In March 2018, NHS England published guidance on conditions for which over the counter items should not routinely be prescribed in primary care. Clinical commissioning groups are expected to take this into account in formulating local polices, and prescribers should then reflect local policies in their prescribing practice.3

Vitamins and minerals are included in the list of €items of limited clinical effectiveness,€ with the NHS estimating that around £48.1 million is spent unnecessarily each year on VMS products.

The guidance says there is €insufficient high-quality evidence€ to demonstrate the clinical effectiveness for widescale VMS prescribing. €Vitamins and minerals are essential nutrients which most people can and should get from eating a healthy, varied and balanced diet. In most cases, dietary supplementation is unnecessary.€

The guidance also points out that as many vitamins and minerals are classified as foods, they do not have to meet the quality, safety and efficacy criteria that the medicines regulator, the MHRA, sets for medicines.

However, there are exceptions for when VMS can be prescribed on the NHS:

·       a medically diagnosed deficiency, including for those patients who may have a lifelong or chronic condition or have undergone surgery that results in malabsorption, although continuing need should be reviewed on a regular basis;

·       calcium and vitamin D for osteoporosis;

·       malnutrition including alcoholism (following NICE guidance).

The guidance states that €maintenance or preventative treatment is not an exception.€