Consultation on proposed amendments to the Selected List Scheme (SLS) in Wales

This consultation describes proposed changes to the Selected List Scheme (SLS) in Wales.

The proposals involve:

• removing restrictions on the prescribing of certain medicines by GPs by removing those medicines from the SLS
• amending the wording of the restrictions on the circumstances under which oseltamivir and zanamivir can be prescribed by GPs in Wales

Medicines proposed for removal from the SLS

• Clobazam
• Locabiotal Aerosol
• Niferex Elixir 30ml Paediatric Dropper Bottle
• Nizoral® 2% cream

Drugs for erectile dysfunction proposed for removal from the SLS

• Alprostadil
• Avanafil
• Sildenafil
• Tadalafil

Restrictions not affected by these proposals

Following publication of the independent review of gender identity services for children and young people in April 2024, the UK Government put legislation in place to restrict the prescribing of gonadotrophin releasing hormone (GnRH) analogues by non-NHS and non-UK registered healthcare professionals.

Subsequently, amendments were made to the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) (Wales) Regulations 2004 in July and November 2024 to restrict the prescribing of GnRH analogues to people aged under 18 years of age by GPs, other than in specified circumstances.

Restrictions in the SLS relating to GnRH analogues (also known as “puberty blockers”) are outside the scope of the review.

Accordingly, this consultation does not propose any changes to the existing SLS restrictions governing the use of GnRH analogues.

What is the purpose of this consultation?

To seek the views of:

• NHS organisations
• persons who provide NHS general medical services
• persons who provide NHS pharmacy services
• professional bodies with an interest in prescribing or dispensing
• manufacturers and distributors of the medicines affected
• bodies that represent manufacturers and distributors
• other stakeholders
• the wider public

on the proposed changes to the SLS in Wales.

Who will this consultation be of most interest to?

The proposed changes will be particularly relevant to:

• local health boards
• persons who provide NHS general medical services
• persons who provide NHS pharmacy services
• professional bodies with an interest in NHS prescribing or dispensing services
• manufacturers and distributors of the medicines affected
• the bodies that represent manufacturers and distributors

How long will the consultation be open?

The consultation will be open for 12 weeks from the 23 September 2026.

This period is intended to provide sufficient time for:

• NHS organisations
• healthcare professionals
• professional bodies
• manufacturers and distributors
• representative organisations
• patients
• stakeholders
• members of the public

to consider the proposals and submit their views.

The consultation will close on 17th December 2026.

Responses received during this period will be considered alongside other available evidence to inform decisions on whether any amendments to the Selected List Scheme should be taken forward.

Understanding the terms used in this consultation

Throughout this document, two different types of indication are referred to.

SLS indication

The circumstances in which a medicine may currently be prescribed by a GP on the NHS under the Selected List Scheme.

Marketing authorised indication

The uses for which a medicine is licensed by the Medicines and Healthcare products Regulatory Agency (MHRA), as described in the product's marketing authorisation.

In some cases, the marketing authorised indications for a medicine are broader than the circumstances in which it may currently be prescribed under the SLS.

This consultation seeks views on whether some of these statutory prescribing restrictions remain necessary.

The Selected List Scheme (SLS)

The Selected List Scheme (SLS) is set out in Schedule 2 to the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) (Wales) Regulations 2004 (“the 2004 Regulations”).

Schedule 2 specifies a list of medicines that may only be prescribed under a general medical services (GMS) contract in the circumstances defined in the Schedule and therefore places statutory restrictions on the prescribing of these medicines on the NHS in Wales.

In practical terms, this means the SLS determines:

• which medicines can be prescribed on the NHS by a General Practitioner (GP)
• the specific circumstances in which they can be prescribed

Where medicines are subject to SLS restrictions, prescriptions must be endorsed to confirm that the patient meets the specified criteria set out in Schedule 2, to support appropriate dispensing and reimbursement.

The National Health Service (General Medical Services Contracts) (Wales) Regulations 2023 state that GPs must not prescribe medicines included in the SLS unless the patient and prescribing purpose meet the relevant requirements specified in the 2004 Regulations.

When prescribing an SLS medicine, the GP must annotate the prescription with “SLS” to confirm these requirements are met.

Community pharmacies cannot dispense prescriptions for these medicines unless they are endorsed in this way.

The medicines and prescribing restrictions set out in Schedule 2 are reproduced in Part XVIIIB of the Drug Tariff, a document which sets out which medicines and appliances may be prescribed on the NHS, together with the conditions under which they may be supplied and reimbursed.

The SLS was originally introduced to minimise the risk of inappropriate prescribing in circumstances where:

• evidence of effectiveness was limited at the time
• there were specific patient safety or prescribing stewardship concerns
• there was a need to manage the NHS’s exposure to high or uncertain costs

Rationale for change

Over time, the Selected List Scheme (SLS) has been updated to reflect changes in clinical evidence, standards of care and guidance.

However, some restrictions have remained unchanged since the current regulations came into force in 2004.

As clinical practice and the evidence base have developed, this raises the question of whether these restrictions remain the most appropriate and proportionate way to manage prescribing behaviours.

Currently, making changes to the SLS requires amendments to be made to the regulations.

The process of making these amendments takes considerable time.

As a result, the current arrangements are insufficiently responsive to new evidence or updated guidance.

This can limit the ability to prescribe medicines in line with the most recent evidence from clinical practice.

Other mechanisms are in place which influence GPs’ and other prescribers’ treatment decisions.

These are commonly used in NHS practice and are demonstrably effective.

These include:

• audit and feedback
• prescribing indicators which measure prescribing behaviour and variation against agreed standards

Evidence shows that these approaches can be highly effective in improving prescribing behaviour.

This includes:

• reducing inappropriate prescribing
• improving alignment with clinical guidance

Audit and feedback have been shown to improve prescribing across a range of areas and there is robust evidence which shows these approaches can lead to consistent improvements in practice through lasting behavioural change.

They are widely used in healthcare systems and are considered a practical and effective way to influence clinical behaviour.

In Wales, the National Prescribing Indicators (NPIs) provide a clear example of this approach.

These indicators are developed by the All Wales Medicines Strategy Group (AWMSG) and help health boards, primary care clusters and prescribers to compare their prescribing against agreed, evidence-based standards.

This supports the identification of areas for improvement.

Routine monitoring and benchmarking against NPIs is associated with changes in prescribing patterns.

This includes reductions in the use of high-risk or low-value medicines in some priority areas, such as the prescribing of opioids.

These non-statutory approaches provide an effective and proportionate way to influence prescribing behaviour.

They also offer greater flexibility than statutory control and can be updated more quickly in response to new evidence and changes in guidance.

We have therefore reviewed the medicines and restrictions within the SLS to determine whether statutory restrictions on prescribing are still needed in all cases.

The review also considered whether the same goals of:

• safe prescribing
• appropriate prescribing
• cost-effective prescribing

could be achieved through other, non-statutory approaches.

The following proposals are informed by the review.

Background

Clobazam is a benzodiazepine medicine.

It was included in the SLS to permit prescribing for the management of seizures associated with epilepsy while restricting its use in the management of anxiety, reflecting historic concerns regarding inappropriate benzodiazepine use in primary care.

Current SLS status and use

SLS indication

• Treatment of epilepsy

Marketing authorised indications

• Treatment of epilepsy
• Short-term management of anxiety

Prescribing data for Wales demonstrate continuing use of clobazam, with a slightly higher number of prescription items dispensed in 2024 to 2025 compared with 2023 to 2024.

However, the overall use of clobazam remains low with only 29,000 items dispensed in 2024 to 2025.

Licensed formulations remain available, supporting its continued clinical relevance.

Alternative benzodiazepines are available for similar indications, including:

• clonazepam for epilepsy
• diazepam for anxiety
• lorazepam for anxiety
• oxazepam for anxiety

Clinical considerations

Removing clobazam from the SLS would simplify prescribing arrangements without adversely affecting epilepsy care, as patients would continue to receive clobazam where clinically appropriate, but without the administrative requirement for SLS endorsement.

Removal would, however, permit clobazam to be prescribed for short-term anxiety management.

Compared with other benzodiazepines such as lorazepam and oxazepam, clobazam has a longer duration of action, which may increase the risk of sedation and next-day ‘hangover’ effects, making it a less suitable treatment choice.

This is particularly relevant in patients with hepatic impairment and would need to be considered by prescribers.

Removing the restriction will also mean people whose epilepsy is treated with clobazam will no longer have the potential risk that their treatment is delayed or interrupted because the SLS annotation has not been added to their prescription.

There is a small risk of medication errors arising from confusion between clobazam and clonazepam due to name similarity.

Safeguards are in place across NHS prescribing and dispensing systems, although medicines with similar names are more prone to selection errors.

Removal of the SLS annotation could marginally increase this risk if the SLS annotation is currently acting as a safety prompt, however this risk is considered to be low.

Financial and system considerations

Total Welsh primary care spend (WP10 and WP10HP) on clobazam in 2024 to 2025 was approximately £650,000, a reduction from around £770,000 in the previous year.

This reduction occurred despite increases in prescription items and total Defined Daily Doses (DDD) (a standard way of comparing medicine use, based on the average daily adult dose for its main use), indicating a reduction in unit cost.

While clobazam could be prescribed for short-term anxiety, potentially leading to increased prescribing and associated spend within NHS Wales, any such increase is likely to be limited by:

• prescriber unfamiliarity with its use for this indication
• existing health board formulary controls
• national guidance on benzodiazepine prescribing

In addition, the National Prescribing Indicator for benzodiazepines and Z-drugs (such as zopiclone and zolpidem) demonstrates an overall trend of declining utilisation across these drug classes, suggesting a continued shift away from benzodiazepine use in routine practice.

Prescribing could be monitored through the AWMSG National Prescribing Indicator for hypnotic and anxiolytic drugs, with clobazam added to the monitored list if required.

Routine clinical safeguards would remain in place to support appropriate prescribing, including:

• national and local guidance on benzodiazepine use
• health board formulary arrangements
• prescribing review
• audit and feedback
• monitoring through existing NHS Wales medicines management systems

These mechanisms are considered sufficient to identify and respond to inappropriate or unexpected prescribing and provide a more proportionate means of managing risk than retaining a statutory SLS restriction.

Rationale for proposal

Clobazam no longer appears to require statutory restriction through the SLS to ensure appropriate use, with clinical and safety risks manageable through:

• guidance
• formularies
• prescribing oversight

The relative drawbacks of clobazam when compared to other benzodiazepines, the decreasing use of this group of medicines as a whole, and the continued visibility of an NPI tracking changes in benzodiazepine use, means we do not believe removing clobazam from the SLS will result in meaningful increases in its prescribing.

For some patients there may be small benefits to removing clobazam from the SLS.

Conclusion

Removal of clobazam from the SLS would simplify prescribing and reflect modern clinical practice.

While there is potential for increased use in the management of short-term anxiety, this can be mitigated through existing benzodiazepine prescribing stewardship mechanisms.

Given that clobazam is lower cost than commonly used second-line alternatives, no significant unmanaged financial risk is anticipated.

Consultation question

Question 1: Do you agree with the proposal to remove clobazam from the Selected List Scheme?

Background

Locabiotal® (fusafungine) was a locally acting antibiotic nasal and oromucosal spray licensed for infections and inflammatory conditions of the upper respiratory tract, including:

• rhinitis
• rhinopharyngitis
• tonsillitis
• laryngitis

Many of these conditions are self-limiting and frequently viral.

At the time of its inclusion in the SLS, there was limited evidence of meaningful clinical benefit and concern about widespread prescribing in primary care for conditions where antimicrobial treatment was often unnecessary.

Current SLS status and use

SLS indication

• Treatment of infections and inflammation of the oropharynx

Marketing authorised indications

• No current marketing authorisation

Locabiotal® was withdrawn from the market following an EU-wide regulatory review that identified a risk of rare but serious allergic reactions, including:

• bronchospasm
• anaphylaxis

Marketing authorisations were revoked.

The product has not been prescribed in Wales for several years.

Clinical considerations

Regulators concluded that the safety risks associated with Locabiotal® could not be adequately mitigated in routine clinical practice and outweighed its limited and clinically marginal benefits.

Financial and system considerations

There is no current prescribing or expenditure associated with Locabiotal® in Wales.

Rationale for proposal

The product is:

• discontinued
• clinically obsolete
• no longer relevant to NHS prescribing

Conclusion

Removal of Locabiotal® aerosol represents an administrative update reflecting market withdrawal and current practice.

There is no clinical or financial risk associated with this proposal.

Consultation question

Question 2: Do you agree with the proposal to remove Locabiotal® aerosol from the Selected List Scheme?

Background

Niferex® Elixir (30 ml paediatric formulation) was a presentation of an oral liquid iron preparation licensed for the treatment and prevention of iron-deficiency anaemia in infants and children.

Current SLS status and use

SLS indication

• Prophylaxis and treatment of iron deficiency

Marketing authorised indications

• This presentation of the product has been discontinued.

Clinical considerations

Alternative iron preparations with comparable efficacy are available.

Financial and system considerations

It has not been prescribed in Wales since 2019.

There is no current prescribing or expenditure associated with this product.

Rationale for proposal

The product is discontinued and so is no longer clinically relevant.

Conclusion

Removal reflects product discontinuation and current prescribing practice.

There is no clinical or financial risk associated with this proposal.

Consultation question

Question 3: Do you agree with the proposal to remove Niferex® Elixir 30 ml paediatric dropper bottle from the Selected List Scheme?

Background

Nizoral® 2% cream is a topical antifungal containing ketoconazole, licensed for superficial fungal skin infections.

It was included in the SLS to restrict prescribing to specific indications, reflecting historic concerns about widespread use for common fungal infections.

Current SLS status and use

SLS indication

• Treatment of seborrhoeic dermatitis.
• Treatment of pityriasis versicolor.

Marketing authorised indications

For topical treatment of fungal skin infections (including dermatophyte, candidal and Malassezia infections), such as:

• ringworm
• athlete’s foot
• pityriasis versicolor
• seborrhoeic dermatitis

Clinical considerations

Topical ketoconazole now has a well-established safety profile with minimal systemic absorption.

National guidance supports its use for defined fungal skin conditions.

Financial and system considerations

Nizoral® 2% cream is the only 30 g ketoconazole cream currently available in the UK and it is already dispensed in Wales to fulfil prescriptions written generically for ketoconazole 2% cream.

As such, the SLS restriction on Nizoral® 2% cream does not deliver meaningful cost control and creates inconsistency with other antifungal products.

Rationale for proposal

The restriction no longer achieves its original policy intent.

Conclusion

Removal would simplify prescribing and improve consistency without increasing clinical or financial risk.

Consultation question

Question 4: Do you agree with the proposal to remove Nizoral® 2% cream from the Selected List Scheme?

Background

Medicines contained within the SLS used in the treatment of erectile dysfunction include:

• phosphodiesterase-5 inhibitors:
  • sildenafil
  • tadalafil
  • vardenafil
  • avanafil
• the prostaglandin E1 analogue alprostadil

These were included in the SLS primarily for cost-containment reasons when first introduced.

Current SLS status and use

SLS indication

• Treatment of erectile dysfunction

Marketing authorised indications

• Treatment of pulmonary arterial hypertension (specific presentations of sildenafil and tadalafil)
• Signs and symptoms of benign prostatic hyperplasia (tadalafil)
• Temporary maintenance of the patency of the ductus arteriosus until corrective or palliative surgery can be performed in infants who have congenital defects and who depend upon the patent ductus for survival (specific presentations of alprostadil)

Under the SLS, NHS prescribing of medicines for erectile dysfunction is restricted to men who meet defined eligibility criteria.

These include erectile dysfunction arising as a consequence of:

• diabetes mellitus
• multiple sclerosis
• Parkinson’s disease
• poliomyelitis
• prostate cancer
• severe pelvic injury
• certain single-gene neurological diseases
• spina bifida
• spinal cord injury

Eligibility also extends to men:

• following radical pelvic surgery
• following prostatectomy
• receiving renal replacement therapy by dialysis
• following renal transplantation

NHS prescribing is additionally permitted where a man has been diagnosed as suffering severe distress resulting from erectile dysfunction, where that assessment has been made by a specialist service or by a general practitioner acting under arrangements agreed with a Local Health Board.

A legacy provision also applies to men who were receiving NHS-funded treatment for erectile dysfunction prior to 14 September 1998.

These restrictions apply irrespective of whether the medicine is prescribed generically or by brand name.

Clinical considerations

Removal of the treatments for erectile dysfunction from the SLS is unlikely to significantly change clinical management.

However, improved NHS access to the treatments may reduce use of unregulated internet sources, improving patient safety where medicines obtained online may be:

• counterfeit
• substandard
• used without appropriate screening for contraindications

Nevertheless, it is recognised that erectile dysfunction remains a sensitive condition for many individuals.

Factors that may continue to influence help-seeking behaviour include:

• stigma
• embarrassment
• reluctance to engage with healthcare professionals

Earlier presentation to general practice through improved access may allow identification of underlying or contributory conditions associated with erectile dysfunction, such as:

• cardiovascular disease
• diabetes
• hypertension
• dyslipidaemia
• endocrine disorders
• medication-related adverse effects

Erectile dysfunction may be an early marker of wider cardiometabolic risk, and engagement at this stage may support appropriate assessment, advice and referral where clinically indicated.

This may offer wider health benefits beyond symptomatic treatment alone.

Financial and system considerations

In April 2019 the total cost of NHS prescriptions for alprostadil, avanafil, sildenafil, tadalafil and vardenafil products used in the management of erectile dysfunction in Wales was approximately £180,000 compared with approximately £117,000 in October 2025.

Over the whole period (April 2019 to October 2025), the mean number of items dispensed per month remained constant at approximately 29,000.

It should be noted that demand for these medicines is expected to increase in the coming years due to the rising prevalence of chronic conditions such as:

• diabetes
• Parkinson’s disease

While improving access to these treatments may result in some increase in prescribing and associated costs, overall expenditure is likely to remain lower than prior to the widespread availability of generic versions of these medicines.

Under current SLS arrangements, access to NHS-funded treatment for erectile dysfunction on the basis of severe distress has required additional eligibility assessment processes, delivered either through specialist services or through general practitioners operating under locally commissioned arrangements agreed with health boards.

These arrangements have created an administrative and service burden beyond routine primary care prescribing, with associated opportunity costs for the health system.

Removal of SLS restrictions would:

• remove the requirement for eligibility-based assessments linked solely to prescribing
• potentially reduce administrative complexity
• avoid the need for maintaining separate referral pathways
• avoid the need for maintaining separate commissioning arrangements

While this simplification would not remove the clinical need for psychosexual or specialist support where clinically indicated, it could reduce system costs associated with gatekeeping and eligibility verification.

Any efficiencies generated through the removal of these arrangements may partially offset increases in prescribing volume and expenditure, particularly in the context of widespread availability of low-cost generic medicines.

There is, however, potential for increased workload in primary care, particularly if greater access leads to more patient consultations relating to:

• diagnosis
• prescribing
• follow-up

In addition, removal of restrictions carries a residual risk of diversion and misuse of medicines, although this risk is considered manageable within existing prescribing safeguards and professional oversight.

Rationale for proposal

The restrictions on prescribing treatments for erectile dysfunction were introduced at a time before generic versions of those treatments were routinely available.

The availability of generic medicines for the treatment of erectile dysfunction has greatly reduced their cost to the NHS despite increasing use.

Restricting NHS prescribing to specified groups can no longer be justified on cost grounds alone.

Removing the restrictions may encourage more men to present to their GP with erectile dysfunction symptoms.

Some of these men will have underlying health conditions which would otherwise not have become known until later when their health deteriorated.

This may enable earlier diagnosis and improved outcomes for some men.

Removing the restriction will also promote equity.

Whilst some men may currently purchase erectile dysfunction treatment over the counter from pharmacies or on private prescription from their GP or another independent sector provider, the costs of doing so are relatively high and act as a barrier to accessing treatment, particularly for men from less affluent socioeconomic groups.

The proposal to allow GPs to prescribe these treatments to a wider cohort of men would:

• remove the financial barrier to treatment
• promote equity

While there is a small risk that some men who currently pay for their erectile dysfunction treatment will return to NHS treatment, many could continue to access treatment outside the NHS because they are uncomfortable presenting to their GP for this condition.

Ongoing stewardship could be delivered through:

• formularies
• guidance
• monitoring
• AWMSG low-value prescribing dashboards
• potential development of a National Prescribing Indicator (NPI)

Conclusion

The cost impact to the NHS of prescribing treatments for erectile dysfunction has materially changed with the widespread availability of low-cost generic medicines.

Removing SLS restrictions is unlikely to result in a step-change in expenditure, while eliminating the need for specialist or locally commissioned eligibility assessments.

Potential benefits include:

• reducing reliance on unregulated online sources
• supporting earlier identification of associated long-term conditions
• supporting earlier intervention for associated long-term conditions
• providing wider system and patient benefits

Consultation question

Question 5: Do you agree with the proposal to remove drugs used in the treatment of erectile dysfunction from the Selected List Scheme?

Question 6: What impact, if any, do you think this change would have on equity of access to the treatment of erectile dysfunction with the medicines included in the list?

Question 7: Please explain your answer, including the points highlighted below, in the box provided below:

Background

Oseltamivir (Tamiflu®) and zanamivir (Relenza®) are included in the SLS for the treatment and prophylaxis of influenza in specified clinical circumstances.

The SLS currently includes provisions that limit prescribing of antivirals to situations where there has been either:

• a formal notification by the Welsh Ministers that influenza is circulating in the community
• confirmation through community-based virological surveillance that influenza is circulating locally

The requirement for central notification that influenza is circulating in the community was removed from the SLS requirements in England in 2025.

Removing the requirement for ministerial notification or confirmation through local surveillance would enable prescribers to prescribe antivirals to people with suspected influenza regardless of the overall levels of circulating virus.

This would more closely align the Welsh restrictions with those in England.

This would reduce confusion while maintaining the same underlying clinical intent.

Current SLS status and use

SLS indication

• Treatment and prophylaxis of influenza

Marketing authorised indications

• Treatment and prophylaxis of influenza

Clinical considerations

These proposed changes do not alter:

• the clinical circumstances in which treatment or prophylaxis is appropriate
• eligibility criteria
• patient groups
• timing of treatment

The patient groups most at risk from influenza, and for whom the National Institute for Health and Care Excellence (NICE) considers prescribing to be cost effective, will continue to be listed in the SLS.

We do not propose to change the groups of eligible people who can receive treatment or prophylaxis.

Clinical decision‑making would continue to be informed by:

• national influenza guidance
• prevailing epidemiological advice

Financial and system considerations

Prescribing of influenza antivirals in primary care in Wales is currently limited, with approximately 400 items dispensed to non-hospitalised patients in 2024 to 2025.

This low level of prescribing reflects the combined effects of:

• seasonal influenza activity
• restrictive clinical eligibility criteria
• existing SLS requirements, including the need for confirmation that influenza is circulating

Removal of the CMO Letter and Local Virological Confirmation requirements would eliminate administrative and system-level barriers that can delay initiation of treatment.

This would provide an opportunity for more timely prescribing in eligible patients, particularly:

• in the early stages of influenza circulation
• where formal notification has not yet been issued

As a result, the proposed amendments may lead to an increase in prescribing within eligible populations.

Any increase is expected to reflect more responsive and timely clinical decision-making, rather than a change in clinical thresholds for treatment.

While increased prescribing may increase medicines expenditure, earlier treatment in at-risk populations may reduce complications, including hospitalisation, and overall system costs are not expected to increase materially.

Rationale for proposal

Access to oseltamivir and zanamivir in Wales should not differ from other parts of the UK.

Removal of the CMO Letter and Local Virological Confirmation requirements will:

• reduce perceived access differences
• maintain the clinical criteria under which these medicines should be prescribed

Conclusion

Removal of the CMO Letter and Local Virological Confirmation requirements is expected to improve:

• clarity
• consistency
• timeliness of access to antiviral treatment

while maintaining:

• existing clinical safeguards
• existing eligibility criteria

with a cost-neutral overall impact.

Consultation question

Question 8: Do you agree with the proposal to remove the CMO Letter and Local Virological Confirmation requirements for oseltamivir and zanamivir? Please explain your answer.

Question 9: To what extent do you agree that the proposal to remove the CMO Letter and Local Virological Confirmation requirements will enable more timely prescribing of influenza antivirals for eligible patients?

Proposal 1: removal of clobazam from the SLS

Question 1: Do you agree with the proposal to remove clobazam from the Selected List Scheme?

Proposal 2: removal of Locabiotal® aerosol from the SLS

Question 2: Do you agree with the proposal to remove Locabiotal® aerosol from the Selected List Scheme?

Proposal 3: removal of Niferex® Elixir 30 ml paediatric dropper bottle from the SLS

Question 3: Do you agree with the proposal to remove Niferex® Elixir 30 ml paediatric dropper bottle from the Selected List Scheme?

Proposal 4: removal of Nizoral® 2% cream from the SLS

Question 4: Do you agree with the proposal to remove Nizoral® 2% cream from the Selected List Scheme?

Proposal 5: removal of drugs used in the treatment of erectile dysfunction from the SLS

Question 5: Do you agree with the proposal to remove drugs used in the treatment of erectile dysfunction from the Selected List Scheme?

Question 6: What impact, if any, do you think this change would have on equity of access to the treatment of erectile dysfunction with the medicines included in the list?

Question 7: Please explain your answer, including:

• which population groups may be most affected (for example by socioeconomic status, age, or health conditions)
• whether this change may alter how people access treatment (for example NHS prescribing versus private or over-the-counter purchase)

Proposal 6: removal of CMO Letter and Local Virological Confirmation requirements for oseltamivir and zanamivir

Question 8: Do you agree with the proposal to remove the CMO Letter and Local Virological Confirmation requirements for oseltamivir and zanamivir? Please explain your answer.

Question 9: To what extent do you agree that the proposal to remove the CMO Letter and Local Virological Confirmation requirements will enable more timely prescribing of influenza antivirals for eligible patients?

Wider impacts of the proposed changes

Question 10: Are there any other impacts, including unintended consequences, that should be considered in relation to any of the proposed amendments?

Welsh language

Question 11: What, in your opinion, would be the likely effects of the proposed changes to the SLS on the Welsh language?

We are particularly interested in:

• any likely effects on opportunities to use the Welsh language
• not treating the Welsh language less favourably than English
• opportunities to promote any positive effects
• opportunities to mitigate any adverse effects

Question 12: In your opinion, could the proposed changes to the SLS be formulated or changed so as to:

• have positive effects or more positive effects on using the Welsh language and on not treating the Welsh language less favourably than English
• mitigate any negative effects on using the Welsh language and on not treating the Welsh language less favourably than English

1. Ivers N, Yogasingam S, Lacroix M, Brown KA, Antony J, Soobiah C, et al. Audit and feedback: effects on professional practice. Cochrane Database Syst Rev. 2025;CD000259.
2. Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;(6):CD000259.
3. Carter M, Abutheraa N, Ivers N, Grimshaw J, Chapman S, Rogers P, et al. Audit and feedback interventions involving pharmacists to influence prescribing behaviour in general practice: a systematic review and meta-analysis. Fam Pract. 2023;40(5–6):615–628.
4. Moe-Byrne T, Chambers D, Harden M, McDaid C. Behaviour change interventions to promote prescribing of generic drugs: a rapid evidence synthesis and systematic review. BMJ Open. 2014;4(5):e004623.
5. Fujita K, Moles RJ, Chen TF. Quality indicators for responsible use of medicines: a systematic review. BMJ Open. 2018;8(7):e020437.

Submit your comments by 17 December 2026, in any of the following ways:

• complete our online response form
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Pharmacy and Prescribing Branch,
Welsh Government,
Cathays Park,
Cardiff,
CF10 3NQ

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Wilmslow
Cheshire
SK9 5AF

Telephone: 01625 545 745 or 0303 123 1113

Website: ico.org.uk

Number: WG54915

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