In 2018–2019 prescribing expenditure in NHS Wales totalled £0.91 billion. This represented 5.9% of total Welsh Government expenditure. It is therefore vital that a prudent approach is taken to review what items are prescribed within general practice.

The NHS Chairs and Chief Executives of NHS Wales have provided a collective response to the Cabinet Secretary for Health and Social Services regarding the financial and performance challenges facing the NHS. Part of this improvement programme includes a commitment to identify opportunities to improve primary care prescribing with opportunities for disinvestment being examined and guidance provided for NHS Wales.
This action has been progressed via the Pharmacy Directors peer group and the All Wales Prescribing Advisory Group.

The aim of this document is to minimise the prescribing of items that offer low clinical effectiveness to patients or where more cost-effective treatments are available. Thirteen items/item groups have been identified for the purposes of this document. These are:

Items of low clinical effectiveness:

amiodarone
bath and shower emollients
chloral hydrate and cloral betaine
dronedarone
minocycline
probiotics
rubefaciants
silk garments
vitamins and minerals

Items where more cost-effective alternatives are available:

alimemazine
aliskiren
blood glucose testing strips
silver dressings.

The recommendations are based on the NHS England document: Items which should not be routinely prescribed in primary care: Guidance for CCGs, with agreed additions from the All Wales Prescribing Advisory Group (AWPAG) meeting held in June 2019.

This proposed advice aims to reduce inappropriate variation in prescribing of items identified as low priority for funding across NHS Wales. This will ensure that health boards and clinicians are able to make the most efficient use of the resources available to them. Implementation will be monitored via the Welsh Analytical Prescribing Support Unit (WAPSU) using the existing Low Priority for Funding Medicines dashboard developed and updated by All Wales Therapeutics and Toxicology Centre (AWTTC).