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.

The policy is based on the NHS England/NHS Clinical Commissioners guidance which was introduced to prevent variation in access to 25 products which fall into one of the following categories:

  • Products of low clinical effectiveness (no good evidence that they work) or with significant safety concerns
  • Products which are clinically effective (there is evidence that they work) but where more cost-effective options are available to the NHS
  • Products which are clinically effective (there is evidence that they work), but are deemed low priority for NHS funding

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.

  • Aliskiren
  • Amiodarone
  • Bath and shower preparations for dry and pruritic skin conditions
  • Co-proxamol
  • Dosulepin
  • Dronedarone
  • Glucosamine and chondroitin
  • Herbal treatments
  • Homeopathy
  • Immediate release fentanyl (not fentanyl patches)
  • Lidocaine plasters
  • Liothyronine
  • Lutein and antioxidants
  • Minocycline for acne
  • Needles for insulin pens (only those that have a cost over the stated threshold)
  • Once daily tadalafil
  • Omega-3 fatty acid compounds
  • Perindopril arginine
  • Prolonged release doxazosin
  • Rubifacients (excluding topical non-steroidal anti-inflammatory drugs (NSAIDs)
  • Silk garments
  • Targinact® (oxycodone and naloxone combination product)
  • Tramacet® (paracetamol and tramadol combination product)
  • Trimipramine
  • Vaccines administered exclusively for the purposes of travel (those stated in the policy)

GPs will no longer start new prescriptions for the majority of the items included in the policy and are reviewing patients already receiving prescriptions. Practices will contact people 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 here.