Overarching resources

Bulletin 339: Low priority prescribing

Our updated low priority prescribing guidance covers the NHS England Items which should not routinely be prescribed in primary care guidance and provides general advice. Individual support bulletins are available in the webkit which have the implementation resources.

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Individual item implementation resources

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


This resource covers Aliskiren which is one of the items less suitable for prescribing in the NHS England guidance.

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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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Amiodarone and Dronedarone

This resource supports the implementation of the NHS England items which should not routinely be prescribed in primary care guidance.

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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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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 support review of patients prescribed dosulepin with a view to switching to a safer agent.

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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.


This bulletin has been updated to reflect the latest national guidance on liothyronine and it's place in therapy.

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Minocycline for Acne

This resource reviews the use of Minocycline products in acne and advises on safer alternatives.

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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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Omega-3 fatty acids

This bulletin provides information and resources to support deprescribing of these products which are considered low priority for prescribing and not cost-effective (with the exception of icosapent ethyl prescribed in line with NICE TA805).

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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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Silk Garments

This bulletin supports the implementation of NHS England (NHSE) guidance on items which should not be routinely prescribed in primary care and the All Wales Medicines Strategy Group (AWMSG) guidance on items identified as low value for prescribing in the NHS Wales-Paper 3 in relation to silk garments.

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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.


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.


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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Self care resources

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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Management of infantile colic

The management of infantile colic bulletin covers the treatment of colic and the place in therapy for lactase, simeticone and gripe water products.

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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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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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