Effective prescribing and therapeutics

The Scottish Government works to ensure safe and effective use of medicines in NHS Scotland. We do this by promoting best practice and providing tools, analysis and support to prescribers, patients and carers. We work with NHS Health boards to review regional prescribing and identify areas for Quality Improvement work through a set of National Therapeutic Indicators.

We are committed to making improvements in prescribing to ensure the best outcomes for patients.

Person-centred medicines reviews

The way medicines are prescribed varies because of differences in how individuals respond to medicines and can be affected by multiple conditions that a person is living with. The number of people living with more than one condition and taking multiple medicines is growing. When someone takes two or more medicines at a time it is known as Polypharmacy. Taking multiple medicines can be beneficial but there can also be potential harms. These include interactions between drugs or between drugs and diseases, which outweigh the intended benefits. Patients’ needs can also change over time, so it is important to regularly review prescriptions.

We led on the EU funded iSIMPATHY project to ensure the best and most sustainable outcomes in patients taking multiple medicines through the use of the 7-Steps medicine review process. Medicines reviews are a meeting with a doctor or pharmacist to talk about any medicines you are taking, and ensure they are the right medicines for you.

The 7-steps medicines reviews encourage:

shared decision-making
a personalised approach to care
reducing harm and waste
addressing unwarranted variation

Our digital shared decision aids and information on the Polypharmacy Manage Medicines website and app provide practical support for patients to be involved in decision-making.

We work with stakeholders and patient groups to look at effective de-prescribing strategies following medicines reviews, and signpost to alternative therapeutic options where available. This reduces potential harms from inappropriate use of medicines, medicines waste and addresses what matters to the individual.

We are also working to implement the recommendations made by the Short Life Working Group on Prescription Medicine Dependence and Withdrawal

Quality prescribing guides

We produce condition focused Quality Prescribing Guides to support prescribers in their decision making and ensure awareness and use of these guidelines. These guides are developed in partnership with experts in NHS Scotland, patient groups, third sector organisations and individuals who are experts by experience and are regularly reviewed.

Our guides are not intended to supersede other prescribing advice such as SIGN and NICE but to complement them. They offer additional practical advice and options for tailoring care to the needs and preferences of individuals.

The guides are also adapted as toolkits to download on the Polypharmacy Manage Medicines app and website. There are toolkits for healthcare professionals and for patients and carers. Professionals are recommended to download both toolkits, so they can guide and support patients in using the resources. Patients and carers can also choose to download the professional toolkit for more detailed information.

Our guides

We have published the following guides:

Prescribing support tools

We have developed prescribing support tools for health boards, GP practices, prescribing teams and individual prescribers to support improvements in prescribing.

National Therapeutic Indicators (NTIs)

NTIs are a set of key prescribing indicators developed in conjunction with the Quality Prescribing Guides. You can view the NTIs on the Public Health Scotland (PHS) website. The NTIs are updated quarterly, enable benchmarking at board and practice level and are open access improving transparency. Practices can see variance between their board and other parts of Scotland, identifying appropriate areas to target for patient review.

Scottish Therapeutic Utility (STU)

STU is a computer programme that extracts data from GP IT systems with a focus on repeat prescribing and high-risk prescribing. STU complements the NTIs by enabling the practice/prescriber to run similar searches against practice data to identify patients that match pre-set criteria. This can help the practice/prescriber identify individuals who would benefit from review. STU is available free of charge to all practices.

Decision support tools

Our guides are delivered as decision support tools through the Right Decision Service platform. These are available as web and mobile apps and prompts within electronic health record systems which support safe, personalised decisions by bringing two types of evidence together:

validated evidence based on research and practice experience
evidence from the lived experience of people who use health and care services

These decision support tools enable professionals to work in partnership with the people they care for, providing sustainable, high-quality care based on what matters most to them.

Patient Reported Outcome Measures (PROMS)

Through the iSIMPATHY project, we developed a set of Patient Reported Outcome Measures (PROMS). Patients answer questions both before and after their medication review, which helps to show the difference the review has made to them.

Sustainability

We aim to improve sustainability and address environmental impacts through reducing medicines waste and recommending more sustainable therapeutic and non-therapeutic options where they are right for the patient. We will do this by:

promoting appropriate prescribing and initiation of medicines
regular person-centred medication reviews
deprescribing where appropriate

Draft guidance consultation

There is variation in prescribing of medications across NHS Scotland. This can include items that may have low or limited effectiveness, safety concerns, or provide low value for money for NHS Scotland where there are more cost-effective items available. This can also include instances of antibiotics being prescribed unnecessarily or for longer than the recommended duration, increasing antimicrobial resistance.

We are therefore consulting on draft guidance on achieving value and sustainability in prescribing medication between 11 July 2024 and 8 September 2024.

Contact:

Email: EPandT@gov.scot

Health improvement