Low Value Medicines (LVM)

The low value medicines (LVM) highlights 18 areas for review. This page brings together the current PrescQIPP resources to support reviewing individual patients as well as data for commissioners to compare prescribing.

Further resources will be added to this area as they are updated/published.

Items which should not routinely be prescribed in primary care

This overarching document provides information on the evidence base, alternative treatments and savings available from reviewing patients prescribed a treatment from the NHS England items which should not routinely be prescribed in primary care guidance.

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Low value medicines support tools

As part of the NHS England consultation document on “low value medicines” a set of anonymised graphs have been included for each of the 19 products in the appendix to demonstrate the variation in prescribing across all the England CCGs.

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LVM Searches

Each of the packs contains a set of 19 system searches to support the low value medicines project.

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Patient information (pdf versions)

These leaflets explain why each of the 18 medicines are included in the NHS England Items which should not routinely be prescribed in primary care guidance.

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Patient information (adaptable versions)

These are adaptable versions of the patient information leaflets in word version for subscribing CCGs to adapt to meet local needs.

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Importing low value medicines patient information leaflets into clinical systems

These clinical system tools will allow you to import the low value medicines leaflets into GP clinical systems and code patients receiving the leaflets or advice.

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Tramacet®

This bulletin focuses on Tramacet® (paracetamol 325mg/tramadol 37.5mg) and provides the rationale for new patients to be initiated on paracetamol or paracetamol with codeine.

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Rubefacients

This bulletin reviews the place in therapy of the rubefacients which also have a NICE do not attached to them. An audit and patient letter are available as supporting tools.

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Travel vaccines

This bulletin and supporting resources will support CCGs wishing to review their prescribing policies on travel vaccines. It identifies vaccines that should not be prescribed on the NHS for travel.

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Trimipramine

Trimipramine is a tricyclic antidepressant (TCA) that has been subject to significant price increases. This bulletin reviews the use of trimipramine with resources to support stopping or switching treatment in depression in adults.

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Liothyronine

This bulletin looks at the place in therapy of liothyronine and combination products containing levothyroxine and liothyronine. In light of a limited evidence base supporting its use and the increased cost of these products, a review of therapy is recommended.

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Lidocaine plasters

This bulletin looks at lidocaine plasters and provides the rationale for not initiating lidocaine plasters in new patients, and for current patients to be considered for discontinuation of their prescription for lidocaine plasters.

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Doxazosin MR

This bulletin supports the review of doxazosin MR prescribing and supports a switch to the immediate release formulation in line with the NHS England "Items which should not routinely be prescribed in primary care" guidance.

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Fentanyl

Immediate release fentanyl has a NICE do not do as a first line treatment for breakthrough pain. This bulletin will focus on fentanyl immediate-release formulations.

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Tadalafil once daily

Once daily tadalafil is not a cost effective treatment option. Currently on demand sildenafil is the preferred option.

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Omega-3 fatty acids

This bulletin focuses on omega-3 fatty acids and provides the rationale for therapy to be stopped or for patients to be switched to alternative agents and for new patients not to be started on omega-3 fatty acids.

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Perindopril arginine

This bulletin, focuses on different perindopril formulations (salts) which are not directly equivalent. It provides the rationale for new patients to be commenced on generic perindopril erbumine, also known as tert-butylamine.

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Antioxidant vitamins for AMD

The evidence to support the use of antioxidant vitamins to reduce the progression of age related macular degeneration is limited. This bulletin reviews the evidence available and supports reviewing and stopping treatment with antioxidant vitamins.

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Co-proxamol

This bulletin discusses the use of co-proxamol and supports reviewing and discontinuing prescribing in patients still taking this unlicensed medicine.

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Oxycodone/Naloxone (Targinact ®)

This bulletin and resources provide further information on the evidence base for for using oxycodone/naloxone prolonged release tablets, the rationale to stop treatment and also suggests alternative treatment options.

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Herbal remedies

The MHRA allows herbal products to be marketed for minor health conditions that don’t require medical supervision, upon receipt of a Traditional Herbal Registration (THR). Claims to treat major health conditions are not allowed under a THR and would need a marketing authorisation. Under a THR there is no requirement to prove scientifically that a product works, the registration is based on longstanding use of the product. These products should be purchased as part of self care.

Homeopathic remedies

In 2010, a report by the House of Commons Science and Technology Committee found that the use of homeopathy was not evidence based and any benefits to patients was down to placebo effect.

Dosulepin

These resources review the place in therapy of dosulepin which is listed as a NICE 'do not do'. The drug has a very small margin of safety between the maximum therapeutic dose and potentially fatal doses.

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Glucosamine

There is limited evidence to support the use of glucosamine and chondroitin products and they are listed as a NICE do not do. This bulletin reviews the use of glucosamine (with or without chondroitin) preparations.

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Update on prescribable items of low priority for NHS funding

Julie Wood, Chief Executive of NHS Clinical Commissioners joined us for a follow up to the webinar on 7th February which identified a number of prescribable items of low value for NHS funding.

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National guidance

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

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