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GPs set to be banned from prescribing homeopathy

NHS England is planning to stop the prescribing of homeopathy as part of new guidance for CCGs on medicines that can be considered to be of low priority for funding.

Homeopathy is a new item on the list of possible low-value medicines that GPs will be banned from prescribing.

Originally NHS England said that it would review just 10 items, but it has added eight new treatments, including homeopathy and herbal treatments.

It has also said that it is reviewing over 3,200 products that could be purchased over the counter, including at pharmacies, petrol stations or convenience stores.

The original consultation document failed to include homeopathy in its treatments that should be banned.

However, following a consultation, a paper presented at today’s NHS England board meeting said: ‘NHS England’s view is that, at best, homeopathy is a placebo and a misuse of scarce NHS funds which could better be devoted to treatments that work.

‘Data on the residual use and cost of homeopathy on the NHS are hard to come by. A recent Freedom of Information request by a third party suggested that at least £578,000 has been spent on prescribed homeopathy over the past five years, with the total cost being higher than that when the cost of consultations was factored in.’

Talking at the NHS England Board meeting today NHS England medical director Sir Bruce Keogh said: ’I think this (homeopathy) has been an issue which has concerned scientific professionals for a long period of time.

‘We can no longer shy away from addressing this particular issue. If we want our NHS to be evidence based and outcomes focused, then we must expect to have difficult conversations over difficult issues.’

Gluten-free foods are subject to a separate consultation by the DH, says NHS England.

RCGP chair Professor Helen Stokes-Lampard said: ’We know that a number of treatments are of little or no value, and are at best a placebo. We also know many other medications are available very cheaply over the counter and are much more readily obtainable than when they first became available on prescription, and both GPs and the public should be mindful of this.

’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 rather than request a prescription – but imposing blanket policies on GPs, that don’t take into account demographic differences across the country, or that don’t allow for flexibility for a patient’s individual circumstances, risks alienating the most vulnerable in society.’

The BMA GP Committee’s prescribing subcommittee chair Dr Andrew Green said that the Government should be ‘blacklisting’ these drugs to remove the pressure from GPs.

He said: ‘GPs have a contractual duty to prescribe drugs that their patients need, and pressure must not be placed on them to act in a way that may contravene those regulations. Where there are clinical reasons that drugs should not be provided on the NHS, such as for co-proxamol or homeopathic substances, then these should be added to the “blacklist” which formally prevents NHS supply.’

Which items could GPs be banned from prescribing?

Co-proxamol

Dosulepin

Prolonged-release Doxazosin

Immediate- release Fentanyl

Glucosamine and Chondroitin

Herbal treatments

Homeopathy

Lidocaine plasters

Liothyronine

Lutein and antioxidants

Omega-3 Fatty Acid Compounds

Oxycodone and Naloxone combination product

Paracetamol and Tramadol combination product

Perindopril Arginine

Rubefacients

Once-daily Tadalafil

Travel vaccines

Trimipramine

Readers' comments (33)

  • Should also ban anything that is available over the counter inc for over 60's. Introduce a system where patients can be given a nonFP-10 script from the doctor to allow them to purchase greater volumes of paracetamol and the like. Would save the NHS millions i'm sure.

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  • NHS ENGLAND won't ban any items because they are afraid of patients.
    Instead they will leave it to "individual GP discretion" and then when we don't prescribe the items we will get referred to the GMC.

    Anyway, Jeremy Hunt is a fan of homeopathy !!

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  • I'm staggered that anyone who claims to be a doctor in the 21st century is prescribing this anti-scientific, irrational nonsense. As for resisting patient pressure- I look them in the eye and say that I only practice scientific rational medicine. They are free to make their decision from there on.

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  • For those patients already on a regular homeopathic prescription, GPs could, for a small fee, refill the empties with the generic version which is piped into the surgery!

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  • Nhsfatcat

    GPs also banned from farting in a thunder storm and weeing into the sea.

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  • The well publicised Australian NHMRC report from 2015 followed a suppressed report from 2012 which found evidence of benefit from Homeopathic prescribing.
    The delay between the 2 reports was due to massaging the inclusion criteria such that of the 176 eligible studies used in 2012 (not 1,800 as trumpeted in the media) only 5 met a spurious inclusion criterion of n150 in 2015, and needless to say those 5 were negative.
    Worth checking the data rather than relying on reports.
    The Commonwealth Ombudsman is looking into the matter which some Lawyers have alleged to be the worst case of scientific research fraud they have seen in 30 years.

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  • Curious how eye wateringly expensive placebo's have dodged this ban!!
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/
    Abstract
    Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain. Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory. But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect. Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin. Nevertheless, they all show the same therapeutic benefit. Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind. The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.

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  • Doctor McDoctor Face

    I banned myself 30 years ago.

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  • I am always concerned, as a matter of principle, about banning things, because later longer-term investigations often seem to turn up things that work better than we thought, or in a different area. Banning substances stops doctors being scientists and investigating correlations that they have 'just noticed'. When I first started practising, amitriptyline wasn't used for pain: now it is.
    Similarly, we all know of patients who don't respond well to certain medicines - they need alternatives that at first may seem less useful (Co-proxamol, for example). To have someone centrally banning medicines is surely not a helpful way to go, because it cuts off any ability of doctors to tailor their prescriptions to the needs of the actual patient in front of them.

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  • Please ban benzo's

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  • I can't really understand why doctors use the placebo word as some kind of demonic incantation. They probably haven't read any scientific study about how it works - for instance Benedetti's book on placebo effects.

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  • Hold on - based on the dilution principle, isn't this the equivalent of overdosing the whole population...

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  • Hang on Do good 3.36 pm

    Is the paper you quote by the same Irving Kirsch who co authored "essentials of clinical hypnosis" ?

    If so pots and kettles come to mind

    C

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  • GP Partner/Principal21 Jul 2017 1:49pm.
    A bit confusing
    Does that apply also to:

    Prisoners on Release
    The Patient or his/her Partner is getting Pension Credit Guarantee Credit (PCGC)
    Universal Credit (UC)
    People Receiving Income-based Jobseeker’s Allowance
    The Patient or his/her Partner is receiving Income Support (IS)
    The patient or his/her Partner is entitled to, or named on, a valid NHS Tax Credit (TC) Exemption Certificate
    Anyone on a low income can apply to get this certificate.
    Patients who have a valid Maternity Exemption Certificate
     a permanent fistula (for example, caecostomy, colostomy, laryngostomy or ileostomy) which needs continuous surgical dressing or an appliance
     a form of hypoadrenalism (for example, Addison’s Disease) for which specific substitution therapy is essential
     diabetes insipidus and other forms of hypopituitarism
     diabetes mellitus, except where treatment is by diet alone
     hypoparathyroidism
     myasthenia gravis
     myxoedema (that is, hypothyroidism which needs thyroid hormone replacement)
     epilepsy which needs continuous anticonvulsive therapy
     a continuing physical disability which means you cannot go out without the help of another person
     cancer

    and the 88% of the population who do not pay prescription charges?
    http://www.politics.co.uk/reference/nhs-prescription-charges

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  • Cesca seems to prefer to ignore the NHS annual waste of £250 million plus on proven placebo with not insignificant side-effect profiles which we have been cleverly encouraged to prescribe.

    What's not to like about cherry picking low hanging fruit and undertaking personal slur distraction techniques rather than critically reading the article? To do so is surprisingly informative and brings one to the final paragraph which is germane to the Supreme Court's Montgomery Ruling:

    "Fortunately, placebos are not the only alternative to antidepressant treatment. My colleagues and I have conducted a meta-analysis of various treatments for depression, including antidepressants, psychotherapy, the combination of psychotherapy and antidepressants, and “alternative” treatments, which included acupuncture and physical exercise (Khan, Faucett, Lichtenberg, Kirsch, & Brown, 2012). We found no significant differences between these treatments or within different types of psychotherapy. When different treatments are equally effective, choice should be based on risk and harm, and of all of these treatments, antidepressant drugs are the riskiest and most harmful. If they are to be used at all, it should be as a last resort, when depression is extremely severe and all other treatment alternatives have been tried and failed."'An adult person of sound mind is entitled to decide which, if any, of the available forms of treatment to undergo, and her consent must be obtained before treatment interfering with her bodily integrity is undertaken.


    "https://mdujournal.themdu.com/issue-archive/issue-4/informed-consent-a-year-on-from-montgomery

    'The doctor is therefore under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments.

    'The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient's position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.'


    At the heart of the Supreme Court's judgment is a repudiation of medical paternalism, which is replaced with the value of self-determination. The patient is no longer a passive recipient of medical treatment, but a partner in the provision of that treatment."

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  • SSRIs/SNRIs

    In addition to iatrogenic: - Emotional Blunting, Adverse Behavioural and Personality changes, life threatening and fatal neuro-toxicites: -Intense Agitation, Akathisia, Toxic Psychosis, Suicidality and completed suicide at ALL AGES,
    Disinhibited Aggression, Violence (including homicide).

    - Long term dependence, unbearable withdrawal syndromes, -
    (Suffering and despair aggravated by prescriber denial)? -

    -- Sexual Dysfunction in men and woman, sometimes of profound severity.
    Post SSRI Sexual Dysfunction which may last for months, years, and in some cases apparently indefinitely. (Vulnerable to prescriber denial)?

    In addition to the evidence of fraudulent and ghost written clinical trials, the pharmaceutical marketing on the back of the now denied and discredited myth of the "chemical imbalance" is hardly an endorsement for the "gold standard" of "Evidenced Based Medicine".

    By all means recognise and remove drugs which have no therapeutic efficacy unless a safe placebo basis for prescription is fully explained to the patient.

    In recognising and eliminating "Marketing Based Medicine" surely
    Primum Non Nocere demands that we address the most dangerous first?

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  • doctordog.

    It's a marvellous feeling , being banned from doing something you never did.

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  • I don't prescribe 'em, never will, don'tcare if others do or don't, clearly both harmless and ineffective other than placebo, if cheap then carry on, there are far more expensive pseudo-placebos masquerading as "proper" medication out there that should be banned first.

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  • This proposed 'legislation' is unnecessarily cruel and authoritarian. People of all ages and creeds are interested in natural remedies recommended by doctors. What this diktat from above down means in practical terms is that old, young and disadvantaged people will now have to pay for these remedies even if they are recommended by the patient's GP . Less than kind medicine in this commentator's opinion.

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  • It amazes me that there are doctors here who appear, at least from their comments, to be in favour of using homeopathy and even describe it as "natural" and "recommended". Not talking about using as placebo, but actually believing that homeopathy works. Really surprised by this. I do hope no one still practices blood-letting or healing with crystals, or adjusting energy/vital force circuits in primary care on NHS.
    But then MPs apparently urge us to prescribe poetry, so why not spiritual healing?

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