accreditation decision report for consultation - nice · british national formulary publications:...

British National Formulary Publications: British National Formulary, British National Formulary for

Children: Accreditation Report for consultation

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Guidance

producer:

British National Formulary Publications

Guidance

product:

British National Formulary, British

National Formulary for Children

Date: 29 August 2013

Version: 1.4

Accreditation Decision Report – for consultation



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Contents

Introduction ..................................................................................................................... 3

Accreditation recommendation ........................................................................................ 3

Reapplication for accreditation ........................................................................................ 6

Appendix A: NICE Accreditation analysis ........................................................................ 7

Appendix B: Bibliography .............................................................................................. 20

Appendix C: NICE Accreditation Advisory Committee, external advisers and NICE

Accreditation team......................................................................................................... 27



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Introduction

The NICE Accreditation Programme recognises organisations that demonstrate high

standards in producing health or social care guidance. Users of the accredited guidance

may therefore have high confidence in the quality of the information. Organisations can

publicly display a seal of approval called an Accreditation Mark for 5 years after their

processes have been accredited. The process for accrediting producers of guidance

and recommendations for practice is described in the process manual.

Accreditation recommendation

It is proposed that the process used by British National Formulary Publications to

produce the British National Formulary and British National Formulary for Children

is not recommended for accreditation. This decision is subject to public consultation

before a final decision is made.

Background to the guidance producer

The British National Formulary (BNF) is published by the British Medical Association

(BMA) and the Royal Pharmaceutical Society (RPS), through the British Medical Journal

(BMJ) Group and the Pharmaceutical Press. The British National Formulary for Children

(BNFC) is published by the RPS, BMA, Royal College of Paediatrics and Child Health

(RCPCH) and the Neonatal and Paediatric Pharmacist Group (NPPG). BNF

Publications is a consortium of these organisations. Funding for the guidance is

provided by the health services of the 4 home countries of the UK, and the contract is

managed by NICE. BNF Publications also produce the Nurse Prescribers’ Formulary

(NPF) which is a developed from a sub-set of the information in the BNF and BNFC.

The process used to produce the NPF is the subject of a separate decision due to some

key differences in the process, which are explained in that decision report.

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The BNF and BNFC aim to provide prescribers, pharmacists and other healthcare

professionals with accurate and up-to-date information about the use of medicines,

including key information on selection, prescribing, dispensing and administration. This

includes categorical information specific to individual medicines (termed ‘medicines

information’ in this report), and more general information about conditions, classes of

medicines and when it is appropriate to use them (termed ‘clinical information’ in this

report). This information is advice designed to guide the decision making of prescribers,

and is developed according to a standard process which can be assessed using the

accreditation criteria.

Summary

The Accreditation Advisory Committee considered that the processes used by BNF

Publications to produce the BNF and BNFC demonstrated compliance with 18 of the 25

criteria for accreditation, with 6 criteria not fully met, and 1 criterion not met.

Overall the scope and purpose of the BNFC and BNFC are clear. The publications are

based on a systematic search for evidence that takes into account the risks, benefits

and side effects of different treatment options. The advice is presented clearly and a

variety of support tools are available to aid implementation.

Whilst the process has strengths, there are concerns about the lack of stakeholder

involvement for some groups and the lack of a process for systematically assessing the

strengths, weaknesses and areas of uncertainty in the evidence and communicating

them to the end user. It is not clear that the process for peer review is external and the

lack of involvement of particular groups of stakeholders may affect the suitability of the

content for some users. In addition, the end user cannot tell when different sections

were last updated or reviewed and the prices of medicines have not been updated since

2011.

The assessment identified several areas where processes fall short of the required

standard. The main improvement that must be made is:



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to develop and implement a robust process to systematically and transparently

assess the strengths, weaknesses and areas of uncertainty in the evidence base

and communicate them to the end user.

Further recommendations for improvement of the process include:

continuing with the recruitment of lay members to the formulary committees and

ensuring lay participation is meaningful

involving all relevant stakeholder groups and target users including Community

Practitioners and Nurse Prescribers in developing recommendations

ensuring external peer review of the recommendations

updating the prices of medicines in the publications

ensuring the end user knows when each section was last updated or reviewed

ensuring the content, format and language is appropriate for all target users

This draft decision is now going out for consultation, and the decision will be reviewed

by the committee in the light of any feedback received before making a final

recommendation.

Professor Martin Underwood

Chair, Advisory Committee

August 2013



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Reapplication for accreditation

Following a final decision in which accreditation has not been granted, guidance from

the non-accredited producer will still be available on the NICE Evidence site but will not

be identified by the accreditation mark graphic.

Guidance producers that have not been awarded accreditation may reapply from 1 year

after the previous assessment. The organisation should address any concerns

highlighted in the original assessment before reapplying. The NICE Accreditation team

will provide detailed feedback and advice on areas in which improvement is needed to

meet the criteria in a future application.

British National Formulary Publications: British National Formulary, British National Formulary for Children: Accreditation Report for consultation

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Appendix A: NICE Accreditation analysis

The Advisory Committee considered the following analysis of the guidance producer’s compliance with NICE Accreditation

criteria, which covers 6 discrete domains. The full analysis leading to the accreditation decision is shown below.

Domain Criterion Evidence for meeting the criterion Accreditation

decision

Scope and

purpose

Does the guidance producer have a policy in place and adhered to that requires them to explicitly detail:

1.1 Overall objective The BNF1 and BNFC

2 are produced according to a standard format

3,4,5.

The aims of the publications are stated in prefaces and on the rear covers

of the publications1,2

.

Criterion met

1.2 The clinical, healthcare or social questions covered

The BNF1 and BNFC

2 aim to address high-level questions of drug safety,

effectiveness, appropriateness, dosage and adverse effects for all

medications covered. Information relating to these key questions such as

cautions, contraindications and side effects is provided in a standard

format3,4,5

for each medicine or class of medicine. Clinical questions

outside the medicines information are answered through the clinical

information found at the start of each chapter and section. This can be

seen in the BNF1 and BNFC

2.

Criterion met


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decision

1.3 Population and/or target audience to whom the guidance applies

The target audiences for BNF and BNFC are detailed on the rear

covers1,2

. The overall target population is broad given the variety of

medicines covered, but specific populations are defined by the indications

for each medicine1,2

.

Criterion met

1.4 Guidance includes clear recommendations in reference to specific clinical, healthcare or social circumstances

The standard format3,4,5

of the BNF1 and BNFC

2 and help to ensure

recommendations are given in reference to specific clinical or healthcare

circumstances. Guidance is provided for individual medicines to treat

specified conditions including indications, contraindications and

cautions1,2

, which cover the clinical circumstances in which a medicine is

recommended or not.

Criterion met

Stakeholder

involvement

Does the guidance producer have a policy in place and adhered to that means it includes:

2.1 Individuals from all relevant stakeholder groups, including patient groups, in developing guidance

The document ‘Standing Orders of the Formulary Committees of the

British National Formulary’6 details the composition of the Joint Formulary

Committee (JFC) and the Paediatric Formulary Committee (PFC). The

committees include pharmacists and clinical representatives from a

number of stakeholder groups, but do not include nurse prescribers for

example, who are also an audience for the publications as they are

expected to refer to them when using the NPF8. The publications

1,2 detail

the membership of the committees and the contributing expert advisers.

Not fully met


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decision

2.2 Patient and service user representatives and seeks patient views and preferences in developing guidance

Some sources of evidence that the BNF1 and BNFC

2 involve patients in

the development of their guidance, as described in ‘Standard reference

sources’7. Patients are also involved in the development of cautionary and

advisory warnings provided as appendix 3 of the BNF1 and BNFC

2. There

are no lay or patient representatives on the JFC or PFC however6, so

some recommendations are developed without lay or patient input. The

guidance producer has stated that recruitment of lay members to the JFC

and PFC is underway, but lay members are not currently in place.

Not fully met

2.3 Representative intended

users in developing

guidance.

The document ‘Standing Orders of the Formulary Committees of the

British National Formulary’6 details the composition of the JFC and the

PFC. The committees include target users such as pharmacists and

doctors, but do not include users of the NPF8 who are also expected to

refer to the publications. The publications1,2

detail the membership of the

committees and the contributing expert advisers.

Not fully met

Rigour of Does the guidance producer have a clear policy in place that:


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decision

development 3.1 Requires the guidance

producer to use

systematic methods to

search for evidence and

provide details of the

search strategy

‘Standard reference sources’7 and ‘Journal allocation list’

9 provide lists of

key sources of evidence which are scanned regularly for new medicines

and clinical information. This includes updated summaries of product

characteristics (SPC), drug safety updates (DSU), guidelines and journals.

NICE also regularly notifies the guidance producer of any new relevant

evidence it produces. This process is another systematic route to identify

new evidence. Evidence of regular scanning of sources is provided by an

internal tracking spreadsheet10

.

Criterion met

3.2 Requires the guidance

producers to state the

criteria and reasons for

inclusion or exclusion of

evidence identified by the

evidence review

High level inclusion and exclusion criteria are detailed in the document

‘Criteria for inclusion and exclusion of products in BNF and BNF for

Children’11

. Evidence about all prescription-only medicines licensed for

use in the UK is included. ‘Specials’ (unlicensed medicinal products for

individual patients) are excluded. There are additional inclusion criteria

covering certain non-prescription medicines, and devices that may be

prescribed for use with medicines. The section of the BNF1 and BNFC

2

‘How the BNF is constructed’ provides information on some of the

inclusion criteria for evidence based upon the type and source of

information.

Criterion met


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decision

3.3 Describes the strengths

and limitations of the

body of evidence and

acknowledges any areas

of uncertainty

Medicines information that comes explicitly and exclusively from SPCs is

authoritative and reliable, however many other sources of evidence are

included in the development of the BNF1 and BNFC

2, so it is vital there is

an appropriate process to appraise such evidence. The document

‘Standard reference sources’7 ranks sources of evidence according to how

accurate and reliable the guidance producer considers the information

from those sources to be, but there is no systematic process to appraise

individual items of evidence from those sources. Ranks include large

groups such as journals, and evidence from sources within the same rank

appears to be considered of equivalent quality. The transcripts12

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discussions by expert advisers, the JFC and PFC do not demonstrate

systematic consideration of the strengths and weaknesses of the

evidence. There is no process for communicating the strengths,

weaknesses and areas of uncertainty in the evidence base to the end

user. The publications indicate where medicines information deviates from

an SPC and in some cases where clinical information comes from a

specific guideline producer, but the strength of the information provided is

unknown.

Not met.


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decision

3.4 Describes the method

used to arrive at

recommendations (for

example, a voting system

or formal consensus

techniques like Delphi

consensus)

The process13

states that content changes based on updated SPC or

DSUs are made by the editorial team. Any other evidence is first

examined by the editorial team, then expert advisers who are practising

clinicians, then the JFC or PFC. The document ‘Standing orders of the

formulary committees of the British National Formulary’6 explains that

consensus is used to reach decisions. Where consensus is not possible a

voting system is used. Transcripts of conversations demonstrate this

process in action12

.

Criterion met

3.5 Requires the guidance

producers to consider the

health benefits against

the side effects and risks

in formulating

recommendations

The BNF1 and BNFC

2 present medicines information in a standard

format3,4,5

that details contraindications and side effects. The clinical

information also discusses the risks and side effects of classes of

medicines for different conditions. Any amendments to this information,

unless directly derived from SPCs or DSUs, requires discussion by the

JFC or PFC following input from external advisers13

. The transcripts of

these discussions12

show consideration of the risks, benefits and side

effects in reaching recommendations for both medicines and clinical

information.

Criterion met


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decision

3.6 Describes the processes

of external peer review

Recommendations from the JFC and PFC are reviewed by editors who

work for BNF Publications with no prior involvement in assessing the

evidence or developing the recommendations. A screenshot of an internal

content change tracker14

provides evidence of this process. It is not clear

however that there is sufficient separation between different members of

the editorial team for this to represent a process of external peer review.

Expert advisers review entire chapters of the publications but this occurs

post-publication and it is not stated that those advisers should not have

had prior involvement in developing the recommendations.

Not fully met

3.7 Describes the process of

updating guidance and

maintaining and

improving guidance

quality

The BNF1 and BNFC

2 are produced every 6 months in hard copy and are

updated monthly online15

. The process states that medicines information

is reviewed at least every 3 years, or sooner if new evidence becomes

available13

. Clinical information is updated when new evidence becomes

available through the systematic scanning of evidence sources. The BNF1

and BNFC2 clearly state how often they are updated in hard copy and

online, but it is not clear to the end user when each section was last

updated or reviewed. The prices of medicines have not been updated

since 2011 due to an on-going change in process.

Not fully met

Clarity and Does the guidance producer ensure that:


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decision

presentation 4.1 Recommendations are

specific, unambiguous

and clearly identifiable

The format of information in the BNF and BNFC is governed by a number

of style guides3,4,5

which ensure the advice is clearly presented.

Examination of the BNF1 and BNFC

2 show that the recommendations are

specific, unambiguous and clearly identifiable.

Criterion met

4.2 Different options for the

management of the

condition or options for

intervention are clearly

presented

The standard format3,4,5

of the BNF1 and BNFC

2 ensures a range of

medicines are presented where available, allowing the prescriber to the

most appropriate medicine. Examination of the BNF1 and BNFC

2 shows

that the options for management or intervention are clearly presented.

Criterion met

4.3 The date of search, the

date of publication or last

update and the proposed

date for review are clearly

stated

The BNF1 and BNFC

2 are printed publications with a copyright statement

on the first page containing the year of publication. The BNF displays the

month and the year of publication on the front cover1. The updating

frequency for each publication is stated both in the process13

and in the

publications12

. This also informs users of the period of new evidence taken

into account in the new edition compared to the previous edition (6

months for the BNF, 1 year for the BNFC, and monthly for the BNF and

BNFC online). This is an appropriate alternative to a single date of search

as the publication relies on regular searching of many evidence sources.

Criterion met


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decision

4.4 The content of the

guidance is suitable for

the specified target

audience. If patients or

service users are part of

this audience, the

language should be

appropriate.

The process13

includes multidisciplinary committees6 to help ensure the

content is suitable for the target audience, but some sections of the target

audience are not represented, for example community practitioner nurse

prescribers. Therefore there are some gaps in the process for ensuring

the content is suitable for the target audience.

Not fully met

Applicability

Does the guidance producer routinely consider:

5.1 Publishing support tools

to aid implementation of

guidance

The BNF1 and BNFC

2 are designed as succinct reference tools. They

include guidance on how to write prescriptions, prescribing for particular

groups, and details of major changes since the last edition. Online

versions of the BNF and BNFC are available15

to subscribers or those with

an NHS Athens account that contain recent updates and provide a quick

way to find medicines information. The BNF is also available as an

application for smart-phones16

which may assist prescribers who do not

have access to a hard copy whilst working.

Criterion met


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decision

5.2 Discussion of potential

organisational and

financial barriers in

applying its

recommendations

Both the BNF1 and the BNFC

2 contain the section ‘Taking medicines to

best effect’ that provides advice for prescribers in overcoming barriers to

adherence of a medicines regimen. The section ‘Controlled drugs and

drug dependence’ explain the organisational and legislative barriers to

prescribing controlled drugs along with the requirements for prescriptions.

Positive or negative NICE technology appraisals are indicated in the

guidance1,2

, which may indicate to prescribers that NHS funding might not

be available for certain drugs.

Criterion met

5.3 That their guidance is

current, with review

criteria for monitoring

and/or audit purposes

within each product.

There are processes to monitor usage of the BNF through market

research activities17

. The BNF1 and BNFC

2 all contain MHRA ‘yellow

cards’ for reporting suspected adverse reactions to medicines. This

demonstrates a form of monitoring included within the guidance product

as yellow cards are important for monitoring medicines in the marketplace.

Criterion met

Editorial Does the guidance producer:


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decision

independence 6.1 Ensure editorial

independence from the

funding body

The health services of the 4 home countries of the UK are the funding

source, but it would be impossible to ensure adequate professional

stakeholder involvement without including a variety of health service

employees in development of the BNF1. In practice the NHS employees

who sit on the committees are not responsible for purchasing the BNF.

BNF Publications is also independent of the pharmaceutical industry and

receives no funding from them. The publications do not include adverts for

any products. All committee members and external advisers are required

to declare any conflicts of interest6,20

.

Criterion met

6.2 Demonstrate

transparency about the

funding mechanisms for

its guidance

The funding source for the BNF1 and BNFC

2 are the health services of the

4 home countries of the UK, and the contract is managed by NICE. The

BNF and BNFC include a statement that they are funded by sales to the

health service1,2

.

Criterion met

6.3 Record and state any

potential conflicts of

interest of individuals

involved in developing

the recommendations

The standing orders of the formulary committees6, terms of reference for

expert advisers18

and declaration of interests form for expert advisers20

provide comprehensive, appropriate policies for declaring and managing a

range of conflicts of interest. BNF editorial staff are required to declare

conflicts through the Royal Pharmaceutical Society register of interests19

.

Both the policies and declarations are available upon request.

Criterion met


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decision

6.4 Take account of any

potential for bias in the

conclusions or

recommendations of the

guidance

The process of evidence identification is systematic. Funding is

transparent, editorial independence from the funding source is achieved,

and there is a comprehensive policy for declaring and managing conflicts

of interest6,18,19,20

. Together these steps help to ensure the possibility of

bias is reduced.

Criterion met


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decision

1 British National Formulary

2 British National Formulary for Children

3 BNF style guide

4 BNFC style guide

5 Style guide for hepatic, renal, pregnancy, and breast-feeding messages in BNF and BNFC

6 Standing Orders of the Formulary Committees of the British National Formulary

7 Standard reference sources

8 Nurse prescribers’ formulary

9 Journal allocation list

10 logs of systematic searches

11 Criteria for inclusion and exclusion of products in BNF and BNF for Children

12 transcripts of discussions by expert advisers, the JFC and PFC

13 Creating content for referential (human readable) BNF and BNFC

14 screenshot of an internal content change tracker

15 Online versions of the BNF and BNFC

16 BNF application for smart-phones

17 User research report

18 BNF and BNFC Advisors Terms of Reference

19 Royal Pharmaceutical Society register of interests

20 Declaration of Interests Form – Advisor

http://www.bnf.org/bnf/index.htm

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Appendix B: Bibliography

Appendix B lists the additional information taken into account in the analysis and

considered by the committee.

Document name Description Location

Appendix 1: BNF and

BNFC Use Cases

Scenarios demonstrating use

of the BNF

supplied

Appendix 2: When to

seek expert input on

clinical issues

Explains when expert

advisers and committees are

used

supplied

Appendix 3: Creating

content for referential

(human readable) BNF

and BNFC

Process document for

creating BNF and BNFC

content

supplied

Appendix 4:

Discussions: JFC Use

of aminoglycosides with

ototoxic diuretics

Example of expert adviser

discussion over content

supplied

Appendix 5: Recruiting

a new adviser

Procedure for recruiting

expert advisers

supplied

Appendix 6: Standard

reference sources

List of sources and quality

criteria used by the BNF

supplied

Appendix 7: Readability

Testing report for BNF

Appendix 9 - Cautionary

and advisory labels for

dispensed medicines

Demonstrates patient

involvement in developing

patient information

supplied

Appendix 8: BNF: latest

user research Oct 2012

User research findings supplied

Appendix 9: BNF List of journal sources supplied



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journal allocation

11/2012

Appendix 10: Procedure

for processing SPCs

Procedure for processing

SPCs

supplied

Appendix 11:

Processed SPC for

Exembol [argatroban]

Example of processed SPC

supplied

Appendix 12: BNF SOP

Checking doses

SOP for checking doses supplied

Appendix 13: BNF and

BNFC Advisors Terms

of Reference

Terms of Reference for

expert advisors

supplied

Appendix 14: BNF

Standing Orders of the

Formulary Committees

of the British National

Formulary


Formulary Committees of the

British National Formulary

supplied

Appendix 15: Criteria

for inclusion and

exclusion of products in

BNF and BNFC

Information on what types of

products are covered

supplied

Appendices 16a-d:

Email correspondence

related to NYDA®

Email correspondence

related to NYDA®

supplied


Processing the Nurse

Prescribers’ Formulary

lists

Information on how the list of

medicines and devices in the

NPF is arrived at

supplied



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Processing the Dental

Practitioners’ Formulary

lists

Information on how the list of

dental medicines in the BNF

and BNFC is arrived at

supplied

Appendix 19: BNF Style

guide

BNF Style guide supplied

Appendix 20: BNFC

Style guide

BNFC Style guide supplied

Appendix 21: Style

guide for hepatic, renal,

pregnancy, and breast-

feeding messages in

BNF and BNFC


Appendix 22: BNF Side-

effects help guide


Appendix 23: BNF

ACBS Product

placement decision

guide

Editorial guide supplied

Appendix 24: BNF

ACBS Style guide

Style guide supplied

Appendix 25: Google

analytics of BNF

website

Website statistics for BNF

website

supplied

Appendix 26: Royal

Pharmaceutical Society

Register of Interests

Declaration of interests form

for the RPS

supplied



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form

Appendix 27: British

Society of Antimicrobial

Chemotherapy

guidelines for the

antibiotic treatment of

endocarditis in adults

2012

Sample of evidence identified

by searches

supplied

Appendix 28: BNF

endocarditis

BSAC Endocarditis BNF

analysis (2012)

supplied

Appendix 29: BNF


Formulary Committees

of the British National

Formulary

Standing orders supplied


BNFC Advisors Terms

of Reference

Terms of reference supplied

Appendix 31:

Declaration of Interests

Form – Advisor

Declaration of interests form supplied


Creating content for the

Nurse Prescribers’

Formulary for

Community

Practitioners

SOP for developing the NPF Supplied

Appendix 33: Extract of

NICE CG102: Bacterial

meningitis and

Sample of evidence identified

by searches

supplied



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meningococcal

septicaemia in children:

full guideline

Appendix 34: BNFC

Adviser questions

posted on pre-hospital

antibiotics for meningitis

Expert advisers’ review of

evidence

supplied

Appendix 35: JFC

paper on pre-hospital


JFC review of evidence supplied

Appendix 36: PFC

paper on pre-hospital


PFC review of evidence supplied

Appendix 37: PFC

paper on maximum

dose of adenosine


Appendix 38: PFC

paper on lisinopril heart

failure dose


Appendix 39: PFC

paper on the role of

spironolactone in

nephrotic syndrome


Appendix 40: PFC

paper on the nebulised

dose of colistimethate

sodium


Appendix 41: JFC

paper tiotropium

JFC review of evidence supplied

Appendix 42: BNFC Expert advisers’ review of supplied



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Adviser discussion on

plasma concentration

monitoring of

colistimethate

evidence

Appendix 43: BNFC


benzylpenicillin dose in

neonates


evidence

supplied

Appendix 44: BNFC


intravenous infusion

dose of metronidazole

in neonates


evidence

supplied

Appendix 45: UK

Ophthalmic Pharmacy

Group comments on

chapter 11, BNF 64

Expert adviser review of BNF

chapter

supplied


BNFC Advisors Terms

of Reference

Terms of reference supplied

Appendix 47: Drug

Safety Update March

2013 vol. 6, issue 8

Drug safety update supplied


BNF for Children

update for health

professionals

Update of changes for BNF

and BNFC

supplied

Monthly important new

information.pdf

Letter from NICE detailing

changes to medicines

information of interest to the

supplied



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BNF



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Appendix C: NICE Accreditation Advisory Committee,

external advisers and NICE Accreditation team

NICE Accreditation Advisory Committee

The Accreditation Advisory Committee operates as a standing advisory committee of

the Board of the National Institute for Health and Care Excellence (NICE). The

Committee provides advice to NICE on a framework for accrediting sources of evidence

that should be recognised as trusted sources of information for the NHS. The chair of

the Committee is appointed by the NICE Board and the meetings are conducted by the

chair, or in his/her absence the vice chair. The current Chair is Martin Underwood. A full

list of the Advisory Committee membership is available on the NICE website. Members

are appointed for a period of 3 years. This may be extended by mutual agreement for a

further 3 years, up to a maximum term of office of 10 years.

The decisions of the Committee are arrived at by a consensus of the members present.

The quorum is set at 50% of committee membership. The Committee submits its

recommendations to the NICE Guidance Executive which acts under delegated powers

of the NICE Board in considering and approving its recommendations.

Committee members are asked to declare any interests in the guidance producer to be

accredited. If it is considered that there is a conflict of interest, the member is excluded

from participating further in the discussions. Committee members who took part in the

discussions for this accreditation decision are listed below.

Title Name Surname Role Organisation

Dr Adrian Brown Principal Screening Advisor NHS England

Professor Ann Caress Professor of Nursing University of Manchester

Ms Joyce Epstein Lay member Lay member

Dr Elvira Garcia Public Health Medicine

Consultant

Locum

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Dr Steve Hajioff General Practitioner and Public

Health Consultant

Public Health England

Ms Ruth Liley Assistant Director of Quality

Improvement

Marie Curie Cancer Care

Professor Stuart Logan Professor of Paediatric

Epidemiology

Peninsula College of Medicine &

Dentistry

Dr Edward Ng General Practitioner Ley Hill Surgery Sutton Coldfield

Dr Carl Parker General practitioner North Tees and Hartlepool

Foundation Trust

Dr Mahendra Patel Senior Lecturer & Consultant

Pharmacist

Universities of Huddersfield and

Bradford

Dr Karen Ritchie Head of Knowledge

Management

Healthcare Improvement Scotland

Ms Mandy Sainty Research and Development

Manager

College of Occupational

Therapists

Dr Pete Smith Vice President National Association of Primary

Care

Dr Sara Twaddle Head of Evidence &

Technologies / Director of SIGN

Healthcare Improvement Scotland

Professor Martin Underwood Head of Division of Health

Sciences, Professor of Primary

Care Research

The University of Warwick

Dr Stephen Webb Consultant in Anaesthesia &

Intensive Care Medicine

Papworth Hospital NHS

Foundation Trust

Deputies

Title Name Surname Role Organisation Deputising for

Ms Josephine Kavanagh Research Officer Institute of Education Professor Sandy Oliver

External Advisers for this application

Dr Andrea Hilton, Lecturer and practising pharmacist, University of Hull, UK Dr Marlies Ostermann, Consultant in Critical Care and Nephrology, Guy's & St Thomas' Hospital, London, UK



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Adrian Palfreeman, Consultant Physician University Hospitals Leicester, UK Adrian Reyes-Hughes, Clinical Consultant, Clinical Strategy & Health Information Services, UK

NICE Accreditation team for this application

James Stone, Accreditation Technical Analyst, National Institute for Health and Care

Excellence, Manchester, UK

Stephanie Birtles, Accreditation Technical Analyst, National Institute for Health and

Care Excellence, Manchester, UK

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