Items which should not be routinely prescribed in primary care: consultation

NHS Clinical Commissioners (NHSCC) and NHS England have developed a proposal to improve patient care by no longer routinely prescribing 18 medicines which are either:

  • Clinically ineffective, unsafe, or not cost effective; or
  • Where the NHS can offer a clinically proven alternative for patients.

In partnership with NHSCC, NHS England brought together an expert clinical working group to review the evidence, and they have developed recommendations on 18 products for a public consultation.

The objective is to produce commissioning guidance to support clinical commissioning groups (CCGs) in their decision-making, to address unwarranted variation, and to provide clear national advice to make local prescribing practices more effective. Any savings from implementing the proposals will be reinvested in improving patient care.

While many doctors and other prescribers are no longer prescribing these 18 medicines for patients, the evidence shows there is variation across the country and the NHS currently spends £141 million p.a. on these medicines.

Clearly the NHS needs a fair and consistent national position for everyone. As part of its national commissioning role, NHS England is taking a lead on this initiative and is working with NHSCC on behalf of CCGs from across England.

Subject to the outcome of the consultation, guidance on the initial 18 medicines is likely to be published by NHS England and CCGs will be asked to consider its implementation with their communities, ensuring they take into account their legal duties to advance equality and to reduce health inequalities.

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

NHS England and NHSCC are also seeking people’s views on whether a wider list of 3,200 products that are available over-the-counter, without prescription, may be considered appropriate for future restriction. At this stage, we are seeking views generally on this element, to inform the next phase of the work by the clinical working group which will consider this category of products.

The consultation is open from 21 July to 21 October 2017:

Respond to the consultation