The policy for items which should not routinely be prescribed in primary care is intended to support appropriate use of NHS resources.

Primary care services provide the first point of contact in the healthcare system, acting as the ‘front door’ of the NHS. Primary care includes general practice, community pharmacy, dental, and optometry (eye health) services.

This policy provides recommendations for items which should not routinely be prescribed in primary care because they are unsafe, ineffective for some or all patients, or are not cost-effective. It is based on national policy guidance from NHS England, which was introduced to address variation in access to the 24 products listed in the policy.

This policy is intended to ensure access to NHS funding is equal and fair, whilst considering the needs of the overall population and evidence of clinical and cost effectiveness.

This policy is intended to ensure access to NHS funding is equal and fair, whilst considering the needs of the overall population and evidence of clinical and cost effectiveness.

Items where no prescribing is appropriate because there are significant safety concerns or there is no evidence of clinical effectiveness for all patient populations, i.e. no exceptions apply:

  • co-proxamol
  • glucosamine and chondroitin
  • herbal treatments and other natural products
  • homeopathy
  • minocycline for acne
  • omega-3 fatty acid compounds (excluding icosapent ethyl)
  • silk garments.

Items where prescribing may be appropriate in some exceptional circumstances. For these items, if no other item is clinically appropriate or available it may be appropriate to prescribe:

  • aliskerin
  • bath and shower preparations for dry and pruritic skin conditions
  • dosulepin
  • doxazosin (prolonged release)
  • lutein and antioxidants
  • oxycodone and naloxone combination product
  • paracetamol and tramadol combination product
  • perindopril arginine
  • rubefacients, benzydamine, mucopolysaccharide and cooling products (excluding NSAIDs and capsaicin)
  • trimipramine

Items where there are named exceptional circumstances where it is clinically justifiable to prescribe. There should be no prescribing outside these named circumstances:

  • amiodarone
  • dronedarone
  • immediate release fentanyl
  • lidocaine plasters
  • liothyronine
  • needles for pre-filled and reusable insulin pens
  • travel vaccines (limited to named vaccines)

GPs and local hospitals are expected to prescribe or recommend medication in line with this policy and will no longer start new prescriptions for the majority of the items included in it.   You may have your medication reviewed if you are prescribed one of these medicines; you will be contacted as necessary, so there is no need to make an appointment specifically about this policy.

In the majority of cases there are other more effective, safer and/or better value alternatives available to the treatments that NHS England and NHS Birmingham and Solihull are recommending should not be routinely prescribed in primary care.

Patient leaflets explaining the recommendations for each of the products listed are available on the PrescQIPP website.