This was published yesterday and applies in England.
Please follow the link in order to see this as intended - I have edited out references to medicines other than liothyronine.
Date published: 3 August, 2023
Date last updated: 3 August, 2023
Medicine, Primary care
Items which should not routinely be prescribed in primary care: policy guidance
This policy guidance provides recommendations for items which should not be prescribed in primary care because they are unsafe, ineffective for some or all patients, or are not cost-effective. It is for integrated care boards, other organisations commissioning services, and prescribing healthcare professionals, and updates and replaces the guidance published in June 2019.
This policy guidance is issued as general guidance under s14Z51 of the NHS Act 2006 to reduce unwarranted variation, improve patient outcomes and provide value for money for the NHS. It provides recommendations for items which should not routinely be prescribed in primary care because:
there are significant safety concerns with the item
there is a lack of robust evidence of clinical effectiveness for the item
the item is clinically effective but more cost-effective interventions are available
the item is clinically effective but deemed a low priority for NHS funding.
These items include medicines, devices, food supplements and other treatments.
This guidance is for:
integrated care boards (ICBs)
organisations commissioning services.
prescribing healthcare professionals.
It updates and replaces the guidance published in June 2019. More detail about how this guidance was developed and what has been updated can be found in the frequently asked questions.
About the recommendations
The policy recommendations are grouped under two categories:
Items where no prescribing is appropriate (no exceptions apply).
Items where prescribing may be appropriate in some exceptional circumstances.
The following policy recommendations apply to all items in both categories:
do not initiate in primary care
deprescribe in patients currently prescribed this item.
The following policy recommendations apply to some items in the second category due to one or more exceptions:
prescribe only if no other item or intervention is clinically appropriate.
prescribe only if no other item or intervention is available.
prescribe only if the item is for an indication named in this guidance.
Additional prescribing guidance is provided for some items, including alternatives and where a multidisciplinary approach is required. Prescribers should also follow local prescribing policies.
The recommendations do not override the individual responsibility of healthcare professionals to support their patients in agreeing the most appropriate treatment options for them through taking a shared decision-making approach.
Policy recommendations
Items where no prescribing is appropriate (that is, no exceptions apply)
Items where no prescribing is appropriate because there are significant safety concerns or there is no evidence of clinical effectiveness for all patient populations.
Recommendations (2)
Do not initiate in primary care.
Deprescribe in patients currently prescribed this item.
Prescribe only if no other item or intervention is clinically appropriate.
Prescribe only if no other item or intervention is available.
Prescribe only if for an indication named in this guidance.
These recommendations apply to:
liothyronine:
follow NHS England prescribing advice on liothyronine when initiating or reviewing the prescribing of liothyronine
the recommendations do not apply to patients who have already been reviewed by an NHS consultant endocrinologist
all other patients currently taking liothyronine should be reviewed by an NHS consultant endocrinologist to determine future treatment plans
new patients with overt hypothyroidism whose symptoms persist on levothyroxine may be prescribed liothyronine after a 3-month or longer review by an NHS consultant endocrinologist
Further detail, including useful references and the rationale for an item’s inclusion, can be found in the Appendix.
Implementation
ICBs will need to make implementation decisions locally, ensuring they consider their legal duties to advance equality and have regard to reducing health inequalities.
Effective implementation of the policy recommendations requires engagement across primary and secondary care, and development and use of shared care arrangements where appropriate. ICBs should follow guidance on Shared care for medicines and Responsibility for prescribing between primary and secondary/tertiary care.
Support for patients who may request a change to their current prescription is also recommended.
To allow commissioners to monitor prescribing, dashboards showing current prescribing patterns for the items included in this guidance are available to them from NHS Business Services Authority (NHSBSA) in ePACT2, PrescQIPP and OpenPrescribing.net. Data on spend and volume is summarised by item and is available at regional, area team, integrated care system (ICS), primary care network (PCN) and practice level. When monitoring, the clinical exceptions defined in this guidance should be taken into account and care taken to ensure that zero prescribing goals are not used inappropriately.
Interesting page I Found On Hypothyroidism
