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DH 'blacklist' required to enable GPs to curb OTC prescribing, says GPC lead

Exclusive NHS England's plan to draw up national guidelines preventing GP prescribing of certain over-the-counter or low-value medicines are 'unworkable' and 'totally unacceptable', the GPC's clinical lead has said.

NHS England said in March that its review, set to launch this month, would lead to 'guidance' that 'will support CCGs in making decisions locally about what is prescribed on the NHS'.

But GPC clinical policy lead Dr Andrew Green said that this measure alone would be ‘wholly inadequate’, and could put GPs at risk of breaching their contracts.

NHS England's review is due to focus on certain ‘low-value’ treatments such as lidocaine plasters, as well as items available for purchase without a prescription including gluten-free foods and over-the-counter items.

But making this workable would mean ‘blacklisting’ the items so they can no longer be supplied on an NHS prescription – or else the Government will need to change GPs’ terms of service under the GMS contract, Dr Green said.

He told Pulse: ‘Guidance from my point of view is totally unacceptable because it doesn’t deal with the fundamental problem, which is the discontinuity between these attempts to reduce prescribing and the requirements under our contract.’

He added: ‘It has to be introduced, in my view, by either removing the substances from the list of things that we can prescribe, or by amending our regulations to allow that to take place. Guidance is useless.'

It comes as Pulse has learned that grassroots GPs will be pushing for GPC policy to blacklist OTC items at next month's LMCs conference.

Dr Shaba Nabi, a GP in Bristol and Avon LMC representative, said hers was among several LMCs proposing a ‘DH-led’ ban in an LMC motion.

She told Pulse: ‘No one can dictate to a GP what they should and shouldn’t prescribe unless it is DH-led.

'So NHS England and CCGs can produce guidance, but unless certain over-the-counter meds are blacklisted, the patient can still demand treatments and complain if they don’t get them.’

Dr Green said the GPC's stance on DH blacklisting of drugs would be determined by LMC conference policy, but that the GPC would only accept any ban if backed by legislation.

There is already a blacklist of drugs that GPs may not prescribe, which appears under Schedule 1 of the 2004 GMS contract.

The list, which includes drugs experts agreed had no clinical or therapeutic advantage over other cheaper drugs, was first set up in 1985 and no new iterms have been added since 2004.

Which items could be blacklisted?

NHS England's review is focusing on an initial list of 10 medicines and items - although it said this was just the start, and it has a view to introducing further restrictions in the future.

The priority items for review are:

  • Liothyronine;
  • Gluten-free foods (DH consultation already launched);
  • Lidocaine plasters;
  • Tadalafil;
  • Fentanyl;
  • Co-proxamol;
  • Travel vaccines;
  • Doxazosin;
  • Rubs and ointments;
  • Omega 3 and fish oils.

Readers' comments (19)

  • Azeem Majeed

    If the Department of Health and NHS England want to curb prescribing of some OTC drugs and drugs of limited therapeutic value, then these drugs should not be allowed to be prescribed on NHS prescriptions. This is preferable to issuing 'guidance' and also more legally sound.

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  • NHS ENGLAND WILL SAY IT IS ULTIMATELY DOWN TO "GP DISCRETION"-USUAL TWO-FACED BUCK-PASSING

    SO IF WE DON'T DO AS THE PATIENT SAYS EXPECT A GMC REFERRAL AND IF WE DON'T DO AS THE CCG SAYS EXPECT AND INVESTIGATION.

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  • Don't be silly... you already have a GMC obligation to use NHS funds responsibly which entails not prescribing OTC meds in most circumstances. It is also something the RCGP requires all trainees to be taught, requiring the trainee to show responsible use of NHS funds. And if you read section 14 of the GMS contract correctly and carefully this does not breach our contract.

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  • there needs to be a NHS formulary of meds available free of charge. If you want "the orange ones" because they taste better etc. then you are out of luck unless you pay. AS with all guidance - docs and patients will find a way around it. The current system in my CCG is that we don"t prescribe certain drugs unless the patient starts shouting at us and then we quickly give in for fear of a complaint.

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  • "Dr Green said the GPC's stance on DH blacklisting of drugs would be determined by LMC conference policy, but that the GPC would only accept any ban if backed by legislation."

    Blacklisting IS backing by legislation. GPs can then tell the patient that these drugs cannot be issued on an FP10 with no comeback whatsoever. But I will believe this only when it actually happens.

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  • DoH should publish a list of items which cannot be prescribed on the NHS and make it available through national and local newspapers.This would prevent patients from approaching GPs for scriptsas they will know beforehand that they will not get these specifics.
    This is how they put restrictions and also make public aware of new drugs available on the national health services elsewhere in Europe. Why can't we have that here? GPC can discuss this with DoH and help getting clarity while raising patient awareness.

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  • Mark Howson | GP Partner/Principal21 Apr 2017 10:24am

    There is a clearer GMC obligation to treat patients with appropriate medication regardless if it is an OTC drug.

    this is blatantly an attempt to transfer risk without support which is typical of NHSE.

    Worth looking at how pharma is guiding some patient groups wrt medications!

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  • Completely agree - if this is what they want us to do, that is fine - however it is clearly not going to happen in the lead up to an election!!
    Paracetamol tax!

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  • @Jo Smit 10.24

    If drugs are blacklisted then GPs cannot physically prescribe on an FP10. There would be no grounds for a patient to complain or the GMC to investigate. If this happens then it would be one of the few examples that NHSE/DoH takes direct responsibility for demand management.

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  • The DoH need to take responsibility,and enable us to do a private script for the same drugs so patients can get a decent supply.16 paracetamol anyone!

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