BNFC 20-year anniversary: Editorial retrospective
Practical and evidence-based, BNF for Children (BNFC) is the only child-focused drug formulary in the world that is both independent, and has rigorous, accredited content creation processes.
With a catalogue of over 1000 drugs, it is trusted by over 220,000 health professionals who prescribe, dispense, and administer medicines for childhood disorders, helping them make confident decisions at the point of care.
Content in BNFC encompasses best practice guidelines together with advice from a network of paediatric experts and is published under the authority of a Paediatric Formulary Committee (PFC).
How has BNFC evolved over the last 20 years to become the first choice for concise medicines information for children, and how will it continue to evolve to meet the needs of health professionals over the next 20 years and beyond?
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The Beginning of BNFC
In the 1990s, it became clear that a critical gap existed in medicines information for children.
The realisation that children are not simply “mini adults” and differ in their response to drugs, alongside the fact that many medicines used in children are unlicensed or used off-label, highlighted the urgent need for specialised guidance.
This led to the publication of the first edition of Medicines for Children (MfC) in 1999 by the Royal College of Paediatrics and Child Health (RCPCH) Publications Ltd.
Drawing upon the expertise of many paediatricians and members of the then Neonatal and Paediatric Pharmacists Group (NPPG), it brought together specific information and prescribing guidelines for children and neonates.
View the full BNFC timeline and see how its content has evolved over two decades.
MfC was a huge success in the UK and abroad, however, it became clear that the tremendous goodwill of specialist clinicians alone would not be sufficient to maintain and build upon this success.
There was an undisputed need for a national formulary for children, and a recognition that securing the future of this formulary would require engaging with an external organisation with a proven track record in publishing definitive formularies.
As the cornerstone of UK healthcare since the publication of its first edition in 1949, and its well-established role in guiding the safe use of medicines across all ages, BNF was perfectly positioned to lead this effort.
A new partnership was created between the British Medical Association (BMA), the then Royal Pharmaceutical Society of Great Britain (RPSGB), together with the RCPCH and the NPPG as publishers of MfC.
An editorial committee, which included representatives from RCPCH, NPPG, BMA, RPSGB, the Medicines and Healthcare products Regulatory Agency (MHRA), and the Royal College of General Practitioners, was established to oversee the creation of BNFC.
The Health Minister at the time, Lord Warner, acknowledged the work that was in progress to create BNFC, and allocated funds for its publication and distribution, setting the stage for a pivotal change in paediatric healthcare.
After more than a year of work, the first edition of BNFC was officially launched on 14th July 2005, at an event attended by HRH Princess Anne.
The second edition, BNFC 2006, incorporated user feedback to improve the speed and accuracy of information retrieval.
Early feedback published alongside BNFC 2008 showed an impressive shift: a survey of over 600 health professionals revealed that 74% now turned to BNFC as their primary resource for paediatric medicines information.
In addition, 70% felt more aware of suitable treatments, and 40% believed BNFC had changed their clinical practice.
Over half of users reported that it reduced the need to seek advice from colleagues, and almost half of users felt that it improved the quality of prescribing for children under shared care arrangements between primary and secondary care.
BNFC’s Digital Evolution
Since its launch in 2005, print BNFC has been published annually. Over the years, the colourful book covers have formed a rainbow of books, instantly recognisable to health professionals working throughout the NHS and beyond.
In the late 1990s the then Labour government set out its vision for the NHS. This included an information strategy, which led to the creation of the National Programme for IT, a multi-billion-pound programme of investment intended to develop the NHS’s IT structure.
The access needs of health professionals across the NHS were changing, and BNFC had to change to meet these needs. The drive for BNFC (and BNF) to become a digital-first publication began.
BNFC’s digital evolution started with transitioning the print-only publication onto MedicinesComplete, Pharmaceutical Press’s digital platform. MedicinesComplete provides trusted evidence-based information about medicines to inform and support best patient care.
Adding BNFC to this platform enabled users to easily search for information in BNFC and provided the capability to quickly move between other knowledge products, helping clinicians make confident, timely decisions.
Monthly online updates to BNFC content were introduced in 2012, ensuring health professionals have access to the most current information on new medicines, safety alerts, dose changes, and other significant changes.
2015 marked a fundamental change to the structure of BNFC content to bring consistency and clarity across each of the platforms on which BNFC could be accessed and enable better products to be created for users.
This paved the way for the launch of the official BNF and BNFC app in 2017, which allowed offline access to content on mobile devices.
2019 saw the introduction of data licensing, enabling content to be integrated with other clinical systems.
Connections to the NHS and the wider health system
Today, under national agreements with parts of the NHS in the UK, health professionals working in the NHS have unrestricted access to BNFC at the point of need.
The close connection to the health system continues, and the principle of ensuring that the medicines information needs of health professionals are met is still an important driver when considering updates to BNFC.
Feedback from users continues to be an essential part of meeting these needs. BNFC receives a large volume of correspondence from users within the health system.
Each query is triaged, assessed, and responded to by the Editorial Team, and where appropriate, the feedback received may lead to a review and update of content. Feedback on content is also sought proactively via user testing.
The creation of BNFC clinical recommendations may require actively seeking feedback on content from a network of expert advisory groups, comprised of clinicians recognised as experts in their field of practice.
The agreed proposal is then review by the BNFC’s clinical governance committee, the PFC, which is made up of of pharmacists, doctors, nurses, lay representatives, and members from UK health departments, national guideline bodies, and the MHRA.
This may also be followed by an open consultation via the BNFC’s peer review process. At each step of this process, the views of health professionals are sought to ensure these recommendations are safe, effective, and relevant to users of BNFC.
BNFC’s rigorous content creation process and its collaboration with expert clinicians have consistently led the way in paediatric prescribing.
A key example is the update to oral iron dosing for iron deficiency anaemia (IDA) in children.
This followed an update to BNF recommendations for oral iron salts in adults to align with guidance published by the British Society of Gastroenterology (BSG) in 2021.
The BSG guidance recommended oral iron doses which were lower than those traditionally used in adults, and lower than doses used in children, prompting a review of dosing in BNFC.
The BNFC Editorial Team appraised primary literature, UK and international guidelines, and consulted with experts from the British Society of Paediatric Gastroenterology, Hepatology and Nutrition, RCPCH, and NPPG.
The proposed recommendations, together with the expert advice received, were reviewed by the PFC, and then by BNFC users via open consultation, before being published in BNFC.
Engagement with health professionals, as part of the BNFC’s content creation process, guided the development of a new, unique dosing regimen for neonates and children under 12.
The Future of BNFC Digital Integration
BNFC’s integral partnership with the NHS is strengthened by the RPS’ landmark investment in Dosium’s Touchdose.
This clinical decision support technology aims to improve the speed, consistency, and safety of prescribing.
Touchdose is the only decision support solution that automatically calculates the correct dosage of a drug for any individual patient using exclusive integration with BNF and BNFC, as well as local guidelines.
In 2024, the rollout of Touchdose began at West London Children’s Healthcare, bringing BNFC’s trusted content to the patient’s bedside–a major step towards reducing medication errors, improving patient outcomes and streamlining clinical workflows.
This effort is supported by an early study conducted by Imperial College researchers, which found that the use of Touchdose reduces prescribing errors by 84% compared with standard clinical practice.¹
BNFC has evolved from a vital print formulary into a dynamic tool that is on its way to being seamlessly integrated into the daily workflow of health professionals.
It uniquely combines authoritative, independent, evidence-based guidance with clinically validated drug information, while remaining accessible, up-to-date, and tailored to the demands of modern paediatric practice.
With innovations like Touchdose, BNFC’s trusted advice is poised to unlock its full potential, as the era of BNFC integration is only just beginning.
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References
- Dosium: Imperial study reveals 84% reduction in prescribing errors using Dosium (https://www.dosium.com/latest/imperial-study-reveals-76-per-cent-reduction-in-prescribing-errors-using-dosium)
