Low value medicines in OpenPrescribing Hospitals

We recently launched OpenPrescribing Hospitals, including the new Measures feature. OpenPrescribing Hospitals measures are designed to help highlight variation across hospitals and initiate discussions among teams that understand the intricacies of local arrangements. We think, with some caveats, that measures aimed at identifying low value prescribing could reveal important variation.

What is low value prescribing

NHS England has recently published priorities and planning guidance for 2025/26. A key part of this is a renewed focus on implementing ‘Low value prescribing’ guidance. You may also have heard this called ‘Low value medicines’ or by its full official name of ‘Items which should not routinely be prescribed in primary care’.

The main focus of these guidelines is on prescribing in primary care and we provide dashboards within OpenPrescribing to monitor this. However, we think many are applicable to hospitals too (more below) and so we are working to implement a selection of appropriate low value prescribing measures in OpenPrescribing Hospitals to support NHS priorities as published in the planning guidance.

Why is low value prescribing relevant in hospitals?

Many of the items covered by the low value prescribing guidelines are for chronic conditions, for example, doxazosin for hypertension. This means that if these medications are initiated in hospital, primary care teams will likely be expected to continue prescribing them unless an active effort is made to review and switch treatment during transfer of care, potentially creating unnecessary workload. The NHS Standard Contract also sets out that the “provider must have regard to Guidance on Prescribing in Primary Care” when supplying or recommending an item to be prescribed, and specifically list the ‘Low value prescribing’ guidance as part of this.

Integrated care boards (ICBs) are responsible for spending across the whole system (both primary and secondary care). We already provide dashboards to monitor ‘low value prescribing’ in primary care. Even where medications are intended solely for hospital use, the guidance that prescribing represents ‘low value’ generally (though not always) applies in hospitals as much as primary care. If a drug should not be used in primary care then in most cases it shouldn’t be used in local hospitals either.

There are cases where the applicability of the guidance in hospitals isn’t always straightforward - for example, patients may be admitted on these medications and there might not be an appropriate opportunity to review. Or local contracting arrangements might make a specific medication better value for the hospital to use.

We are in the early stages of developing OpenPrescribing Hospitals. We are starting with a small number of the low value prescribing measures and hope to expand this over time based on the feedback we receive:

• Doxazosin modified-release - the percentage of doaazosin issued which is as modified-release tablets.
• Perindopril arginine - the percentage of perindopril issues which is perindopril arginine.

Below is what the doxazosin modified-release measure looks like. It’s not very interesting, but that’s a good thing! It shows that the median monthly number of low value doxazosin tablets (those which are modified-release and are more expensive) issued by individual trusts is 0.

When we look at the regional breakdown, we can see that there is some small variation.

When we look at the national level, we can see that in May 2024, there were 1.2k defined daily doses issued each month.

Let us know your thoughts

Your feedback is extremely valuable to us, especially at this early stage.

• Are there any low value medicines you’d like to see included in OpenPrescribing Hospitals measures?
• Do you disagree with any of the low value medicines measures?
• Do you have any other suggestions for measures?

Expect to see new measures and functionality in the coming weeks and months based on the needs of users.

Please share any comments or feedback with us. We would also be happy to join short calls, team meetings etc if you would prefer to give feedback in this manner.