Achieving Value and Sustainability in Prescribing Medication
Published: 28/08/24
The Scottish Government are consulting on draft guidance on achieving value and sustainability in prescribing by reducing unwarranted variation across health boards.
This includes items of low and limited clinical value, diabetic sundries, and antimicrobial stewardship.
There is variation in prescribing of medications across NHS Scotland. This can include items that may have low or limited effectiveness, safety concerns, or provide low value for money for NHS Scotland where there are more cost-effective items available. This can also include instances of antibiotics being prescribed unnecessarily or for longer than the recommended duration, increasing antimicrobial resistance.
This guidance aims to promote the effective use of medicines and minimise unwarranted variation in prescribing practice across NHS Scotland. It supports the principles of Realistic Medicine through shared decision-making, encouraging medication review, and ensuring medicines are prescribed appropriately.
Consultation Questions
We have a total of 31 questions with some being multi-part, please answer as many as you feel able to.
1. Co-proxamol
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
2. Glucosamine and Chondroitin
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
3. Herbal Treatments
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
4. Homeopathy
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
5. Minocycline for acne
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
6. Aliskiren
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
7. Bath and Shower Emollients
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
8. Dipipanone
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
9. Doxazosin Modified Release preparation
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
10. Lutein and Antioxidants
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
11. Nefopam
do not initiate in primary care or secondary care.
deprescribe in individuals currently prescribed this item.
12. Omega 3 Fatty Acids excluding icosapent ethyl [Vazkepa®]
do not initiate in primary care or secondary care.
deprescribe in individuals currently prescribed this item.
13. Oxycodone and Naloxone combination product
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
14. Paracetamol and Tramadol combination product
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
15. Perindopril Arginine
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
16. Probiotics
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
17. Rubefacients and Poultices
do not initiate in primary or secondary care
deprescribe in individuals currently prescribed this item
18. Alimemazine
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
19. Amiodarone
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
20. Ascorbic Acid
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
21. Buprenorphine Patches
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
22. Chloral Hydrate
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
23. Dosulepin
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
24. Dronedarone
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
25. Immediate Release Fentanyl
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
26. Lidocaine
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
27. Liothyronine
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
28. Trimipramine
prescribe only if for an exception or indication named in this guidance.
consider deprescribing in individuals currently prescribed this item where appropriate.
prescribe only if no other item or intervention is clinically appropriate
prescribe only if no other item or intervention is available
29. Blood Glucose Monitoring Strips (costing more than £10 per 50 strips)
do not initiate strips that cost over £10 for 50 strips
deprescribe or change in individuals 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
30. Insulin Pen Needles (costing more than £5 per 100 needles)
do not initiate needles that cost over £5 for 100 needles
deprescribe or change in individuals 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
31. Antimicrobial Stewardship
Avoid prescriptions for antibiotics in self-limiting or viral infections to reduce the risk of antibiotic resistance. Promote self-management for these situations: e.g., rest, symptomatic relief and hydration. Encourage people to become antibiotic guardians.
Ensure that antibiotic courses are prescribed for the appropriate duration. (e.g., three days for uncomplicated UTI’s in women and five days for community acquired and hospital acquired pneumonia)
Reinforce advice that antibiotics are taken as directed to ensure effectiveness (Take at regular intervals, do not skip doses and check that the full course is taken). Advise that patients do not save antibiotics for later or share unused antibiotics with family or friends.
Ensure a management plan is documented within 72 hours when commencing IV antibiotics, including consideration of continuation and rationalisation of treatment with the potential for stopping, or switching IV to oral therapy.
Prescribe oral solid dosage forms where possible, minimising use of liquid preparations or IV to where they are necessary and appropriate.
Offer resources and advice to patients and families on learning how to swallow pills.
Encourage that any unused medicine is returned to community pharmacy for safe disposal.
Signpost and encourage healthcare staff to update education in antibiotic management using SAPG and NES materials on TURAS.