Prescribing: Hospital or specialist only medicines

Listed drugs are unsuitable for prescribing in primary care (but see # below). Please note that not all listed medicines have been approved for use in every SWL Trust. Always check the provider’s formulary for the current status of individual drugs.

This may include specialist primary care services such as formally accredited GPs with special interests.​

This list is subject to continuous review (2 monthly) by the SWL Medicines Optimisation Group to recommend removals, additions & potential drugs suitability for shared care. Please check with the Clinical Commissioning Group (CCG), ISPS service – NEL Commissioning Support Unit (NEL) or provider Pharmacist for current status

Products which meet any of the following criteria are normally not suitable for primary care prescribing:

  • Medicines requiring ongoing specialist intervention and specialist monitoring
  • Patients receive the majority of on-going care, including monitoring, in hospital and the only benefit of transferring care would be to provider costs
  • Medicines which are unlicensed or are being used outside of product license (e.g. licensed medicine used for unlicensed indication or at an unlicensed dose) (see also section 11 of SWL Interface Prescribing Policy)
  • Medicines which are only available through the provider i.e. are not available on FP10, including ‘borderline’ products when used outside approved indications
  • The product is being used as part of a provider-initiated clinical trial or the continuation of a provider-initiated clinical trial or compassionate use, where no arrangement has been made in advance with the commissioner to meet the extra cost of treatment
  • The GP has ​​​insufficient information to participate in a shared care prescribing arrangement where applicable
  • No shared care prescribing arrangement exists and the GP does not feel competent in taking on clinical responsibility for the prescribing of a drug
  • Medicines and other prescribable products which have not been approved for addition to the provider’s formulary
  • PbR-excluded drugs and devices where shared care prescribing is not agreed
  • All anti-cancer medicines except where shared care prescribing or other agreements exist
  • Drugs subject to High-tech hospital at home guidance (EL(95)5)
  • Packages of Care
    • Total Parenteral Nutrition
    • CAPD Fluids
    • Desferrioxamine, deferiprone
    • Injectable antibiotics, antifungals and antivirals (unless special local arrangements exist)
    • Injectable cytotoxics eg. cytarabine, aldesleukin
    • Oral anti-cancer medicines e.g. capecitabine, fludarabine, imatinib
    • Drugs used in the treatment of HIV/AIDS
    • Drugs used in the treatment of tuberculosis
    • Drugs for IVF (see SWL ICB infertility and assisted conception)
    • All orphan drugs*; e.g. Agalsidase (Fabrazyme®) imiglucerase (Cerezyme®)
    • Insulin pumps and consumables (package of care)
  • All other treatments funded by NHS England unless specifically agreed to be provided through a shared care prescribing agreement​

*Orphan drugs are those designated by the EMEA to promote development of drugs to treat rare diseases or conditions.  They have marketing exclusivity for 10 years with assistance from the EMEA in optimising drug development and applications for marketing approval.


  1. The interest of the patient is paramount and there may be occasions where the patient’s best interest is served by obtaining the medication in primary care.
  2. It is acknowledged that there may already be patients receiving treatment in primary care with these drugs. Clinicians should exercise their discretion as to whether to continue prescribing.​
  3. See SWL and St George’s Mental Health Trust Medicines Formulary: Appendix D – Approved unlicensed indications for licensed medicines or unlicensed medicines 
  4. See SWL Interface Prescribing Policy
  5. See SWL Interface Policy: Appendix 1: Hospital Specialist Only Drug List 200326