Items which should not routinely be prescribed in primary care - Overarching resources

Phase 1 - Guidance individual item implementation resources

Note: PILs, presentations and searches can be found in the overarching resource section.

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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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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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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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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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.

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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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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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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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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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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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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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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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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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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Phase 2 - Low priority prescribing guidance

Self care webkit

This page brings together all the PrescQIPP medicines self care resources as well as showcase good practice and examples of projects.

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Probiotics (update coming soon)

This bulletin provides an overview of the information in the PrescQIPP DROP-List bulletin on probiotics.

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Vitamins and Minerals

This bulletin reviews the place in therapy for the multivitamin and mineral supplements and also the vitamin B complex products.

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Phase 3 - Guidance individual item implementation resources

Aliskiren (coming soon)

Amiodarone and Dreonedarone (coming soon)

Bath and shower emollient preparations

This bulletin and supporting resources have been developed to support the implementation of the NHS England items which should not routinely be prescribed in primary care guidance.

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Minocycline for Acne (coming soon)

Needles for pre-filled and reusable insulin pens (update coming soon)

This bulletin looks at cost effective choices of needles and also advises on the appropriate use of safer sharps.

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Silk Garments

This bulletin reviews the place in therapy for silk and antimicrobial garments to ensure prescribing is appropriate and excessive quantities of garments are not prescribed.

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Data

Low priority prescribing

This visualisation contains data from January 2016 and will allow you to monitor trends in prescribing.

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Primary care scorecard

All phases of the NHS England Low priority prescribing guidance have been incorporated into the primary care scorecard see our scorecard section for the full range of resources.

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National Guidance

NHS England has taken action to reduce inappropriate prescribing certain 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. The guidance is available here.

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