Chester Clinic

Tottingtonmp.nhs.uk

Prescribing for Clinical Need Policy
Version Control
Policy Category: Medicines Optimisation CCG GP Member Practices Version history:
Version No. Date
Changes Made:
Initial version based on policy from Eastbourne, Hailsham and Seaford /Hastings and Rother Clinical Commissioning Groups drafted by Medicines Management Team Aligned with existing minor ailment scheme & addition of Greater Manchester formulary link prior going to Patient Cabinet Costings added, additions to product list Product list and costing amendments Product list and costings amended. Appendix 2 revised. Product list and costings amended Amendments following Clinical Cabinet workshop Formatting & finalisation. Contents
1. Summary . 3 2. Policy rationale .3 3. Treatments for minor ailments ….4 4. Treatments where there is insufficient evidence of clinical benefit or cost effectiveness.4 5. Preparations where there is not a clinical need to treat .4 Appendix 1 List of minor ailments and treatments available without prescription…………………….…5 Appendix 2 List of products with insufficient evidence to prescribe.8 List of products where there is not a clinical need to treat……………………………….….9
Patient and Public Engagement
The principles of the policy were discussed by NHS Bury's Patient Cabinet who agreed that NHS spending should be evidence based and cost effective. The Patient Cabinet highlighted the need to publicise the local Minor Ailments Scheme more widely. The Governing Body of NHS Bury CCG advises that only treatments that are clinically effective and provide a clear health benefit to patients should be prescribed on NHS prescriptions. All other treatments should be considered a low priority and are detailed within Criteria for inclusion on the Low Priority Prescribing List:
1. Treatments for minor ailments. 2. Treatments where there is insufficient evidence of clinical benefit or cost- 3. Preparations where there may not be a clinical need to treat. Clinicians should only prescribe medicines that are known to be clinically effective
and provide a health benefit to the patient.
Policy Rationale

NHS Bury CCG is keen to ensure that only treatments that are clinically effective and provide a
clear health benefit to patients are prescribed on NHS prescriptions. This is to ensure that CCG
resources provide interventions with a proven health gain for the population. Therefore NHS
Bury CCG prioritise resources based on evidence of the clinical effectiveness and safety of
treatments, their cost effectiveness, and on which interventions provide the best health
outcomes.
In the case of treatments which can be prescribed on NHS prescriptions, the CCG is reviewing
treatments that provide limited health benefit. They should be considered a LOW PRIORITY
and not suitable for prescribing unless patients fall into an exception category.
Some medicines that are used to treat minor ailments do not require the patient to be seen by a
GP. These products can be purchased from pharmacies and supermarkets. Pharmacy staff are
expert on providing advice around minor ailments; they are easy to access without an
appointment and most provide Bury's local Minor Ailments Scheme. This will free up GP time to
see more complex patients.
Some other products are clinically ineffective or are not cost effective. These treatments will not
have undergone rigorous clinical trials to demonstrate that they are effective. It is inappropriate
to direct NHS resources towards products that do not have proven efficacy or safety in
preference to licensed medicines.


Treatments for minor ailments
Many minor ailments are not of a serious nature and can be often managed by the individual.
Products aimed at treating the symptoms of many of these ailments may not offer value for
money and should not be prescribed.
Other minor ailments are treated with products available without prescription. These products
can be bought from a Community Pharmacy or supermarket, and all these conditions can be
treated through a locally run minor ailment scheme available at most local Community
Pharmacies, if required. See Appendix 1 for examples of these minor ailments .
4.
Treatments where there is insufficient evidence of clinical benefit or
cost-effectiveness
Many of the products in this category (listed in Appendix 2) are not licensed drugs under the
Medicines Act. This means that they have not undergone the stringent testing laid down by the
regulatory authorities to confirm their safety, quality and efficacy. There is no summary of
product characteristics (SPC) for prescribers to consult and hence no indemnity for prescribers
should the treatment cause harm.
Many of these products are classed as ‘food substitutes' and are not covered by ACBS1
regulations and/or do not appear in the current British National Formulary (BNF) or the Drug
Tariff. They are often not manufactured to the same high pharmaceutical standards used for
licensed medicines; hence there is no guarantee of consistency in formulation and potency.
These treatments will not have undergone rigorous clinical trials to demonstrate that they are
effective. It is inappropriate to direct NHS resources towards products that do not have proven
efficacy or safety in preference to licensed medicines.
5.
Preparations where there may not be a clinical need to treat
Within this category there are treatments that are clinically and cost effective when used in
some patients, but not when used more widely. Also, some treatments are clinically effective but
are not considered to be a good use of NHS resources. If prescribing is deemed to be clinically
necessary, only those products listed in the Greater Manchester Medicines Management Group
(GMMMG) Formulary2 should be prescribed.
Prescribers will be required to consider whether the benefit of prescribing a treatment for an
individual justifies the expense to the NHS. Such judgements should be based purely on
clinical factors and should not be influenced by socio-economic aspects such as the
patient's ability to purchase.
Prescribing of gluten free products is not covered within this ‘Prescribing for Clinical
Need' policy. NHS Bury CCG's Governing Body agreed to reduce the prescribing of gluten free products from September 2015, with a view to exploring a complete halt on prescribing these items for adults from April 2016. Prescribing of Gluten Free products is detailed within a separate policy document. 1 Advisory Committee on Borderline Substances Appendix 1: List of Minor Ailments & Available Treatments
Other brands to be aware of
Minor ailment
Treatment
(N.B. this is not an exhaustive
Exceptions
condition
Paracetamol 500mg tablets* Paracetamol 500mg caplets Paracetamol 500mg capsules Paracetamol 500mg soluble tablets Hedex Panadol Advance. Anadin Ibuprofen Mandafen Ibuprofen 200mg tablets Anadin Joint Pain Ibuprofen 200mg caplets Long term conditions Ibuprofen 200mg liquid capsules requiring regular pain Anadin liquifast Ibuprofen 400mg tablets* Nurofen Calprofen Acute pain,
Ibuprofen 100mg/5ml Susp* Orbifen Cuprofen headache,
temperature
Migraleve Yellow tabs Co-codamol 8/500 mg tablets* Co-codamol 8/500mg capsules Paracodol soluble tabs Co-codamol 8/500mg dispersible tablets Co-codamol 8/500mg effervescent tablets Calpol Six Plus susp 250mg/5ml Paracetamol 120mg/5ml oral susp Children under 2 months. Calpol Infant susp 120mg/5ml Paracetamol 250mg/5ml oral susp Sootheze Six Plus Miconazole cream 2%* Diabetic patients. Lamisil AT (cream, gel, spray) Athletes foot
Lamisil Once Cutaneous Solution Diabetic patients. Scholl advanced (cream, powder Children under 10 years. Eyes or face, ano-genital Hydrocortisone cream 1%* Long term skin conditions requiring regular Allercalm Piriton tabs 4mg Chlorphenamine 4mg tabs* Piriton Allergy tabs 4mg Children under 1 yr. Chlorphenamine oral solution Children with asthma. Allerief oral soln 2mg/5ml(sugar free)* Piriton 2mg/5ml syrup Chlorphenamine solution 2mg/5ml* oxidase inhibitors. Children under 2 yrs. Clarityn Allergy tabs Loratidine 10mg tabs* weighing less than 30kg. Clarityn Rapide tabs Immunocompromised & Cold sores
Aciclovir cream 2%* Children under 12 years. Other brands to be aware of
Minor ailment
Treatment
(N.B. this is not an exhaustive
Exceptions
condition
Brochlor Golden Eye Conjunctivitis
Chloramphenicol 0.5% eye drops* Children under 2 years. Optrex Infected Eye Ointment Chloramphenicol 1% eye ointment* Lumicare Eye Ointment Tubilux Eye Drops Dioralyte sachets* Dioralyte Relief Electrolade sachets* Diah-limit Imodium Chil dren under 12 years. Diarrhoea
Inflammatory bowel Loperamide caps 2mg* Post bowel surgery. Post pelvic radiation. Colorectal cancer. Entrocalm Almond Oil EarCalm Otex Exterol Cerumol Waxsol Sodium Bicarbonate Molcer Benadryl Allergy Relief caps Acrivastine 8mg caps Children under 12 years. Benadryl Plus Caps Beconase hayfever spray Beclomethasone nasal spray* Nasobec aqueous spray Children under 6 years. Pollenase nasal spray Vivabec Spray Benadryl tabs Piriteze Cetirizine 10mg tabs* en under 12 years. Pollenshield Hayfever Benadryl Allergy Relief soln Cetirizine1mg/ml oral solution 1mg/1ml S/F Zirek Allergy soln 1mg/ml Allercalm Piriton tabs 4mg Children under 12 years. Chlorphenamine 4mg tabs* Hay fever
Piriton Allergy tabs 4mg Children under 1 year. Chlorphenamine oral solution Children with Asthma. Allerief Oral soln 2mg/5ml(sugar free)* Piriton 2mg/5ml syrup Chlophenamine solution 2mg/5ml* monoamine oxidase Children under 2 yrs. Children 2-12 years Clarityn Rapide tabs Loratidine 10mg tabs* weighing less than 30kg. Clarityn Allergy tabs Children under 2 years. Clarityn Allergy Syrup Loratidine 5mg/5ml syrup* Allercrom Optrex Allergy Sodium Cromoglycate 2% Eye Catacrom Allergy Relief Pollenase Cromolux Hayfever Opticrom Hayfever Other brands to be aware of
Minor ailment
Treatment
(N.B. this is not an exhaustive
Exceptions
condition
Malathion Aqueous Lotion 0.5%* Derbac-M Liquid 0.5%* Babies under 6 months. Head lice
Linicin Lyclear Mousse Dimethicone Lotion 4% * Babies under 6 months. Lyclear Repellant Nitrid Spray Nyda Spray Gaviscon 250 tabs Gaviscon Advance tabs* ( tabs & liquid) Children under 16 years Gaviscon Advance liquid* Gaviscon Double Action (tabs & heartburn, Upset
Children under 16 years. Omeprazole 10mg* Patients prescribed Nelfinavir (HIV) Infant colic
Infacol Susp 40mg/ml S/F*, Dentinox Infant colic drops Nappy rash
Morhulin Zinc & Castor Oil Snufflebabe nasal drops Sodium Chloride 0.9% Nasal Calpol Soothe & Care (nasal Nasal congestion
Chloride 0.9% Nasal Spray Mandanol nasal drops, Lyclear Babies under 2 months. Permethrin 5% dermal cream* Crotamiton 10% cream* Chlorphenamine 4mg tabs* Children under 1 year. Chlorphenamine oral solution Piriton Allergy tabs 4mg 2mg/5ml(sugar free)* Piriton tabs 4mg Pollenase tabs Anbesol teething gel Babies under 2 months. Calgel teething gel Bonjela Teething Gel* Dentinox (teething gel & Teething
Babies under 2 months. Paracetamol 120mg/5ml oral Babies born before 37 Calpol Infant susp 120mg/5ml susp(sugar free)* Mebendazole 100mg tabs* Threadworms
Pripsen Sachets* Clotrimazole cream 1%* Clotrimazole pessary 500mg* Vaginal thrush
Children under 16. Fluconazole 150mg caps* Diflucan Veracur Bazuka Extra Strength Gel* Diabetic patients Warts & Verrucae
Diabetic patients Salactol Wart Paint*
*Indicates products available via Minor Ailment Scheme
Appendix 2: May be insufficient evidence to prescribe
Category
Examples (N.B. this is not an exhaustive list)
Exceptions
Benylin cough products Codeine Linctus Covonia cough products Pholcodine Linctus Simple Linctus Sudafed cough products Blephaclean Eye Lid Wipe Lid-Care Eyelid Wipe Optrex Supranettes RefreshOphth Soln 0.4ml Ud Ster Eye Cleansing Wipes Products containing glucosamine Products containing chondroitin. Products containing fish oils. Health Supplements
Products containing co-enzyme Q10. Products containing Omega 7. Icaps, Ocuvite, PreserVision Natures own, Natures aid St John's Wort, Heathaid, Kalms, Nytol, Bach flower Herbal Remedies
Homeopathic remedies
Weleda products,Nelson products Menthol & Eucalyptus Inhalation Xylometazoline nasal (0.05% drops & 0.1%spray) Otradrops Otrivine (nasal drops & spray) Nasal Congestion
Sudafed tabs & elixir Pseudoephedrine 60mg tabs Galpseud tabs & linctus Pseudoephedrine 30mg/5ml linctus Probiotics
Mentholatum Radian B AAA Sore Throat Spray Difflam (Throat Spray & rinse) Covonia Throat Spray Sore Throat
Dequadin Lozenges Ultra Chloraseptic Spray High dose vitamin D for proven Vitamin D Pharmacy own brands of Thiamine for alcohol vitamins/multivitamins (i.e.Boots, related conditions & Vitamins, Multivitamin &
Lloyds, Superdrug, Valupak) all mineral preparations
(including Cod liver oil,
Vitamin B products,
Vitamin E products,
Fruitivits Sachets Vitamin A& D products)
bariatric surgery). Vitamin supplements for premature babies
Appendix 3: May not be a clinical need to treat
Exceptions
Category
Examples (N.B. this is not an exhaustive list)
NB: Follow GMMMG formulary if there is a
clinical need to treat
Aluminium oxide 38.09% paste Moderate to severe cases where OTC (including Bravisol paste no1) products have failed (follow antibiotic All Benzoyl Peroxide products (including Panoxyl , Brevoxyl Oxy, Acnecide GM formulary products:
Benzoyl Peroxide 5% cream, aquagel & gel. Benzoyl peroxide10% /hydroxyquinoline Nicotinamide 4% Gel sulphate 0.5% cream* (including Freederm gel, Nicam gel) (*Quinoderm 10% cream) Quinoderm products Alphosyl 2 in 1 shampoo Capasal shampoo Ceanel concentrate shampoo Psoriderm scalp lotion Dandruff T Gel shampoo
(including Benzalkonium chloride 0.5% shampoo (including
cradle Dermax)
E45 Dry Scalp shampoo Ketoconazole shampoo 2% (including dandrazol, ketopine, nizoral) Selsun shampoo Dentinox Cradle Cap Treatment Shampoo Duraphat Fluoride Toothpaste* : To be prescribed by Dentist
Sodium fluoride mouthwash, oral drops, tablets & Dental & toothpaste (including the brands: Colgate, En-de-
Kay, Fluor-a day, fluorigard)* Use in Palliative Care: Oraldene Mouthwash Chlorhexidine gluconate Mouth Wash, Benzydamine Mouthwash & Spray Hydrogen Peroxide Mouthwash 6%* Products
*If recommended by Benzydamine Hydrochloride mouthwash & spray Dentist to be (including the brands: Difflam, Oroeze) * purchased or prescribed on dental Chlorhexidine gluconate mouthwash, oral spray & prescription dental gel (including the brand Corsodyl)* (both NHS & Anbesol gel & liquid n Palliative Care: Rinstead pastilles 3 Follow BNF advice: ‘cradle cap in infants may be treated with coconut oil or olive oil applications followed by shampooing'. Exceptions
Category
Examples (N.B. this is not an exhaustive list)
NB: Follow GMMMG formulary if there is a
clinical need to treat
Aveeno products, Dermacool products, Dermalo Bath Emollient, 1. Emollients only to be prescribed for Dermamist Spray, patients with a confirmed diagnosis of Diprobath Emollient, significant skin disease (including Eucerin products, eczema and psoriasis). Neutrogena products 2. Patients discharged from a specialist centre on a particular product should be Emollients
maintained on the same product if Balneum Products GM formulary products:
Dermol 200 Shower Emollient, Balneum cream, Balneum plus cream products
, Dermol 500 lotion, Dermol 600 bath emollient Doublebase products E45 cream ,E45 Emollient Wash Cream, Hydromol bath & shower emollient, Hydromol ointment(not cream) Hydromol products Oilatum Emollient Oilatum products Bio-Oil Skin Care Oil Coconut oil Products containing Dexpanthenol (Bepanthen baby protective oint, Nivea SOS products) Flexitol products products E45 foot & heel cream,
Glucosamine gel SensetSkin Cleansing Foam Skin Salvation oint Vitamin E cream
Only to be prescribed within ACBS
criteria:
protection against ultraviolet radiation in
Ambre Solaire products abnormal cutaneous photosensitivity, Anthelios products resulting from genetic disorders or Sunscreens Delph products
photodermatoses, including vitiligo and Riemann P20 products those resulting from radiotherapy; Sunsense products chronic or recurrent herpes simplex labialis. Uvistat products GM formulary products:
Sunsense Ultra 50+
Uvistat 50
Appendix 4 Example patient information sheet

Prescribing for clinical need policy – information for patients
Your doctor has provided you with this information sheet following a conversation you have had
regarding prescriptions and their decision to decline your request for a specific treatment.

About prescribing in Bury
Medicines are an integral part of the health care that many patients rely on to manage their health conditions
and over 3.6 million prescriptions are written by local clinicians every year.
Local clinicians including GPs and hospital doctors as well as many others work to the Greater Manchester
Formulary (see. This tool provides guidance on
medicines that meet local and national guidance and are encouraged to be prescribed locally.
What is the prescribing for clinical need policy?
As well as these medicines, there are thousands of alternative or complementary treatments available on the
market that some patients might find help manage their conditions.
In order to provide clear guidance for GPs about which of this extensive range of treatments should be
prescribed on NHS prescriptions, local clinical commissioning groups have worked together with GPs,
consultants, pharmacists, and patients and carers to agree that only those treatments that are clinically
effective and provide a clear health benefit to patients should be prescribed on NHS prescriptions.
The resulting prescribing for clinical need policy has been adopted by all local GP practices in the area. This
policy enables GPs to evaluate whether a treatment meets a patient's clinical need and therefore whether
they should prescribe it.

What treatments are included in the prescribing for clinical need policy?
Many treatments and medicines have a clear evidence base that demonstrates that they are clinically
effective and therefore wil meet a patient's clinical needs. This includes most medicines prescribed by
GPs to treat common conditions such as diabetes, asthma and high blood pressure.

What treatments are not included in the prescribing for clinical need policy?
Some preparations do not meet clinical needs, such as antiperspirants, sunscreens, emollients, wart
treatments and some gluten free products and are therefore not included.
Other treatments including vitamins, ear wax removers, Chinese herbal medicines or homeopathic remedies
do not have sufficient evidence of clinical benefits and are also not included.
Finally, treatments for the symptoms of conditions, such as the common cold, sore throat and cough that
would naturally resolve themselves, if untreated; and treatments for minor ailments, such as vaginal thrush,
that can be treated in the pharmacy, are not included.

What happens if a treatment you would like is not included in this policy?
If a treatment you would like:
 Does not meet a clinical need or  Does not have sufficient evidence of clinical benefit or  If the condition would naturally resolve itself if untreated,
local GP practices will not prescribe it on an NHS prescription.

For more information
The prescribing for clinical need policy has been agreed by all GP practices within NHS Bury CCG. You can
view the policy online:
If your condition changes please speak to your local pharmacist or GP.

Source: http://www.tottingtonmp.nhs.uk/website/P83012/files/2%201%20Prescribing%20for%20Clinical%20Need%20Policy%20Final%20emailed%20070815.pdf