Items which should not routinely be prescribed in primary care - herbal medicines

Below are the database queries which are used to create this measure. These are run against a copy of the BSA prescribing data which we store in Google BigQuery. We're working on making our BigQuery tables publicly available at which point it will be possible to run and modify these queries yourself. But even where code and database queries are not directly useable by others we believe it is always preferable to make them public.

Description Cost of herbal medicines per 1000 patients
Why it matters

NHS England guidance states:

Under a traditional herbal registration (THR) there is no requirement to prove scientifically that a product works; the registration is based on longstanding use of the product as a traditional medicine.

Due to the lack of scientific evidence required to register these products with the MHRA, the joint clinical working group felt that they were suitable for inclusion in this guidance.

In addition to herbal treatments with a THR, other natural products without robust evidence of clinical effectiveness should not be prescribed at NHS expense and fall within these recommendations. These products do not have a THR, are not recognised as supplements in the NHS Drug Tariff and do not appear as medicines in the BNF. These include:

  • natural oils, eg eucalyptus and almond
  • coenzyme Q10 (ubiquinone and ubidecarenone)
  • evening primrose (gamolenic acid).

MHRA withdrew the licence for 2-gamolenic acid preparations in 2002 due to a lack of evidence of efficacy.

NHS England recommend that GPs:
  • Do not initiate.
  • Deprescribe in patients currently prescribed this medicine.

Please note: this measure does not currently include natural oil preparations.
Tags Cost Saving, Efficacy, NHS England - items which should not routinely be prescribed in primary care
Implies cost savings Yes
Authored by richard.croker
Last reviewed 2023-11-20
Next review due 2024-11-20
History View change history on GitHub →

Numerator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(actual_cost) AS numerator
 FROM hscic.normalised_prescribing
 WHERE bnf_code IN ("0102000D0BCAAAF", "010602000BBBGA0", "030902000BEDDA0", "030902000BEDMAY", "030902000BEDSAZ", "091102000AAAIAI", "091102000AABABA", "091102000AABBBB", "091102000AABDBD", "091102000AABGBG", "091102000AABHBH", "091102000AABIBI", "091102000AABJBJ", "091102000AABKBK", "091102000AABMBM", "091102000AABNBN", "091102000AABPBP", "091102000AABRBR", "091102000AABSBS", "091102000AABUBU", "091102000AABVBV", "091102000AABWBW", "091102000BBDAAI", "091102000BBDTBR", "091102000BBFGA0", "091102000BBFPBA", "091102000BBFQAI", "091102000BBFXBB", "091102000BBGSAI", "091102000BBGTBA", "091102000BBHPAI", "091102000BBHTAI", "091102000BBHWBA", "091102000BBHYAI", "091102000BBHZBA", "091102000BBIAA0", "091102000BBIDBD", "091102000BBIFAI", "091102000BBIGBA", "091102000BBIHAI", "091102000BBIKBI", "091102000BBIMBA", "091102000BBINBA", "091102000BBIPBI", "091102000BBIQAI", "091102000BBIRAI", "091102000BBISBA", "091102000BBITBV", "091200000BBCQA0", "091200000BDGSA0", "091200000BDVAFU", "091200000BEWCFU", "091200000BFJKA0", "091200000BFJYA0", "091200000BFRKA0", "091200000BFSKFU", "091200000BFSVA0", "091200000BFTTFB", "091200000BFTUFC", "091200000BFUIFD", "091200000BFULFC", "1003020ADBBAAAA", "120303000BBBYAI", "1305010I0AAAAAA", "1305010I0AAABAB", "1305010I0AAAIAI", "1305010I0AAANAN", "1305010I0BUAAAA", "1305010I0BVAAAA", "1305010I0BVABAB", "1305010I0BWABAB", "190205500BCNFA0", "190601000AAALAL")
 GROUP BY month, practice_id

Denominator SQL

SELECT
     CAST(month AS DATE) AS month,
     practice AS practice_id,
     SUM(total_list_size / 1000.0) AS denominator
 FROM hscic.practice_statistics
 GROUP BY month, practice_id
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