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Independents' Day

NHS England considers ban on 'low value' and over-the-counter prescriptions

GPs could be banned from prescribing 'low value' prescription medicines and other items that are cheaply available over the counter in pharmacies and supermarkets.

NHS England said it would be leading a review of starting from April, with a view to introducing new guidance for CCGs.

It said the new guidance would then be adopted by individual CCGs across England ‘following consultation’. This comes as a recent Pulse survey of over a thousand GPs showed nearly six in 10 support such a ban.

Initially, the review will focus on ’a set of 10 medicines which are ineffective, unnecessary, inappropriate for prescription on the NHS, or indeed unsafe, and that together cost the NHS £128m per year’, NHS England’s announcement said.

It added that it would give ‘careful consideration’ to ensure particular groups of people were not ‘disproportionately affected’.

NHS England said its review, which has been prompted by 'extensive work by NHS Clinical Commissioners which identified significant areas where potential savings can be made', comes as there was a 4.7% increase in the cost of prescriptions dispensed in primary care in 2015 to £9.27bn.

An NHS England spokesperson said: ’New guidelines will advise CCGs on the commissioning of medicines generally assessed as low priority and will provide support to clinical commissioning groups, prescribers and dispensers.

’The increasing demand for prescriptions for medication that can be bought over the counter at relatively low cost, often for self-limiting or minor conditions, underlines the need for all healthcare professionals to work even closer with patients to ensure the best possible value from NHS resources, whilst eliminating wastage and improving patient outcomes.’

RCGP chair Professor Helen Stokes-Lampard acknowledged the cost of OTC prescribing to the NHS, and said 'if we can take sensible measures to reduce these costs then we should'.

But she added: 'If patients are in a position that they can afford to buy over the counter medicines and products, then we would encourage them to do so without a prescription - but this isn’t the case for everyone.

'Prescribing is a core skill in general practice and family doctors will always prescribe in the best interests of the patient in front of us, taking into account the combination of physical, psychological and social factors affecting their health.

'Imposing blanket policies on GPs, that don’t take into account demographic differences across the country, or allowing flexibility for a patient’s individual circumstances, risks alienating the most vulnerable in society - and we will be seeking assurances from NHS England that this won't be the case.'

Dr Andrew Green, the GPC's prescribing lead, told Pulse: 'The GPC supports efforts to make sure that prescribing is cost effective, and we also support efforts to make sure that patients self care wherever possible.'

'The difficulty is that GPs have a requirement under their Terms of Service to prescribe drugs that are needed.'

Pulse has already revealed multiple CCGs implementing local restrictions on the prescribing of gluten free foods and over-the-counter medications, and Dr Green said a properly considered national policy could be better for GPs.

He added: 'If there is going to be a change, we'd support it being national rather than local, but it has to be more than guidelines. If they're going to stop GPs prescribing certain things then it would need to be changed in legislation, and politicians will need to bear an public backlash.

Without legislation GPs would be running the risk of a complaint, Dr Green said, and the BMA would always advise doctors to prescribe in line with the regulations rather than managers wishes.

Dr Green also said any change must not leave the most vulnerable without access to the medications they require.

He warned there could be unintended consequences as a result of poorly thought through changes, for example if low cost over the counter painkillers or antihistamines were no longer available on prescription so GPs were required to prescribe more powerful or more expensive alternatives.

A majority of delegates at the Pulse Live conference in London last week expressed support of a ban on all over-the-counter prescribing, following a debate between GP leaders.

In full: The list of items up for initial review (based on 2015 spend)

  • £30.93m on Liothyronine to treat underactive thyroid
  • £21.88m on gluten-free foods
  • £17.58m on Lidocaine plasters for treating nerve-related pain
  • £10.51m on Tadalafil, an alternative to Viagra
  • £10.13m on Fentanyl, a drug to treat pain in terminally ill patients
  • £8.32m on the painkiller Co-proxamol
  • £9.47m on travel vaccines
  • £7.12m on Doxazosin, a drug for high blood pressure
  • £6.43m on rubs and ointments
  • £5.65m on omega 3 and fish oils

Source: NHS England and NHS Clinical Commissioners

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Readers' comments (33)

  • It is best really that these decisions are taken and managed at national and CCG level rather than leaving these thorny subjects to individual GPs.
    Whatever we do is always wrong and the media love terrorising and demonising GPs.
    Any "grown up debate" is frankly impossible with the huge emotional overlay involved in any rationing decisions.

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  • make a small charge say 50p for all items on prescription. no exceptions. Would soon sort out
    unnecessary ordering by both patients and chemists

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  • Will the drugs be blacklisted (removed from FP10) or will GPs be made to say "no" to patients? I suspect the letter will occur.

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  • what have we been saying for years and trying to do, now they eventually come round to our thinking as they usually do ! Should be fun as there will be lots of patient groups objecting as they do.

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  • So 'testing the water' starts. Expect more of this if the Government doesn't lose support in the polls. They will be closely watching.

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  • If this goes through they must stop gross over-charging for OTC medicines. Just look at the cost a popular OTC antacid/antiflatulent.

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  • surely the key statement is low cost? There are vulnerable groups but if we are talking calpol for instance, if you can't afford the occasional bottle then I think there are far bigger questions to answer for society to answer. The real cost to the NHS for the gp appointment is multiple times the cost of the prescription and hence in financial terms truly ridiculous . No one would pay a credit card fee of £5 to pay a bill of 50p so why does the nhs?
    Having said that current government schemes are anti value for money . schemes for gps in a&e pay the gps a premium rate and yet a lage proportion of the patients seen have to see their own gp as gps outside of routine general practice can't refer to opd, expedite appointments or provide appropriate second opinion. likewise gps streaming in a&e is unlikely to see patients turned away as the personal risk is too high. As the NHS finances become increasingly untenable, I think a wide ranging review of value for money is needed if it is to survive into the next decade, not just a very small reduction in the smarties we prescribe .

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  • Drip drip drip of the privatization/collectivization process.Thanks commissar.

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  • a fee for consultation model as adopted by most countries is the way forward.

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  • I've no issue with banning co-proxamol, but it's wrong to state that these are all unnecessary, ineffective, inappropriate or unsafe treatments. Fentanyl is an ideal choice for many patients with severe pain. Lidocaine plasters are tremendously effective for some patients' pain symptoms, for example in post-hermetic neuralgia. Liothyronine is essential for a small minority of patients who don't tolerate levothyroxine. Likewise, sildenafil simply does not suit some men, when tadalafil does.
    How will the guidance deal with these necessary and justified exceptions?

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