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Low Value Medicines - CLOSED

Last year 1.1 billion prescription items were dispensed in primary care at a cost of £9.2billion.

This growing cost coupled with finite resources means it is important that the NHS achieves the greatest value from the money that it spends. We know that across England there is significant variation in what is being prescribed and to whom. Often patients are receiving medicines which have been proven to be ineffective or in some cases dangerous, and/or for which there are other more effective, safer and/or cheaper alternatives.

NHS England has partnered with NHS Clinical Commissioners to support Clinical Commissioning Groups (CCGs) in ensuring that they can use their prescribing resources effectively and deliver best patient outcomes from the medicines that their local population uses. CCGs asked for a nationally coordinated approach to the development of commissioning guidance in this area to ensure consistency and address unwanted variation.  

There is a consultation, which is being nationally coordinated but also encompasses a local element, is addressed to all CCGs, the public and patients, and any relevant interest group or body. It will be open for 3 months from 21 July until 21 October 2017.

Set out in the consultation document are proposed national guidance for CCGs on medicines which can be considered to be of low priority for NHS funding. The consultation looks at guidance for 18 different medicines.

You can read more about the consultation below:

Please give your feedback on the consultation on the NHS England website here: https://www.engage.england.nhs.uk/consultation/items-routinely-prescribed/

Derbyshire

In Derbyshire, all four Clinical Commissioning Groups have already spent a lot of time looking at medicines ensuring they deliver the best patient outcomes and that prescribing resources are used most effectively.

Local decisions have already been made around the medications in the consultation. The table below shows the list of medication, the instruction on when they can be prescribed or not prescribed and when the decision was made. At the moment, although the guidance is in place, the items can still be prescribed in specific circumstances. Please note these local decisions may change as a result of the National Consultation.

Medicine

Local traffic light classification and place in local guidance

Decision date

 

Co-proxamol

Not routinely recommended unless agreed through the individual funding request route.

April 2014

Dosulepin

Not recommend for use except to allow treatment to continue for patients already on this medication.

Sept 2012

 

Prolonged-release Doxazosin

Not routinely recommended unless agreed through the individual funding request route.

Feb 2017

 

Immediate Release Fentanyl

 

Limited use in cancer patients. Requires specialist initiation and a titration process.

May 2014

 

Glucosamine and Chondroitin

Not routinely recommended unless agreed through the individual funding request route.

April 2012

 

Herbal Treatments

No current local classification

   

Homeopathy

No current local classification

 

 

Lidocaine Plasters

Not recommended for use except in the management of  Post-herpetic Neuralgia.

Jan 2017

 

Liothyronine

For management of depression – to be initiated within a hospital/specialist setting but suitable for shared care with GP under a shared care agreement.

For management of hypothyroidism - Not recommended

For use in oncology treatment and for diagnostic purposes in line with the British Thyroid Cancer guidelines - Prescribing responsibility lies with a hospital consultant or a specialist.

Sept 2016

 

 Aug 2017

 

 Aug 2017

 

Lutein and Antioxidants

Not routinely recommended unless agreed through the individual funding request route

June 2012

 

Omega-3 Fatty Acid Compounds

For use only after consultant lipid specialist recommendation in people with severe hypertriglyceridaemia after trial of fibrates +/- statins

Feb 2017

 

Oxycodone and Naloxone Combination Product

Not routinely recommended unless agreed through the individual funding request route

 

 

Paracetamol and Tramadol Combination Product

Not routinely recommended unless agreed through the individual funding request route

Feb 2014

 

Perindopril Arginine

Not routinely recommended unless agreed through the individual funding request route

Feb 2015

 

Rubefacients (excluding topical NSAIDs)

Not routinely recommended unless agreed through the individual funding request route

March 2017

 

Once Daily Tadalafil

Only recommended as a  2nd line option in patients who have undergone nerve sparing prostatectomy, after a daily trial of generic sildenafil.

Jan 2017

 

Travel Vaccines

 

(NHS England has asked Public Health England to conduct a review of travel vaccines currently available on the NHS to assess their appropriateness for prescribing on the NHS. These vaccines include;

 Cholera

 Diptheria/Tetanus/Polio

 Hepatitis A

 Typhoid

For Hepatitis B, Yellow fever and Rabies vaccines for travel – Not routinely recommended unless agreed through the individual funding request route.

Various

 

Trimipramine

Not routinely recommended unless agreed through the individual funding request route

Jan 2017

 
Last modified: 23/10/2017