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Items which should not be routinely prescribed in primary care

7th December 2017

NHS England and NHS Clinical Commissioners have now published guidance for Clinical Commissioning Groups (CCGs) on items which should not be routinely prescribed in primary care. This follows a recent consultation (see our news item).

The list includes items which may be relevant to palliative care. Since the consultation, slight changes to the guidance for fentanyl immediate-release products and lidocaine patches have been made (see below).

In summary, it is now recommended that prescribers in primary care should not initiate the following products for any new patient and that CCGs should support the deprescribing of these products:

  • immediate-release fentanyl products; unless for palliative care and in line with NICE guidance and in conjunction with specialist recommendation
  • lidocaine plasters – unless for post herpetic neuralgia in line with NICE guidance
  • oxycodone and naloxone combination products
  • rubefacients (excluding topical NSAIDs)
  • tramadol and paracetamol combination products.

Note. If, in exceptional circumstances there is a clinical need for immediate-release fentanyl, lidocaine plasters or oxycodone/naloxone combination products to be prescribed in primary care, this should be undertaken in a co-operation arrangement with a multi-disciplinary team and/or other health professional.

Other products covered in the guidance are: coproxamol, dosulepin, doxazosin modified-release, glucosamine and chondroitin, herbal treatments, homeopathy, liothyronine, lutein and antioxidants, omega-3 fatty acid compounds, perindopril arginine, tadalafil (once daily), travel vaccines, trimipramine.

A further consultation on the prescribing of over-the-counter products is expected.

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