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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.