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CCGs rationing prescribing of generic Viagra

Exclusive Some CCGs are already imposing strict limits on the number of generic Viagra tablets that GPs can prescribe men with erectile dysfunction, following a Department of Health decision to lift restrictions on who can be prescribed the drug on the NHS, Pulse has learned.

CCG prescribing teams in some areas have written to GPs to inform them they can now prescribe sildenafil to any man with erectile dysfunction because of the change in national regulations – but also told them they must limit the number of treatments to one per week, or four tablets a month, in the same way branded erectile dysfunction drugs continue to be restricted.

But GP prescribing experts told Pulse strict prescribing caps were unnecessary and GPs should not be forced to ration the treatment.

Medicines management teams across the UK have this month been reviewing and updating their prescribing guidelines for generic sildenafil, after the DH regulations were changed to remove sildenafil from the list of treatments that can only prescribed for erectile dysfunction to men with specific underlying conditions, such as prostate cancer and diabetes.

But in guidance seen by Pulse, CCGs advise GPs to continue to prescribe no more than one treatment or tablet a week because of concerns about prescribing budgets and the risk of patients selling the drugs on.

Updated advice issued by NHS Telford and Wrekin CCG, written after the DH’s decision, reads: ‘In light of the pressure on NHS budgets, patients who are eligible for NHS treatment should be prescribed the lowest effective dose, with a maximum frequency of dosing of ONE tablet per week (i.e. FOUR tablets per MONTH).’

It quotes a Health Service Circular statement that says: ‘Prescribers may also wish to bear in mind that some treatments for impotence have been found to have a “street value” for men who consider, rightly or wrongly, that these treatments will enhance their sexual performance and that excessive prescribing could therefore lead to unlicensed, unauthorised and possibly dangerous use of these treatments.’

Advice from NHS West Essex CCG said: ‘Patients who have been prescribed sildenafil privately because they did not meet the SLS eligibility criteria will be able to have generic sildenafil prescribed on the NHS. We recommend that quantities are not changed and remain the same.

‘When prescribing these products please consider that these drugs do have a street value and quantities should be agreed after a discussion with the patient assessing realistic needs.’

But Dr Martin Duerden, prescribing advisor to the RCGP and a GP in Conwy, Wales, questioned whether GPs should be expected to ‘ration’ the treatment - and whether the cost concerns were valid.

Dr Duerden said: ‘Can we really ration sex in this way? The reality is that prescriptions for generic sildenafil have no restrictions and I think each person should be assessed as individuals – some will need more, some will need less.’

Dr Duerden welcomed NHS West Essex CCG’s commitment to allowing GPs to use their clinical judgement - the CCG says GPs may continue to follow DH advice permitting more than one treatment per week if they feel it is appropriate - but criticised references to the ‘street value’ of the drug.

He added: ‘The issue of “street value” for these drugs is obviously a concern but common sense and clinical judgement should prevail. Cost should not be much of an issue – eight tablets cost around £3.’

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee and a GP in Hedon, East Yorkshire, agreed GPs should be able to use their judgement to prescribe generic sildenafil rather than adhere to imposed limits – and said GPs should ignore local guidance if they felt it was too restrictive.

Dr Green said: ‘I would advise GPs to prescribe in exactly the same way as they would for other drugs, that is to supply a quantity to meet the patient’s reasonable need with an awareness of the possibility that a few patients might seek supplies for the use of others not themselves.’

He added: ‘Sildenafil is no different from any other drug in this respect, it is the GP’s signature on the prescription and the GP who bears responsibility for it, and so the GP must decide on its appropriateness both in terms of the drug itself and also in terms of the quantity prescribed. GPs should be mindful of local guidance but if in the opinion of the GP there is a reason for prescribing outside those guidelines then they should do so.’

Readers' comments (8)

  • Vinci Ho

    Guidelines are guidelines and they should not inhibit the clinician to use discretion for individual case. This is also another strong case for GPs to remain independent in practising rather than living under corporate organisations.

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  • My local PCT (back then) also tried to impose limit on gluten free product. I've told them frankly, if they wanted to argue with patients how many bread they should eat in a week, they can very well do this themselves as I see no medical evidence on optimal amount of bread/pasta/cookies etc to be eaten. I've never heard anything back and they didn't bother me again.

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  • John Glasspool

    Yes, this headline is misleading; they CANNOT restrict it- they can only ask.

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  • Peter Swinyard

    Street value? Oh per-lease. A patient yesterday declined an NHS script for sildenafil as my local pharmacy dispenses 8x100mg tablets privately for a fiver. He say no point in paying £8+ as a prescription tax instead!

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  • Peter - Not sure if you can prescribe medication which is available in NHS privately. I was previously told by medicine management manager I should not do this.

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  • I think CCGs might well make use of the saved Viagra to perk up their potency and maybe share some with the LMCs and BMA.

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  • Bearing in mind how cheap a private Rx is now for sildenafil, I think it was a stupid idea to remove the restriciton... It's also an added cost pressure which could have been avoided, bearing in mind the state of the NHS, we need to save the maximum we can...

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  • Most pharmacies now use private PGDs (no prescription is required) to supply ED drugs. I have seen an example that the pharmacy supplies 4x100mg generic sildenafil for £5!
    https://www.pharmacypgd.co.uk/
    So if your local pharmacy is prepared to bring the price of generic sildenafil to less than £8 for 8 tablets, patients are better off that way and GPs will save time too.

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