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OTC prescribing ban delivers fraction of expected savings, shows official data

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NHS England’s ban on a number of over-the-counter items has saved a fraction of what it had set out to achieve, leaving GPs to question whether reducing prescriptions of the items is ‘worth doing’.

Data unveiled by the a minister showed that just £32m worth of savings have been achieved in the two years since NHS England set out the new guidance in March 2018, in a bid to save nearly £100m annually.

At the time, NHS England had estimated it would save £97m per year – meaning the savings are just 16% of what was projected. And with savings of £25.9m announced in 2019, it appeared that only £6.1m was saved in the past year. 

Parliamentary under-secretary at the Department of Health and Social Care (DHSC) Lord Bethell revealed the new figure in answer to a written question last week.

Labour peer Baroness Gale asked the Government ‘how much NHS England has saved since over-the-counter medicines were taken off the prescription list in 2018’.

In response, Lord Bethell said: ‘Since the publication of this guidance, there has been a reduction in spend of £32m on over-the-counter items. 

‘This reduction includes spending on over-the-counter items for conditions that are self-limiting and conditions which lend themselves to self-care, as well as vitamins, minerals and probiotics.’

He added that the estimate is correct as at 10 July and that the list of OTC products is updated as new ones become available.

Kent LMC medical secretary Dr John Allingham told Pulse that CCGs telling GPs not to prescribe medicines that are in the tariff is ‘fundamentally wrong’.

He said: ‘[It] potentially puts us in a position where we’re in breach of good medical practice. 

‘We are obliged to offer care where we can and it’s quite a difficult dilemma to not prescribe something that you can prescribe simply because the CCG has told you not to.’

Dr Allingham added that the ‘minimal’ savings made the drive to curb OTC prescribing seem ‘not worth doing’.

He said: ‘The fact that the savings are so minimal doesn’t make it seem terribly worthwhile. 

‘In fact, if you look at how much manager time was spent to achieve the benefit, it probably really is quite insignificant because where they talk about these savings you forget how many meetings and how many managers were counting things in order to demonstrate the savings.’

He added: ‘The idea of restricting prescription medication for minor ailments is not a bad idea, but it’s how you do it.’

A spokesperson for NHS England told Pulse that the £32m figure is within the range it expects to save.

They added that the figure refers to the cost of OTC items before discounts and does not include any dispensing fees or adjustments for income obtained from prescription charges or prepayment certificates.

Any savings made are normally reinvested into patient care, the spokesperson said.

In 2018, NHS England called on CCGs to curb prescriptions for OTC medicines for conditions such as constipation, diarrhoea and athlete’s foot.

The guidance said putting a halt to the routine prescribing of these medicines would save almost £100m to be reinvested in front-line services. However, Pulse reported last year that the medication rationing had only made a quarter of its targeted savings thus far.

The push to cut OTC prescriptions has been controversial, with GPs receiving an increasing number of patient complaints as they try to follow the guidance.

And NHS England last year issued a ‘letter of comfort’ to GPs, reassuring them they would not be ‘at risk of breaching their contract’ if they refused to prescribe OTC medication after the BMA raised concerns about the issue.

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