Sir,- I am becoming increasingly frustrated with the current versions of the BNF (and DPF) and believe that opening a debate on the matter may contribute to the development of improved products. Notwithstanding the excellent pharmacological data contained within the BNF, I find the current hardcopy version infuriating as, on multiple occasions, it refers the reader to another section which then re-refers to yet another section. In my opinion, it is poorly designed in this regard. I would not be surprised if a significant proportion of the high number of prescribing errors among medical professionals were attributable to the current problems navigating the text for drug interaction and other advice (particularly when the user is under pressure). I believe that the e-bnf has a confusing and frustrating navigation system. The web-based system appears to be so light on information that it may represent a medico-legal threat to users. For example, the page which I visited on amoxicillin oral powder at www.bnf.org/bnf/bnf/current/openat/105952.htm, only gives outline information on available preparations. It gave no dosage, indications or ADR information or links on the relevant frame.

In my opinion it should be possible to simply create the whole BNF in a PDF (the editing function could be disabled), RTF or Word format by converting the original file format used to create the hardcopy version. Such file formats would allow users to navigate the document using the simple search, page jump, hypertext and cross-reference functions (as available in the relevant format). Search speeds would not be an issue with the recent generations of computers. I suspect that copyright issues may have prevented the publication of the original document in a simple formatted text file (or more sophisticated format) matching the original. The BNF is supposed to be a key aid to clinicians not a pharmacological data maze. The committee responsible for the document should take a hard look at improving it and the format/s in which it is presented.

C. R. Macfarlane, Assistant Editor, BNF and S. M. S. Wagle, Assistant Editor, BNF/DPF respond:

Dr Mc Crory is confusing two different publications. On the one-hand, the British National Formulary (BNF) which includes the Dental List, and on the other, the Dental Practitioners' Formulary (DPF) which includes prescribing information on preparations that dental surgeons can prescribe on Form FP10 (GP14 in Scotland). The Dental List in the BNF is a simple list of preparations which a dental surgeon may prescribe on the NHS; the list is not intended to be used as a resource for prescribing information. There is currently no digital (electronic) version of the DPF. Whereas the UK health departments purchase DPFs for distribution to dental surgeons, there is no arrangement for the publishers to provide a digital version. Despite this, a digital version of the DPF was developed but the uptake was very poor and it was agreed that for the time being no further effort should go into producing a digital DPF.

There are several digital versions of the BNF, all of which include the Dental List. The digital version of the BNF on the Internet (http://BNF.org) is made available free-of-charge, without any restriction on access. The publishers receive no funding for this service and it is provided with the sole purpose of making the information available to healthcare professionals as readily as possible. The BNF website is appreciated by healthcare professionals in the UK and particularly abroad. The editorial team and the software developers are very happy to listen to users' comments and make improvements. In any case, the BNF has embarked on a very ambitious (and resource-intensive) programme of developing its digital offerings. The result of some of this work is already visible in the new-look digital BNF on the website. Further innovative features will follow.

Since the digital versions of the BNF contain the same information as the printed book, we are puzzled by Dr Mc Crory's remark that the 'web based system' is light on information. Dr Mc Crory's example about amoxicillin oral powder relates to the Dental List. The Dental List was never intended to include prescribing information on dental indications, doses, and side-effects. As we say, that information is in the DPF.

More generally, Dr Mc Crory finds the BNF's navigation system confusing. Users can either browse through the hierarchy of chapters (in the traditional way) or locate the information by means of a key-word search. Anyone familiar with Google should feel at home with the latter method. So, for example, a search for 'amoxicillin' produces 34 results, displayed according to order of importance and relevance. The first such result links to the amoxicillin monograph in the BNF, which includes information on indications, cautions, contra-indications, side-effects, and doses. This information is not specific to dentistry because the BNF is intended for a far wider audience.

Dr Mc Crory takes issue with the use of cross-references from one section of the text to another. It is customary for medical reference works of this nature not to repeat information in several places; instead, information is provided in its proper context in one place, with pointers to related information elsewhere. Digital reference works also use this approach.

We recognise that healthcare professionals need to learn how to use BNF resources effectively. We are very willing to listen to constructive comments from our healthcare colleagues and to respond to individual issues regarding the BNF family of digital products.