‘Low value’ prescription items could be made OTC only


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07 Apr 2017

Prescription items of ‘low value’ will be reveiwed this month on whether they should be made pharmacy medicines and available over the counter.

The review is being led by NHS England and will come with new guidance for Clinical Commissioning Groups (CCGs)

Following a consultation, NHS England will set out a national approach to be adopted by individual CCGs across England.

It is estimated that the changes could save the NHS a potential £400m per year.

The guidelines will initially be around a list of 10 medicines that the Government has labelled as ‘ineffective, unnecessary, inappropriate for prescription on the NHS, or indeed unsafe’.

Prescribing and dispensing the 10 items has an accumulated cost for the NHS of £128m per year.

‘There are items of relatively low clinical value or priority or are readily available ‘over the counter’ and in some instances, at far lower cost, such as treatment for coughs and colds, antihistamines, indigestion and heartburn medication and suncream,’ NHS England said.

They noted that ‘careful consideration’ would also be given to ensure that particular groups of people are not ‘disproportionately affected’, and that principles of best practice clinical prescribing are followed’.

An NHS England spokesperson said: ‘The increasing demand for prescriptions for medication that can be bought over the counter at relatively low cost, often for self-limiting or minor conditions, underlines the need for all healthcare professionals to work even closer with patients to ensure the best possible value from NHS resources, whilst eliminating wastage and improving patient outcomes.’

The ‘low value’ list:

  • Liothyronine for underactive thyroid (£30.93m per annum)
  • Gluten-free foods (£21.88m per annum)
  • Lidocaine plasters for nerve-related pain (£17.58m per annum)
  • Tadalafil for erectile dysfunction (£10.51m per annum
  • Fentanyl for pain relief in terminally ill patients (£10.13m per annum)
  • Travel vaccines (£9.47m per annum)
  • Co-proxamol for pain relief (£8.32m per annum)
  • Doxazosin for high blood pressure (£7.12m per annum)
  • Rubs and ointments (£6.43m per annum)
  • Omega 3 and fish oils (£5.65m per annum)

Source: NHS Clinical Commissioners

Prof Helen Stokes-Lampard, chair of the Royal College of General Practitioners (RCGP), said: ‘We do welcome these proposals, but cautiously. I think a blanket ban might well introduce some unfair problems.’

She told BBC Radio 4’s Today programme, ‘The difficulty is when people don’t pay prescription charges, so they are entitled to free medication on the NHS, and that’s when they’ll be difficult conversations.

‘It is time that country [has] these difficult conversations but we mustn’t put at risk the health of the vulnerable.’

She continued: ‘It’s a good idea in theory,’ but ‘the devil’s in the detail’.

‘Doing the sensible, straightforward things to save money where we can is great but we mustn’t have vulnerable patients suffering as an unintended consequence,’ she said.

For example, paracetamol can only be dispensed to a maximum of 32 tablets, which is just a four-day supply for someone who is taking the maximum dose.

‘We mustn’t cause unintended harm with a well-intended policy,’ she added.

‘Rationing of care’

Keith Taylor, Green Party MEP said: ‘Behind the misleading headlines about gluten-free foods and suncream, what we see here is another step in the deliberate stripping back and rationing of care’.

‘The painkillers for terminally ill patients, thyroid treatments, high blood pressure drugs and travel vaccines on the NHS Clinical Commissioners’ 10-strong hit list are far from ‘low value’ to the patients that rely on them.

This should be a ‘wake-up call’ for those fighting to preserve the NHS standard of service, he said.

‘Difficult decisions’

However, NHS Clinical Commissioners chief executive, Julie Wood, stressed that ‘difficult choices’ have to be made to reduce spending on prescription items of ‘little or no clinical value’ given the NHS’s unprecedented financial difficulties.

Simon Stevens, chief executive of NHS England, said that the move will help to tackle the ‘inefficiency’ and ‘waste’ in the system.

‘There’s £114m being spent on medicine for upset tummies, haemorrhoids, travel sickness, indigestion, [and] that’s before you get to the £22m-plus on gluten-free [food] that you can also now get at Morrisons, Lidl or Tescos,’ Stevens said.

Following the review, the Department of Health is expected to issue guidance to GPs that the list of items are no longer prescribed.

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