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Gold, incentives and meh

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)

  • 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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