The NHS in South West London is currently facing a significant financial challenge and must focus its resources on the areas of greatest need. We need to make decisions to secure the future of local health services for everyone in NHS SWL. The position statements listed below, provide the clinician with information on any restrictions to prescribing for the specified medicinal product, device or condition.
Antihistamine & Nasal Sprays for Hayfever
Camouflage (covering) Creams & Powders
Coughs, Colds & Nasal Congestion
Diabetes blood glucose and ketone meters, testing strips and lancets
Self Care (for self limiting and minor health conditions)
Shared Care Prescribing with Private Providers – See Shared Care with Private Providers section under Prescribing: Interface Policy for more supporting resources
Semaglutide (Wegovy®) for weight management
Position statements for items which should not routinely be prescribed in primary care (NHS England)
NHS England updated its guidance (in August 2023) on items which should not routinely be prescribed in primary care, because they are unsafe, ineffective for some for or all patients, or are not cost effective. The policy recommendation are grouped under two categories:
- Items where no prescribing is appropriate (that is, no exceptions)
- Items where prescribing may be appropriate in some exceptional circumstances
Please note: The position statements listed below will be updated in due course to reflect updated NHS England guidance. In the meantime prescribers should refer to the NHS England guidance for the most up-to-date information.
Items where no prescribing is appropriate (that is, no exceptions)
Items where no prescribing is appropriate because there are significant safety concerns or there is no evidence of clinical effectiveness for all patient populations.
Recommendations
- Do not initiate in primary care.
- Deprescribe in patients currently prescribed this medicine.
These recommendations apply to:
Homeopathy, Herbal Treatments and Other Natural Products
Items where prescribing may be appropriate in some exceptional circumstances
For all, if no other item is clinically appropriate or available it may be appropriate to prescribe following a shared decision-making conversation between the prescriber and patient, based on evidence-based good quality information, clinical judgement and the patient’s values and preferences. For some items there are also named exceptional circumstances where it is clinically justifiable to prescribe.
Recommendations 1
- Do not initiate in primary care.
- Deprescribe in patients currently prescribed this item.
- Prescribe only if no other item or intervention is clinically appropriate.
- Prescribe only if no other item or intervention is available.
These recommendations apply to:
Bath & Shower Preparations for Dry and Pruritic Skin Conditions
Ocular Supplements (lutein and antioxidants)
Oxycodone & Naloxone Combination Product
Paracetamol & Tramadol Combination Product
Recommendation 2
- Do not initiate in primary care.
- Deprescribe in patients currently prescribed this item.
- Prescribe only if no other item or intervention is clinically appropriate.
- Prescribe only if no other item or intervention is available.
- Prescribe only if for an indication named in this guidance.
These recommendations apply to
Diabetes Pen Needles and Safety Needles
Further detail, including useful references and the rationale for an item’s inclusion, can be found in the Appendix of the updated NHS England guidance
Prescriber: professional and contractual context
During discussions with the patient, when considering what treatment and ongoing monitoring is required, clinicians are asked to be mindful of the following:
- that within their Primary Medical Services contract with NHS England, GPs have a contractual obligation relating to patients with chronic disease to make available such treatment (including any prescription deemed to be appropriate after discussion with the patient) as is necessary and appropriate, and to provide advice in connection with the patient’s health, including relevant health promotion advice
- that reference to local prescribing guidelines is good professional practice
- that consideration of GMC professional obligations to use NHS resources wisely is good professional practice