The National medicines optimisation opportunities guidance will not be updated for 2026/2027, but this is still available on the National Archives.

However, the 2024/2025 opportunities remain a set of important medicines optimisation topic areas that integrated care boards and partner organisations may pursue as improvement initiatives for their population.

The latest up-to-date information on each of the 16 opportunity areas is available below.

Addressing problematic polypharmacy

• Addressing problematic polypharmacy – Futures collaboration platform (registration required)

Addressing low priority prescribing

• Addressing low priority prescribing – Futures collaboration platform (registration required)

Improving equitable adoption of the most clinically and cost-effective medicines

Updated innovation scorecard to include data at a regional level is expected in January 2027.

Local formulary national minimum dataset is in development to better understand the inclusion of innovative medicines in local formularies.

Obtaining secondary care medicines in line with NHS England commercial medicines framework agreements

• Commissioning framework for biological medicines – NHS England
• Medicines procurement and supply chain – NHS England

Standardising product formulations of aseptically compounded medicines

• Standardising product formulations of aseptically compounded medicines – Futures collaboration platform (registration required)

Using best value biologic medicines in line with NHS England commissioning recommendations

• Using best value biologic medicines in line with NHS England commissioning recommendations – Futures collaboration platform (registration required)

Addressing inappropriate antidepressant prescribing

• Addressing inappropriate antidepressant prescribing – Specialist Pharmacy Service

Appropriate prescribing and supply of blood glucose and ketone meters, and testing strips and lancets

• Appropriate prescribing and supply of blood glucose and ketone meters, and testing strips and lancets – Futures collaboration platform (registration required)

Identifying patients with atrial fibrillation and using best value direct-acting oral anticoagulants

• National cardiovascular disease prevention – Futures collaboration platform (registration required)
• Operational note: commissioning recommendations for national procurement for direct-acting oral anticoagulant(s) – NHS England
• Cardiovascular Disease Prevention data and improvement tool – CVDPREVENT
• Quality improvement data packs – CVDPREVENT

Identifying patients with hypertension and starting antihypertensives where appropriate

• National cardiovascular disease prevention – Futures collaboration platform ( registration required)
• Cardiovascular Disease Prevention data and improvement tool – CVDPREVENT
• Quality improvement data packs – CVDPREVENT

Optimising inhaler use to improve respiratory outcomes and reduce carbon emissions

Resources

Case studies and examples of good practice

• Improving health outcomes for respiratory patients while reducing carbon emissions – NHS England
• Improving lung health and the environment at Kirkholt Medical Centre, Rochdale – NHS England

To support implementation

Guidelines and pharmacological management

• Asthma: diagnosis, monitoring and chronic asthma management  – British Thoracic Society, National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network
• Asthma, chronic – treatment summaries – British National Formulary and National Institute for Health and Care Excellence
• Integrated care board, health board and trust toolkit: Implementing the new asthma guideline – Primary Care Respiratory Society
• Recognising uncontrolled asthma in primary care – Health Innovation Oxford
• Short-acting beta 2 agonists (SABA) (salbutamol and terbutaline): reminder of the risks from overuse in asthma and to be aware of changes in the SABA prescribing guidelines – Medicines and Healthcare products Regulatory Agency

Optimising inhaler device choice

• Choosing the right inhaler device for your patients – Asthma + Lung UK
• High quality and low carbon respiratory care – NHS England Workforce, Training and Education
• Inhaler choices – patient support programme – Asthma + Lung UK
• Patient decision aid on asthma inhalers and climate change – National Institute for Health and Care Excellence
• Reducing emissions from inhalers – Greener NHS Knowledge Hub – Futures collaboration platform (registration required)
• Tailoring inhaler devices – Primary Care Respiratory Society

Carbon footprint of inhalers

• Bulletin 295: inhaler carbon footprint, PrescQIPP

Improving valproate safety

• National patient safety alert: valproate: organisations to prepare for new regulatory measures for oversight of prescribing to new patients and existing female patients (NatPSA/2023/013/MHRA) – gov.uk
• Valproate use in men: as a precaution, men and their partners should use effective contraception – gov.uk
• Valproate – reproductive risks – gov.uk
• Medicines and pregnancy registry – Medicines and Healthcare products Regulatory Agency
• Information on valproate – NHS South East Clinical Delivery and Networks
• Discussing the risks of sodium valproate – General Medical Council
• High risk medicines: valproate – Care Quality Commission

Optimising lipid management for cardiovascular disease prevention

• National cardiovascular disease prevention – Futures collaboration platform (registration required)
• NHS Accelerated Access Collaborative – summary of national guidance for lipid management – NHS England
• Cardiovascular Disease Prevention data and improvement tool – CVDPREVENT
• Quality improvement data packs – CVDPREVENT

Reducing course length of antimicrobial prescribing

• Model Health System, population health, antimicrobial resistance reporting for antibiotic duration – primary care prescribing
• Open-access PrescQIPP optimising antimicrobial duration dashboards
• Futures collaboration platform NHS Antimicrobial resistance Programme workspace resources for shorter courses (registration required)

Chronic non-cancer pain management without opioids

• Community Musculoskeletal – Getting It Right First Time (GIRFT)
• Chronic pain – GIRFT
• Opioids aware, Faculty of Pain Medicine, which should be noted to be a significant change in guidance. The recommended oral morphine equivalent (OME) threshold has been reduced from 120mg to 90mg/day, with an ideal target of less than 50mg/day

Switching intravenous antibiotics to oral

• Model Health System, population health, antimicrobial resistance reporting for acute trust antibiotic use: intravenous antibiotic prescribing
• Fingertips Open Access reports of intravenous antibiotic prescribing; DDDs per 1,000 admissions by month and NHS acute trust
• Futures collaboration platform NHS Antimicrobial resistance Programme workspace resources to support timely appropriate IV to oral switch (registration required)
• Short educational video on how nurses can lead the IV to oral antibiotic switch campaign

The National Medicines Optimisation ePACT2 dashboard and other data sources in the NHS BSA national medicines optimisation opportunities can continue to be utilised to review progress and track changes on the opportunity areas. The metrics in the dashboard are currently under review – further information will be added to the Futures collaboration platform medicines efficiencies workspace. Some dashboards are also available in the prescribing measures section of the OpenPrescribing website.

Publication reference for the archived National medicines optimisation opportunities guidance: PRN00587