Value based health and care action plan: measurement framework

Action 12

The Scottish Government will work with NHS Boards and HSCPs to continue to develop and support effective prescribing practices.

Progress to date and future priorities

To drive value-based prescribing, the Scottish Government have published four Quality Prescribing Guides: Respiratory Conditions, Diabetes, Antidepressants and Benzodiazepines and z-drugs. Guides for Polypharmacy and Chronic Pain will be published in early 2026. Each guide promotes and models 7-Steps person-centred medication reviews and contain sections on the environmental impact of medications and how medication reviews support sustainable prescribing. A set of corresponding National Therapeutic Indicators (NTIs) has been developed and reviewed by an expert group for each guide, enabling benchmarking at board and practice level and highlighting variance, identifying appropriate areas to target for patient review. Implementation toolkits are available alongside the guides on the Right Decision Service.

Dashboards that provide Boards with additional context for their data - such as condition prevalence, SIMD and age data - are also now available for respiratory conditions, diabetes, chronic pain, mental health, and polypharmacy. New streamlined board report formats have also been developed, drawing data from the NTIs making the data more easily accessible for Health Boards. A Value Based Prescribing Group has been established, who have supported the review of the NTIs, and the publication of guidance on achieving value and sustainability in prescribing This guidance has supported a reduction in the utilisation of medicines of low clinical value within boards (e.g. lidocaine plasters).^[15] Workshops have been run to develop three horizons prioritisation to address environmental sustainability in prescribing.

The Scottish Government will continue to publish and support the implementation of the suite of Quality Prescribing Guides with associated indicators and dashboards to support monitoring. We will report via the 15-box grid to track the implementation of 7-Steps medication reviews Development of templates to support these medication reviews is in progress.

To avoid medicines waste, the Scottish Government are currently running a pilot project to monitor adherence to medicines^[16] and development of a dashboard that can be used as part of shared decision making. Interim results will be ready during Autumn 2026. The new sustainable prescribing group will begin to meet from March 2026 to take forward work on environmental sustainability of medicines. The Scottish Government are also developing a pathway to integrate pharmacogenomic testing as part of person-centred 7-Steps review which has been funded by EU and will be recruiting patients to the study in April 2026 and developing a Clinical Decision Support (CDS) tool to support reviews alongside high-risk medications.

Monitoring metrics^[17]

The monitoring metrics for Action 12 draw on survey data from health and care professionals, national prescribing data and usage data for key prescribing guides and toolkits. These metrics provide information on how prescribing tools are used, the impact they have and the perceived support they offer in reducing medicines of low or limited clinical value. They also describe the prevalence of key polypharmacy and specific high‑risk prescribing practices across Scotland.

Metric 12.1: 7-step person-centred reviews:

• Supported surveyed health and care professionals to achieve significant (9%) or some reduction (32%) in their use of medicines of low and limited clinical value.
• Had significant (10%) or some (25%) positive impact on health and care professionals’ ability to deliver safer, more effective, and person-centred care.

Metric 12.2: National Therapeutic Indicators:

• Supported surveyed health and care professionals to achieve significant (7%) or some reduction (25%) in their use of medicines of low and limited clinical value.
• Had significant (4%) or some (19%) positive impact on health and care professionals’ ability to deliver safer, more effective, and person-centred care.
• Had significant (9%) or some (17%) positive impact on health and care professionals’ ability to look for unwarranted variation in prescribing practices.

Metric 12.3: Polypharmacy prescribing guidance and implementation toolkits:

• Supported surveyed health and care professionals to achieve significant (11%) or some reduction (32%) in their use of medicines of low and limited clinical value.
• Had significant (10%) or some (24%) positive impact on health and care professionals’ ability to deliver safer, more effective, and person-centred care.

Metric 12.4: High risk prescribing toolkit for Vision and EMIS:

• Supported surveyed health and care professionals to achieve significant (5%) or some reduction (18%) in their use of medicines of low and limited clinical value.
• Had significant (4%) or some (13%) positive impact on health and care professionals’ ability to deliver safer, more effective, and person-centred care.

Metric 12.5: Scottish Therapeutics Utility:

• Supported surveyed health and care professionals to achieve significant (6%) or some reduction (19%) in their use of medicines of low and limited clinical value.
• Had significant (6%) or some (14%) positive impact on health and care professionals’ ability to deliver safer, more effective, and person-centred care.
• Had significant (8%) or some (17%) positive impact on health and care professionals’ ability to look for unwarranted variation in prescribing practices.

Metric 12.6: Scottish Government Quality Prescribing Resources had significant (4%) or some (14%) positive impact on surveyed health and care professionals’ ability to deliver safer, more effective, and person-centred care.

Metric 12.7: Approximately 43 per 1,000 people in Scotland were prescribed 10 or more medicines, including at least one high-risk medication in July-September 2025.

Metric 12.8: Approximately 12 per 1,000 people in Scotland were prescribed three or more of the following medicine classes: benzodiazepines/Z‑drugs, opioids (including tramadol), gabapentinoids, antidepressants, and antipsychotics (excluding depots), ‘triple whammy’, in July-September 2025.^[18]

Metric 12.9: Approximately 1 per 1,000 people in Scotland were prescribed an ACE inhibitor or angiotensin receptor blocker, a diuretic and a Nonsteroidal Anti-Inflammatory Drug, increasing the risk of acute kidney injury; in July-September 2025.

Metric 12.10: Approximately 50 per 1’000 people in Scotland were prescribed 3 or more short-acting beta-agonist inhalers (SABA) per annum in July-September 2025.

Metric 12.11: Interaction with effective prescribing resources (total views between Apr 24 to Mar 25):

• Diabetes Quality Prescribing Guide - 2,351
• Respiratory Quality Prescribing Guide - 2,904
• Antidepressant Quality Prescribing Guide - 1,863
• Benzodiazepine and Z-drug Quality Prescribing Guide - 1,127
• Achieving Value and Sustainability in Prescribing Guidance – 1,022
• Right Decision Service Diabetes toolkit - 9,905
• Right Decision Service Respiratory toolkit - 14,685
• Right Decision Service Polypharmacy toolkit - 89,601
• Right Decision Service ‘Manage My Meds’ toolkit - 10,644