In August 2019 NHS England updated guidance for CCGs* to support them with prescribing. This highlighted drugs which fall into the following categories;
- Products of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns;
- Products which are clinically effective but where more cost-effective products are available, including some products that have been subject to excessive price inflation; and
- Products which are clinically effective but due to the nature of the product are deemed a low priority for NHS funding.
In the majority of cases there are other more effective, safer and/or cheaper alternatives available to the treatments that NHS England is recommending should not be routinely prescribed in primary care.
The guidance is available at: NHS England » Items which should not be routinely prescribed in primary care
The information in the below resource packs should be used in conjunction with the references provided, and the guidance does not remove the clinical discretion of the prescriber in accordance with their professional duties.
*The original guidance was produced when there were CCG's, we have now formed ICB's however the guidance still applies
Doxazosin Modified Release
Omega-3 Fatty Acid Compounds
This workstream was discussed with the department of Diabetes & Endocrinology at United Lincolnshire Hospitals NHS Trust, specifically with a consultant who has been involved in the new lipid management pathway. The Medicines Optimisation team clarified the position of omega-3 treatment in patients with raised lipids.
Icosapent Ethyl (an ethyl ester of the omega-3 fatty acid, eicosapentaenoic acid) is the only omega-3 related product which is now recommended, as this has a NICE TA for use in specific secondary prevention situations. This is Amber 2 on our formulary and can be started and then prescribed in primary care on specialist recommendation. In other situations, the recommendation to the patient would be to buy high strength Omega 3 from the supermarket.
Any patients who have historically been started on Omega-3 preparations (such as Omacor) by lipid clinics can now be deprescribed without re-referral. Obviously if the patient’s lipids remain high, then they can be considered for Icosapent Ethyl if needed. If patients do not qualify for that and wish to continue treatment, then they will need to buy their own Omega 3.