as drug interactions or changes to the way information is presented in digital formats.
The BNF and BNFC are independent professional publications that are kept up-to-date and address the day-to-day prescribing information needs of healthcare professionals. Use of these resources throughout the health service helps to ensure that medicines are used safely, effectively, and appropriately.
The BNF incorporates unlicensed employments of meds when the clinical need can't be met by licensed meds; such use ought to be upheld by appropriate proof and experience.
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