Prescribing - achieving value and sustainability - draft guidance: consultation

6. 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

Question 1a

Do you agree or disagree with the recommendation that prescribers should not initiate Co-proxamol for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 1b

Do you agree or disagree with the recommendation to deprescribe co-proxamol in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 1c

Please provide any further comments on the recommendations for Co-proxamol.

2. Glucosamine and Chondroitin

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 2a

Do you agree or disagree with the recommendation that prescribers should not initiate Glucosamine and Chondroitin for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 2b

Do you agree or disagree with the recommendation to deprescribe Glucosamine and Chondroitin in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 2c

Please provide any further comments on the recommendations for Glucosamine and Chondroitin.

3. Herbal Treatments

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 3a

Do you agree or disagree with the recommendation that prescribers should not initiate herbal treatments for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 3b

Do you agree or disagree with the recommendation to deprescribe herbal treatments in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 3c

Please provide any further comments on the recommendations for herbal treatments.

4. Homeopathy

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 4a

Do you agree or disagree with the recommendation that prescribers should not initiate homeopathy for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 4b

Do you agree or disagree with the recommendation to deprescribe homeopathy in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 4c

Please provide any further comments on the recommendations for homeopathy.

5. Minocycline for acne

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 5a

Do you agree or disagree with the recommendation that prescribers should not initiate Minocycline for acne for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 5b

Do you agree or disagree with the recommendation to deprescribe Minocycline for acne in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 5c

Please provide any further comments on the recommendations for Minocycline for acne.

6. Aliskiren

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 6a

Do you agree or disagree with the recommendation that prescribers should not initiate Aliskiren for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 6b

Do you agree or disagree with the recommendation to deprescribe Aliskiren in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 6c

Please provide any further comments on the recommendations for Aliskiren.

7. Bath and Shower Emollients

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 7a

Do you agree or disagree with the recommendation that prescribers should not initiate bath and shower emollients for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 7b

Do you agree or disagree with the recommendation to deprescribe bath and shower emollients in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 7c

Please provide any further comments on the recommendations for bath and shower emollients.

8. Dipipanone

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 8a

Do you agree or disagree with the recommendation that prescribers should not initiate Dipipanone for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 8b

Do you agree or disagree with the recommendation to deprescribe Dipipanone in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 8c

Please provide any further comments on the recommendations for Dipipanone.

9. Doxazosin Modified Release preparation

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 9a

Do you agree or disagree with the recommendation that prescribers should not initiate Doxazosin modified release preparation for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 9b

Do you agree or disagree with the recommendation to deprescribe Doxazosin modified release preparation in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 9c

Please provide any further comments on the recommendations for Doxazosin modified release preparation.

10. Lutein and Antioxidants

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 10a

Do you agree or disagree with the recommendation that prescribers should not initiate lutein and antioxidants for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 10b

Do you agree or disagree with the recommendation to deprescribe lutein and antioxidants in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 10c

Please provide any further comments on the recommendations for lutein and antioxidants.

11. Nefopam

• do not initiate in primary care or secondary care.
• deprescribe in individuals currently prescribed this item.

Question 11a

Do you agree or disagree with the recommendation that prescribers should not initiate nefopam for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 11b

Do you agree or disagree with the recommendation to deprescribe nefopam in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 11c

Please provide any further comments on the recommendations for nefopam.

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.

Question 12a

Do you agree or disagree with the recommendation that prescribers should not initiate omega 3 fatty acids for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 12b

Do you agree or disagree with the recommendation to deprescribe omega 3 fatty acids in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 12c

Please provide any further comments on the recommendations for omega 3 fatty acids.

13. Oxycodone and Naloxone combination product

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 13a

Do you agree or disagree with the recommendation that prescribers should not initiate oxycodone and naloxone for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 13b

Do you agree or disagree with the recommendation to deprescribe oxycodone and naloxone in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 13c

Please provide any further comments on the recommendations for oxycodone and naloxone.

14. Paracetamol and Tramadol combination product

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 14a

Do you agree or disagree with the recommendation that prescribers should not initiate paracetamol and tramadol for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 14b

Do you agree or disagree with the recommendation to deprescribe paracetamol and tramadol in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 14c

Please provide any further comments on the recommendations for paracetamol and tramadol.

15. Perindopril Arginine

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 15a

Do you agree or disagree with the recommendation that prescribers should not initiate perindopril arginine for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 15b

Do you agree or disagree with the recommendation to deprescribe perindopril arginine in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 15c

Please provide any further comments on the recommendations for perindopril arginine.

16. Probiotics

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 16a

Do you agree or disagree with the recommendation that prescribers should not initiate probiotics for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 16b

Do you agree or disagree with the recommendation to deprescribe probiotics in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 16c

Please provide any further comments on the recommendations for probiotics.

17. Rubefacients and Poultices

• do not initiate in primary or secondary care
• deprescribe in individuals currently prescribed this item

Question 17a

Do you agree or disagree with the recommendation that prescribers should not initiate rubefacients and poultices for any new individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 17b

Do you agree or disagree with the recommendation to deprescribe rubefacients and poultices in all individuals?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 17c

Please provide any further comments on the recommendations for rubefacients and poultices.

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

Question 18a

Do you agree or disagree with the recommendation that Alimemazine is only prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 18b

Do you agree or disagree with the recommendation to deprescribe alimemazine in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 18c

Do you agree or disagree with the recommendation to only prescribe alimemazine if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 18d

Please provide any further comments on the recommendations for alimemazine.

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

Question 19a

Do you agree or disagree with the recommendation that amiodarone is only prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 19b

Do you agree or disagree with the recommendation to deprescribe amiodarone in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 19c

Do you agree or disagree with the recommendation to only prescribe amiodarone if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 19d

Please provide any further comments on the recommendations for amiodarone.

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

Question 20a

Do you agree or disagree with the recommendation that Ascorbic acid is only prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 20b

Do you agree or disagree with the recommendation to deprescribe ascorbic acid in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 20c

Do you agree with the recommendation to only prescribe ascorbic acid if no other item or intervention is clinically appropriate or available.

Question 20d

Please provide any further comments on the recommendations for ascorbic acid.

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

Question 21a

Do you agree or disagree with the recommendation that buprenorphine patches should only be prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 21b

Do you agree or disagree with the recommendation to deprescribe buprenorphine patches in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 21c

Do you agree or disagree with the recommendation to only prescribe buprenorphine patches if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 21d

Please provide any further comments on the recommendations for buprenorphine patches.

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

Question 22a

Do you agree or disagree with the recommendation that chloral hydrate should only be prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 22b

Do you agree or disagree with the recommendation to deprescribe chloral hydrate in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 22c

Do you agree or disagree with the recommendation to only prescribe chloral hydrate if no other item or intervention is clinically appropriate of available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 22d

Please provide any further comments on the recommendations for chloral hydrate.

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

Question 23a

Do you agree or disagree with the recommendation that dosulepin should only be prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 23b

Do you agree or disagree with the recommendation to deprescribe dosulepin in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 23c

Do you agree or disagree with the recommendation to only prescribe dosulepin if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 23d

Please provide any further comments on the recommendations for dosulepin.

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

Question 24a

Do you agree or disagree with the recommendation that dronedarone should only be prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 24b

Do you agree or disagree with the recommendation to deprescribe dronedarone in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 24c

Do you agree or disagree with the recommendation to only prescribe dronedarone if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 24d

Please provide any further comments on the recommendations for dronedarone.

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

Question 25a

Do you agree or disagree with the recommendation that immediate release fentanyl should only be prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 25b

Do you agree or disagree with the recommendation to deprescribe immediate release fentanyl in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 25c

Do you agree or disagree with the recommendation to only prescribe immediate release fentanyl if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 25d

Please provide any further comments on the recommendations for immediate release fentanyl.

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

Question 26a

Do you agree or disagree with the recommendation that lidocaine should only be prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 26b

Do you agree or disagree with the recommendation to deprescribe lidocaine in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 26c

Do you agree or disagree with the recommendation to only prescribe lidocaine if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 26d

Please provide any further comments on the recommendations for lidocaine.

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

Question 27a

Do you agree or disagree with the recommendation that liothyronine should only be prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 27b

Do you agree or disagree with the recommendation to deprescribe liothyronine in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 27c

Do you agree or disagree with the recommendation to only prescribe liothyronine if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 27d

Please provide any further comments on the recommendations for liothyronine.

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

Question 28a

Do you agree or disagree with the recommendation that trimipramine should only be prescribed for an exception or indication named in this guidance?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 28b

Do you agree or disagree with the recommendation to deprescribe trimipramine in individuals where appropriate?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 28c

Do you agree or disagree with the recommendation to only prescribe trimipramine if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 28d

Please provide any further comments on the recommendations for trimipramine.

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

Question 29a

Do you agree or disagree with the recommendation that prescribers should not initiate blood glucose monitoring strips that cost over £10 for 50 strips?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 29b

Do you agree or disagree with the recommendation to deprescribe or change blood glucose monitoring strips that cost over £10 for 50 strips?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 29c

Do you agree or disagree with the recommendation to only prescribe blood glucose monitoring strips that cost over £10 for 50 strips if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 29d

Please provide any further comments on the recommendations for blood glucose monitoring strips that cost over £10 for 50 strips.

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

Question 30a

Do you agree or disagree with the recommendation that prescribers should not initiate insulin pen needles that cost over £5 for 100 needles?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 30b

Do you agree or disagree with the recommendation to deprescribe or change insulin pen needles that cost over £5 for 100 needles?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 30c

Do you agree or disagree with the recommendation to only prescribe insulin pen needles that cost over £5 for 100 needles if no other item or intervention is clinically appropriate or available?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 30d

Please provide any further comments on the recommendations for insulin pen needles that cost over £5 for 100 needles.

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.

Question 31a

Do you agree or disagree with the recommendation to avoid prescriptions for antibiotics in self-limiting or viral infections?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 31b

Do you agree or disagree with the recommendation to prescribe antibiotics for the appropriate duration?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 31c

Do you agree or disagree with the recommendation to ensure a management plan is documented within 72 hours when commencing IV antibiotics?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 31d

Do you agree or disagree with the recommendation to prescribe oral solid dosage forms, minimising use of liquids?

(Agree / Neither agree nor disagree / Disagree / Not sure)

Question 31e

Please provide any further comments on the recommendations for antimicrobial stewardship.