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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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  • prescribing prescription writing GP

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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  • Herpetic, not hermetic :-)

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  • This needs to made law rather than left to Gp's. I would disagree with banning fentanyl, lidocaine patches and tadalafil. Soon there will be cheaper version of these drugs to reduce the price just like with butrans

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  • "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."

    I can't help fail to notice that CCGs, and therefore GPs, will be the ones to do the dirty work.

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  • Let us do them on a private script then,low value sorted.Patient can then buy them at market rates.

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  • In Canada there is a list of medication that patients can get free, or relatively free through their province healthcare plan. GPs can prescribe outside of thus, but patients have to pay the full cost. Having certain diseases exempts patients from paying. In Ireland patients pay for all medication unless they qualify for exemption.

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  • Vinci Ho

    Damned you do
    Damned you don't
    Politicians will say we are the ones who fail their voters .

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  • Interesting news management. This story was broken by the Daily Mail 3 days before statement due on Friday. What actually is that about?

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  • Vinci Ho

    Yes
    If you look at its front page today, it is so 'righteous' , isn't it:
    Talking about the legs of the two woman leaders at the top, blue print to save NHS at the bottom.
    Sometimes, you just wonder how high and how low journalism can get to. Of course , Trump also created the sound bite 'faked news'. It is an understatement that the world has turned into a mess......

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  • Guidance - waste of time, patients will complain including to GMC if we refuse to precribe when available on FP10 - and irrespective of outcome complaints are somewhat time consuming.
    Should be black and white ie not available on FP10

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  • co-proxamol is long gone. why ban fentanyl liothyronine and lidocaine patches. they are clinically indicated .
    stop paracetamol, ibuprofen for children who have no fever. stop all drugs for ED. It is not essential and if thought so then they need to pay for it. sildinafil is cheap so they want they stop other drugs. not fair at all.
    why hypothyroidism exempt them paying for script? stop cough medicines and some rubificents.

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  • If the want to restrict medication on the NHS,all they need to do is find the political courage to extend Ken Clarke's limited list (SLS) ! It's not that painful is it?

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  • i have never known an indication for liothyronine and certainly isnt part of national guidelines - definitely one to not use. the patches on the other hand are much more effective.
    id ban simple antihistamines also

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  • Good, about time too.

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  • the biggest savings could be made if we could solve the problem of medicines waste. patients with cupboards full of unused medication, that the keep ordering so as not to upset the doctor(or pharmacist). or medicines that are prescribed that produce o real benefit. or medicines that cause actual harm.

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  • If it is on FP10, I would prescribe, to hell with guidelines and C Hunt

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  • Remove them from FP10 and patients can't then complain about their GP. We all know it would be the GP's fault.

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  • If they dont remove it from the FP10 just keep on prescribing.It is not our job to help bail out on underfunded sinking ship,as far as I am concerned we need to hasten it's demise.We need to bring on a copayment system.

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  • Talk about fiddling while Rome burns...

    We don't need to ban paracetamol we need twice as many GPs!

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  • The business model of big pharmacy chains surely benefit from this massive wastage??? Former health secretaries, both Tory and Labour, sit on the boards of wholesalers (Ken Clark, Unichem) and big oligopoly pharmacy chains (Patricia Hewett, Alliance Boots) coupled with their massive lobbying powers this can't perhaps be a coincidence? It may be blindingly bleeding obvious but money talks and it appears the NHS is too filthy, rotten and corrupt to the core to sort this out. Any voices raised on this will be silenced by the 'your privatising the NHS brigade' and the BMA. Meanwhile, private companies like the above profit massively from NHS medicines being thrown in the dustbin. The basket case that is the NHS isn't capable of sorting this out.

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  • I agree with 10:25: a small charge of 50p would make people think and bring down costs. It will also prevent Pharmacies from 'dumping medication into patient letterboxes as patients have to pay a pound will be badly upset for unwanted stuff. My neighbouring Pharmacy has only locums it seems and they put in request for ALL medication on patient records sometimes going back to 15 years or contra-indicated. You've got to be able to fathom the waste and eyes in the back of your head not to get into medico-legal problems.
    See what a 5p made to usage of plastic bags in supermarkets.
    Even a 10p charge on a box can make a difference.

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  • if you go to a party where booze is on house, you leave half pint of lager and change to other drink, if you have to pay for drink you will never do that. charge 10% of cost of drug to patients with some exception and see the difference. don't provide every thing for free to those who contributed zero for health.

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  • Since when has Fentanyl been bad? Or Doxazosin, or Lidocaine.

    Mind you agree with Gluten Free foods which are now widely available, and T3 is questionable.

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  • The SSRI s should be next.

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