GPs should no longer prescribe 18 'low value' treatments, NHS England rules

The 18 treatments identified by NHS England should no longer be initiated for any new patients in primary care, and GPs should be supported in deprescribing these treatments in existing patients where appropriate.

The full list of treatments is as follows:

• Co-proxamol (unlicensed)
• Dosulepin*
• Prolonged-release doxazosin (also known as doxazosin modified release)
• Immediate release fentanyl* - this does not apply to patients undergoing palliative care treatment and where the recommendation to use this treatment has been made by a multidisciplinary team and/or other healthcare professional with a specialism in palliative care.
• Glucosamine and chondroitin
• Herbal treatments
• Homeopathy
• Lidocaine plasters* - this does not apply to patients with neuropathic pain who have been treated in line with NICE guidance but are still experiencing neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia). 
• Liothyronine (including Armour Thyroid and liothyronine combination products) - prescribing committees may decide exceptions can be made for patients who have an ongoing need for liothyronine as confirmed by a consultant NHS endocrinologist.
• Lutein and antioxidants
• Omega-3 fatty acid compounds
• Oxycodone and naloxone combination product*
• Paracetamol and tramadol combination product
• Perindopril arginine
• Rubefacients (excluding topical NSAIDs)
• Once-daily tadalafil
• Travel vaccines (vaccines administered exclusively for the purposes of travel) - cholera, diphtheria/tetanus/polio, hepatitis A, typhoid should still be issued on the NHS.
• Trimipramine

*The guidance says that if, in exceptional circumstances, there is a clinical need for this to be prescribed in primary care, this should be undertaken in a cooperation arrangement with a multi-disciplinary team.

Further restrictions to be considered

NHS England also announced that it will consult on plans to restrict routine prescribing of some OTC medicines in certain situations, such as for conditions that are self-limiting or can be managed by the patient. This covers conditions including oral thrush, simple constipation, mild acne, mild hayfever and infant colic.

There may be exceptions to the restrictions for people who lack the appropriate level of cognitive capacity to independently purchase items OTC, people commonly refused the sale of OTC medicines because of contraindications (such as pregnant women), and patients whose condition has not responded sufficiently with a purchased OTC product.

The papers also say that exceptions could apply ‘where the GP believes that in their clinical judgment, exceptional circumstances exist that warrant deviation from the recommendation to self care'.

The consultation will also look at stopping prescribing products, such as paracetamol, that can be purchased cheaper OTC than the cost that would be incurred by the NHS.