Items which should not be routinely prescribed in primary care

NHS England has taken action to reduce inappropriate prescribing of 18 medicines which will improve health and save millions of pounds a year.

National guidance on medicines which should no longer be routinely prescribed in primary care has been published to ensure people receive the safest and most effective treatment available, and save the NHS up to £141 million a year.

After reviewing the responses to its consultation, and a revised version of the guidance, NHS England’s Board agreed to issue the guidance to CCGs immediately.

The guidance is part of the Medicines Value Programme which aims to ensure greater value from the NHS’ £17.4 billion medicines bill, through improving health outcomes; reducing waste, over-prescribing and over-treatment; and addressing excessive price inflation by drug companies.

In 2015/16, 1.1 billion NHS prescription items were dispensed to patients in primary care at a cost of £9.2 billion. With the number of prescriptions increasing by 1.9% a year, it was important that the NHS acted 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 objective was to produce commissioning guidance to support CCGs in their decision-making, to address unwarranted variation, and to provide clear national advice to make local prescribing practices more effective.

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

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.

The commissioning guidance is addressed to CCGs to support them to fulfil their duties around appropriate use of prescribing resources. The guidance does not remove the clinical discretion of the prescriber in deciding what is in accordance with their professional duties and CCGs must take into account their legal duties to advance equality and have regard to reduce health inequalities.