Community Pharmacy Scotland

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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The Scottish Government are consulting on draft guidance on achieving value and sustainability in prescribing by reducing unwarranted variation across health boards.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. 

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