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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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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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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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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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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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 was originally developed in May 2018, however as the price of perindopril erbumine was higher than perindopril arginine it was not published. The prices and references have been updated in this resource and it has been published for those commissioners who still wish to review prescribing.

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This resource covers rubefacients and other miscellaneous topical analgesics and provides support for reviewing prescribing of these products in line with the NHS England low priority prescribing guidance.

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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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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 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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Dental products on FP10

This bulletin has been developed to encourage dentists to prescribe necessary treatments rather than refer to GPs for a prescription (which can take up valuable appointment time).

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This bulletin provides is an update on probiotics. It focuses on reviewing prescribing of probiotics (including VSL#3® and Vivomixx®) and discontinuing therapy in light of the fact probiotic products are no longer approved under the ACBS scheme. An audit and patient letter are available for organisations considering reviewing this therapy area.

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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


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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LPP Masterclass - Challenges of deprescribing Dosulepin

On 23rd March, we welcomed Julia Faulkner, Pharmaceutical Advisor for West Essex CCG, who presented on looking at the challenges of deprescribing Dosulepin.

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LPP Masterclass - Fentanyl IR

On 4th February 2020, we welcomed Linda Lord, Chief Pharmacist for NHS West Suffolk CCG to present a webinar which covered the strategies used in West Suffolk for reducing inappropriate prescribing of fentanyl IR.

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LPP Masterclass - Lidocaine Patches

On 26th February 2020, we welcomed Shu Ling Man from NHS Lambeth CCG to share the way they have been reducing the prescribing of lidocaine patches in their local area.

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LPP indicator - NHS Oversight Framework 2019/20

NHS England and NHS Improvement have worked jointly with NHS Clinical Commissioners and PrescQIPP to develop and publish CCG guidance on Items which should not routinely be prescribed in primary care.

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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 session to the webinar on 7th February which identified a number of prescribable items of low value for NHS funding.

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.