Choosing wisely - recommendations from the RCGP

Jonathan Rocks's picture

A helpful guide for those of us working in primary care as set out by the recent Choosing Wisely campaign. More info to be found at

1. When patients are particularly frail or in their last year of life, unless there is a clear preference otherwise by the patient or advocate, discuss decreasing the number of medicines to only those used for control of symptoms.

2. Be alert to the possibility of dementia when an individual patient is seen rather than routinely screening whole groups of patients unless recommended to do so by the UKNSC.

3. If drug treatment is being considered to prevent heart disease, stroke or osteoporosis in previously well people ensure that this decision is shared with the individual concerned.

4. Only consider blood pressure treatment with drugs to prevent heart disease or stroke when the BP is consistently above 140-159/90-99 in people with additional risk factors.

5. If there is concern that a woman has polycystic ovaries, take a blood test to look for a typical hormone pattern before considering further imaging.

6. If an individual takes a statin at the recommended dose, there is no need to routinely check cholesterol levels unless there is evidence of pre-existing problems such as a heart attack, stroke or family tendency to have problems with lipids.

I'm sure this is just the tip of the iceberg - does anyone else have a suggestion?


Choosing Wisely

Emily Farrow's picture

Hi Jonathan,

Thanks for your post. Alternative recommendations could perhaps include:

An emphasis on shared decision making when prescribing ANY drug and discussion with the patient of what might happen if the drug isn’t taken or prescribed. Of note, a rather old but still relevant WHO report (1) showed adherence to drugs, for long-term conditions in developing countries, was approximately 50%.

An emphasis on reducing antibiotic prescribing where possible with reference to NICE Guidelines on self-limiting respiratory tract infections (2).

Since SDU research attributes 21% of GHG emissions from the NHS in England to pharmaceuticals (3) any reduction in unnecessary prescribing could have really important sustainability benefits.

(1)       World Health Organisation. Adherence to long-term therapies : evidence for action. Geneva: WHO; 2003

(2)       Respiratory tract infections (self-limiting): prescribing antibiotics | 1-guidance | Guidance and guidelines | NICE [Internet]. 2008 [cited 2 November 2016]. Available from:

(3)       Pharmaceuticals | Research and Development | Sustainable Health | Sustainable Development Unit [Internet]. 2012 [cited 2 November 2016]. Available from:

Emily Farrow,  new Clinical Programme Deputy Director at CSH


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