In July 2022, a change in the law created our new organisation, NHS Black Country Integrated Care Board (ICB), to take over local healthcare planning from the former clinical commissioning group (CCG) serving the areas of Dudley, Sandwell, Walsall, and Wolverhampton.

Since the ICB establishment we have been reviewing our prescribing guidance documents. This includes:

  • reviewing the four existing CCG policies to harmonise them into one new position for the ICB
  • implementing updated guidance to consider national clinical guidelines and best practice. 

While the majority of policies were similar, there were several that had some differences. To address these differences, we have reviewed the guidance documents to look at how they can be made the same for the places of Dudley, Sandwell, Walsall, and Wolverhampton 

​As part of these reviews, our medicine management teams have looked at the latest evidence and practice both nationally and locally, to ensure the local offer is fair, effective and safe for the following medicines and products: 

  • Gluten free products
  • Drugs of low clinical value
  • Over-the-counter medicines.

Please read copies of the draft guidance for:

If you would like to request a copy of the draft guidance,

A public involvement exercise will now take place to collect wider views and feedback from local people and staff to inform our final decision-making. 

As part of this exercise, we invite you to share your thoughts through our survey and encourage you to take a look at each proposed policy listed below, along with details of the proposed changes and the new proposed policy.

Click here to complete the survey

This involvement exercise will close on 28 October.
 

Policies under review

This is a harmonised guidance for Sandwell, Dudley and Walsall in line with national guidance. There is no change for Wolverhampton. 

Gluten free products have been available on prescription for coeliac patients (those with a gluten allergy). However, gluten free products are now more readily available and there are more affordable options of gluten free products within supermarkets and other food outlets. 

The proposed guidance standardises the prescribed items, and units available on prescription across the Black Country in line with National Guidance and recommendations by Coeliac UK.  

  • Gluten Free (GF) cakes, biscuits and pizza bases are no longer allowed to be prescribed on the NHS in England 
  • We will continue to prescribe bread, bread rolls and flour mixes based on the following units: 
    • Children under 10 years – 8 units
    • Children aged 11- 18 – 12 units
    • Females aged 19 or older – 8 units
    • Males aged 19 or older – 12 units
    • Breastfeeding and third trimester pregnancy – additional 4 units

Is there a proposed change? 

For all Places, gluten free cakes, biscuits and pizza bases will no longer be prescribed. For Sandwell, Dudley and Walsall there is a change to the number of units prescribed to be in line with national allowances to allow for the removal of those items: 

Dudley: For adults over 18 the number of units has reduced for women from 10 units to 8 and increased for men from 10 units to 12. For children under 10, the number of units was previously on a scale of 10 – 13 units depending on age, but this is now 8 units for all under 10s. For 11–18-year-olds, units previously available was 15 – 18, and is now reduced to 12 units. 

Sandwell: For adults over 18 the number of units has reduced for women from 14 units to 8 and decreased for men from 18 units to 12. For children under 10, the number of units was previously on a scale of 10 – 13 depending on age, but this is now 8 units for all under 10s. For 11–18-year-olds, units previously available was 15 – 18 and is now reduced to 12 units. 

Walsall: Walsall previously offered 8 units for all age ranges and genders. This has now increased to 12 units for children aged 11-18 and adult males. 

Wolverhampton: There is no change.

This is harmonised guidance for Dudley, Walsall and Wolverhampton to meet national guidance. There is no change for Sandwell. 

Drugs of low clinical value are medicines which should not be prescribed in primary care because they are unsafe, ineffective for some or all patients, or are not cost-effective as per updated guidance published by NHS England in August 2023. Some of these drugs may still be prescribed in primary care in certain circumstances or under specialist care.  

The proposed guidance standardises the list of low clinical value drugs across the Black Country in line with National Guidance.  

Within the new national guidance the recommendations are: 

These items will no longer be prescribed at all in primary care: 

  • Co-proxamol 
  • Minocycline for acne 
  • Glucosamine & chondroitin* 
  • Omega 3 fatty acids* 
  • Herbal treatments and other natural products* 
  • Silk garments* 
  • Homeopathy* 

*These items are available to buy over the counter. 

 

These items aren’t routinely prescribed, but may be prescribed in some exceptional circumstances if further criteria are met: 

  • Aliskerin 
  • Bath and shower preparations 
  • Dosulepin 
  • Prolonged release Doxazosin 
  • Lutein and antioxidants 
  • Oxycodene and naloxone combination product 
  • Paracetamol and tramadol combination product 
  • Perindopril Arginine 
  • Trimipramine 
  • Rubefacients, benzydamine, mucopolysaccharide and cooling products  (excluding NSAIDS) 

 

These items can be prescribed if it meets one of more of the following exceptions: 

  1. Prescribe only if no other item or intervention is clinically appropriate. 
  2. Prescribe only if no other items or intervention is available. 
  3. Prescribe only if the item is for an indication named in the guidance – specific and further criteria.  

  • ​​​​Amiodarone 

  • Dronedarone

  • Immediate release fentanyl

  • Lidocaine plasters 

  • Liothryonine 

  • Needles for pre-filled and reusable insulin pens over £5 

  • Travel vaccines 

The guidance does not override the individual responsibility of the healthcare professionals to support their patients in agreeing the most appropriate treatment options for them through taking a shared decision-making approach.  

Is there a proposed change? 

In Dudley, oxycodone was not available on prescription but is now available in line with the harmonised Black Country formulary. For Walsall and Wolverhampton this is a levelled up in policy in line with national guidance where there was previously no policy. There is no change for Sandwell. 

This is a harmonised guidance document with all areas following updated national guidance. 

This proposed guidance is intended to ensure that we are spending NHS budgets in the most appropriate way, and by reducing spending on prescribing items that can be purchased over the counter for minor ailments such as antihistamines, cough mixtures and decongestants, means we can use that money for other healthcare services.  

The proposed policy states that the following medicines will not be available on prescription: 

  • Probiotics
  • Vitamins and minerals 
  • Eyecare products 
  • Emollients 
  • Acute sore throat 
  • Cold sores 
  • Infant colic 
  • Coughs, colds & nasal congestion 
  • Conjunctivitis 
  • Mild cystitis 
  • Cradle Cap 
  • Haemorrhoids 
  • Mild infant dermatitis 
  • Dandruff 
  • Diarrhoea (adults) 
  • Dry/tired/sore eyes 
  • Earwax 
  • Excessive sweating 
  • Headlice 
  • Indigestion and heartburn 
  • Infrequent constipation 
  • Infrequent migraine 
  • Insect bites and stings 
  • Mild acne 
  • Mild dry skin 
  • Mild-moderate hay fever/seasonal rhinitis 
  • Minor burns and scalds 
  • Minor conditions associated with pain, discomfort and fever 
  • Mouth ulcers/sore mouth 
  • Nappy rash 
  • Oral thrust 
  • Prevention of dental caries 
  • Ringworm/athletes foot 
  • Scabies 
  • Sunburn 
  • Teething/mild toothache 
  • Threadworms 
  • Travel sickness 
  • Vaginal thrush 
  • Warts and Verrucae 

Exceptions can occur where a difference in the treatment option made available to patients is directly related to the patient’s clinical condition or is related to the anticipated benefits to be derived from a proposed form of treatment. 

Some of these medicines are readily available via the Pharmacy First scheme, and means that patients will not first have to see a GP to access them with a prescription. For those who do not have to pay for prescriptions, they will continue to receive their medicines for free through the Pharmacy First minor ailment scheme. The pharmacy first scheme can also be accessed remotely for patients who are housebound. 

Is there a proposed change? 

The proposed changes bring the guidance documents in line with updated national guidance which all previously followed national guidance. The changes to national guidance is improved clarity of prescribing criteria.  

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