NHS England have produced a list of items which should no longer be prescribed because they are:
- Not as safe as other medicines
- Not as good (effective) as other medicines
- More expensive than other medicines that do the same thing
- Shouldn’t be available on the NHS in some circumstances
As a result, NHS Dorset has asked that GP teams no longer prescribe the items listed below:
Aliskerin
Amiodarone (not to be initiated in primary care, can be prescribed in primary care if initiated by a hospital specialist)
Bath and shower preparations
Co-proxamol
Doxazosin (prolonged release)
Dronedarone (not to be initiated in primary care, can be prescribed in primary care if initiated by a hospital specialist)
Glucosamine and chondroitin
Herbal treatments and other natural products
High cost needles for pre-filled/reusable insulin pens
Homeopathy
Immediate release fentanyl
Lidocaine plasters
Liothyronine
Lutein and antioxidants
Minocyline for acne
Omega-3 fatty acid compounds (excluding icosapent ethy [vazkepa®])
Oxycodone and naloxone combination products
Paracetamol and tramadol combination products
Perindopril arginine
Rubefacients
Benzydramine
Mucopolysaccharide and cooling products (excluding NSAIDs and capsaicin)
Silk garments
Travel vaccines
Trimipramine
Priority areas for year 1 of the PQS are:
Aliskerin
Review all repeat prescriptions for aliskirin, and as part of shared decision-making conversation between prescriber and patient, review use.
NHS England has highlighted that prescribing of certain items in primary care, such as aliskerin, is not predominately appropriate, either because there are significant safety concerns or there is no evidence of clinical effectiveness for their use.
Run the SystmOne search provided to identify the patients who are receiving aliskerin on repeat prescription & invite patients to a medication review.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F3 Low clinical value
Template patient text message: NHS Dorset has asked all GP teams to review prescribing of aliskerin following NHS England guidance that more effective therapies are available. Please contact the surgery to book an appointment at your earliest convenience.
NHS England have produced a list of items which should no longer be prescribed
Bath and shower preparations
Cease prescribing of bath and shower emollients for patients unless recommended by specialists for severe eczema or infants under the age of 1 year.
Advise patients with diagnosed dermatological conditions to use their usual emollient as a soap substitute in the bath or shower, as per guidance below.
Advise patients to purchase products from a pharmacy if they want to continue using a bath and shower emollient.
These products are included in the NHSE drugs of low clinical value and should not be prescribed.
The clinical rationale comes from the paediatric study, BATHE. Over the period of one year, no advantage was identified to using a specific bath emollient compared to using their usual leave-on emollient to wash with. In most patient cases, the eczema improved in both study groups. There is also a higher risk of falls in the bath for those who use bath emollients.
Run the SystmONE search provided to identify the patients who are receiving these items on prescription.
Communicate the changes to patients involved.
Share relevant resources with the patient.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F3 Low clinical value
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of all bath and shower emollients. There is no clinical benefit in using these products over standard leave-on emollients as soap substitutes. The NHS recommends that these should not be routinely prescribed and your prescription has been stopped. Bath and shower emollients are available to buy from most supermarkets and pharmacies if you would like to continue with this treatment. If you would like to discuss this change further, please contact the surgery.”
Template patient letter – bath & shower emollients
Patient leaflet – using emollients (moisturisers) as soap substitutes
Emollients Briefing (PrescQIPP)
Emollients Bulletin (PrescQIPP)
Bath and Shower Emollients Bulletin (PrescQIPP)
NHS England have produced a list of items which should no longer be prescribed
Dosulepin
Identify patients prescribed dosulepin and through a shared decision–making process, switch to an alternative antidepressant if possible.
Dosulepin (previously, dothiepin) is a tricyclic antidepressant. The National Institute of Health & Care Excellence (NICE) advises “do not switch to, or start, dosulepin because evidence supporting its tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose.”
Identify patients using the SystmOne search provided.
Contact patients affected and invite them for review.
Review and switch to a suitable alternative where possible.
Template patient text message:
“We are writing to all the patients currently prescribed dosulepin, to encourage them to make an appointment to discuss an alternative treatment. The reason for this is that there are some safety concerns with dosulepin and there may be a more suitable and safer drug that the practice can offer you.
We appreciate that changing antidepressant therapy may cause concern for some patients, however we are committed to the safe use of medicines and providing the best healthcare for our patients.
Please make an appointment at the surgery at a convenient time to discuss this further.”
Doxazosin (prolonged release)
Identify prescriptions for modified release (MR) doxazosin tablets and move to standard release tablets.
MR doxazosin tablets are approximately five times the cost of immediate release tablets and yet offer no discernible benefits.
Use the SystmOne search provided to identify repeat prescriptions for MR tablets and change to standard release tablets as per guidance provided.
Communicate the changes to patients involved.
SystmOne has been updated so that initiations of doxazosin MR will be directed to doxazosin immediate release tablets.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F3 Low clinical value
Template patient text message:
“NHS Dorset has asked all GP teams to prescribe doxazosin as immediate release tablets, rather than the modified release tablets. They offer the same health benefits but help the NHS budget to go further. We have updated your prescription as discussed but if you have any concerns, please contact the surgery.”
Specialist Pharmacy Service (SPS) switching doxazoxin XL tablets to standard release tablets
Prescqipp doxazosin modified release tablets bulletin
Patient leaflet – Doxazosin products
References:
- NICE NG136 (Hypertension in adults: diagnosis and management) and NICE CG97 (Lower urinary tract symptoms in men: management): neither documents identify benefits of modified-release above immediate release.
NHS England have produced a list of items which should no longer be prescribed
Liothyronine
Adopt the Dorset position statement on liothyronine use for thyroid hormone replacement, namely:
- Refer existing users of liothyronine (indicated for thyroid hormone replacement) to secondary care endocrinology specialists for review.*
- Decline to prescribe for new liothyronine patients (indicated for thyroid hormone replacement) if initiated by private referrals or Dorset NHS clinicians.
- Only support new initiations of liothyronine (indicated for thyroid hormone replacement) if requested from a non-Dorset NHS endocrine specialist service and supported by a comprehensive shared care agreement.
*While waiting for specialist endocrinology review of existing patients, update prescriptions of tablets to capsule formulations. The tablets and capsules are clinically interchangeable but the capsules are significantly more cost effective. Full details here: Formulation/Presentation Changes – Medicines Optimisation (nhsdorset.nhs.uk)
NHS England has highlighted that prescribing of liothyronine & thyroid extract products is not predominantly appropriate because of safety concerns and limited clinical effectiveness. This position is supported by Dorset NHS Endocrinology specialists.
Interim formulation review will help the Dorset NHS pound go further, and care for a greater number of patients.
Run the SystmOne search provided to identify the patients who are receiving liothyronine & thyroid extract products on repeat prescription for thyroid hormone replacement & refer to secondary care endocrinology specialists as per the NHS Dorset position statement.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F3 Low clinical value.
Dorset Liothyronine position statement
Minocycline for acne
Identify all repeat primary care prescriptions for minocycline prescribed for acne, and cease prescribing. (Minocycline is on the Dorset formulary as a RED drug and can be prescribed from secondary care, as an option for acne treatment in patients who suffer with mood problems when using isotretinoin for acne).
NHS England has identified this drug for this indication as something which should not be initiated, and where in use, should be deprescribed.
NICE guidance on acne vulgaris management advises: “Minocycline is not recommended for use in acne as it is associated with an increased risk of adverse effects such as drug-induced lupus, skin pigmentation and hepatitis.”
The Dorset Formulary states: Minocycline can cause gastrointestinal and dermatological adverse reactions. It has also been associated with hyperpigmentation and systemic lupus erythematosus (SLE) and autoimmune hepatitis. The BNF advises that if treatment continues beyond six months, GPs should monitor patients every three months for hepatotoxicity, pigmentation and SLE.
A PrescQIPP CIC review found no evidence to support the use of one tetracycline over another in terms of efficacy for the treatment of acne vulgaris, and alternative once daily products are available.
Use the SystmOne search provided to identify repeat prescriptions for minocycline for acne. Deprescribe and communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F3 Low clinical value/Minocycline for acne.
Template patient text message:
“We are writing to all the patients currently prescribed minocycline for acne. NHS England has asked all GPs to cease prescribing as there are some safety concerns with minocycline and there may be more suitable therapeutic approaches that the practice can offer you. We have stopped your current prescription, but please make an appointment at the surgery at a convenient time to discuss this further should you need further support.”
NICE NG198: Acne vulgaris: management
NHS England have produced a list of items which should no longer be prescribed
