This page provides information on the updated Vitamin D testing policy for Birmingham and Solihull, introduced from March 2026.

The policy aligns with national guidance and supports more appropriate and consistent use of Vitamin D testing across the system. The information below outlines the updated approach to testing and management.

Patient information leaflets on Vitamin D deficiency and insufficiency are also available on this page. These can be shared with patients to help explain the policy and how Vitamin D can be managed safely.

From March 2026, Birmingham and Solihull Integrated Care System will implement an updated Vitamin D testing policy aligned with national guidance and regional best practice.

The change responds to a sustained rise in Vitamin D test requests since the COVID-19 pandemic, with over a 30 percent increase between 2024 and 2025, and reflects updated evidence from the Endocrine Society (2024) which advises against routine testing in otherwise healthy adults.

The aim is to ensure appropriate, clinically indicated testing, reduce unnecessary investigations, and maintain safe and consistent care across primary and secondary care.

Routine 25-hydroxyvitamin D testing will no longer be undertaken for otherwise healthy adults.

Testing will only be accepted where there is a clear clinical indication, including:

  • Confirmed osteomalacia or osteoporosis
  • Metabolic bone disease, including Chronic Kidney Disease–Mineral and Bone Disorder
  • Persistent hypocalcaemia or hypercalcaemia
  • Specialist requests (for example rheumatology, endocrinology, renal)
  • Coeliac disease requiring annual monitoring
  • Children being investigated for rickets
  • Patient is pregnant ( locally agreed)

This approach aligns testing with evidence-based clinical indications and reduces unnecessary diagnostic investigations.

To support appropriate requesting, the following changes will be implemented in the ICE electronic requesting system:

  • Vitamin D will be removed from the front page of ICE to discourage routine requests.
  • Where Vitamin D is requested without a clear clinical indication, ICE will advise that the test is not routinely available.
  • A bone profile (including adjusted calcium) will automatically be added where appropriate.
  • If calcium is abnormal and/or ALP is raised, the laboratory will reflex test Vitamin D.
  • The standard retesting interval will be 12 months, except where specialist care advises otherwise.

In addition, laboratories will automatically test Vitamin D where results indicate possible deficiency, including:

  • Low calcium.
  • Low phosphate.
  • Raised parathyroid hormone.
  • Raised alkaline phosphatase consistent with Vitamin D deficiency.

This approach ensures patients who require testing continue to receive it, while avoiding unnecessary investigations.

Management of Vitamin D deficiency should continue to follow local formulary and prescribing guidance.

Deficiency (<25 nmol/L)
Treat in line with the local formulary and ROS guideline (February 2020).

Insufficiency (25–50 nmol/L)
Treatment should follow local guidance and only be initiated where clinically indicated.

Birmingham and Solihull’s Over the Counter (OTC) policy applies:

  • Routine maintenance or supplementation should not be prescribed.
  • Patients should be advised to purchase Vitamin D supplements from pharmacies or supermarkets.
  • Prescribing should only occur where there is a documented malabsorption condition or other agreed exception.

This policy does not support empirical prescribing without clear clinical indication, particularly where non-specific symptoms such as musculoskeletal pain would previously have triggered routine testing.

Clinicians should continue to manage confirmed deficiencies according to local formulary guidance.

The following resources are available to support clinicians and patients.

Local clinical guidance

Prescribing Policy

National Guidance and Patient Advice

Additional patient information leaflets from the Birmingham and Solihull Medicines Management Team on managing Vitamin D deficiency and insufficiency are also be available.

This update will help:

  • Improve clinical appropriateness of testing.
  • Reduce unwarranted variation across the system.
  • Avoid unnecessary investigations.
  • Support evidence-based prescribing.
  • Maintain safe, equitable access for patients who need testing.

Thank you for supporting this important evidence-based update, which aims to improve testing quality, prescribing practice, and consistency across Birmingham and Solihull.

SMART Referral Clinical Pathways Resource and ICE System, Vitamin D Updates webinar recording

SMART Referral Clinical Pathways Resource and ICE System, Vitamin D Updates webinar recording