Items which should not be routinely prescribed in primary care

In 2018 the cost of medicines prescribed and dispensed in primary care was £8.8 billion, with the number of prescriptions increasing, it is important that the NHS acts to achieve the greatest value from the money that it spends.

NHS Clinical Commissioners (NHSCC) – the organisation that represents CCGs – originally approached NHS England with a proposal to reduce prescription of ineffective medicines in primary care. As part of its national commissioning role, NHS England started working with NHSCC to review such products, set out an evidence based and consistent approach for patients, and coordinate a national consultation process on behalf of all CCGs.

The intention was to produce a consistent, national framework for CCGs to use, while taking account of local circumstances and their own impact assessment and legal duties to advance equality and have regard to reduce health inequalities.

In partnership with NHSCC, NHS England appointed a joint clinical working group to review the available clinical evidence and develop commissioning guidance for public consultation.

Initially work focused on developing guidelines for an initial list of 18 products which fell into one or more of the following categories:

  • Products of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns;
  • Products which are clinically effective but where more cost-effective products are available, including some products that have been subject to excessive price inflation; and
  • Products which are clinically effective but due to the nature of the product are deemed a low priority for NHS funding.

In the majority of cases there are other more effective, safer and/or cheaper alternatives available to the treatments that NHS England is recommending should not be routinely prescribed in primary care.

Following a first national consultation in July – October 2017, national guidance on 18 items which should no longer be routinely prescribed in primary care was published in November 2017 to ensure people receive the safest and most effective treatment available. Following a further consultation in November 2018 – February 2019 on proposals to review and update the guidance, 1 item was updated and 7 new items were added. Updated CCG guidance was published in June 2019.

The guidance is part of the Medicines Value Programme which aims to ensure greater value from the NHS’ £18.2 billion medicines bill (NHS Digital, 2017/18) through improving health outcomes; reducing waste, over-prescribing and over-treatment; and addressing excessive price inflation by drug companies.

The guidance does not remove the clinical discretion of the prescriber in deciding what is in accordance with their professional duties.

The joint working group has also published guidance on conditions for which over the counter items should not routinely be prescribed in primary care