More POM to P switches could save NHS £1.4bn a year

Switching more prescription-only medicines (POM) to pharmacy-only medicines (P) could save the NHS £1.4bn a year, according to a new report by Frontier Economics.

The report, commissioned by PAGB, the industry body for over-the-counter (OTC) medicines manufacturers, was published this week to mark International Self Care Day, and explores the value of OTC medicines to the NHS and the wider economy.

While savings are dependent on medicine demand and prescribing practices, the report estimates that if future drug reclassifications reduced NHS prescribing levels and spending by 5%, it could save the NHS £1.4bn per year in prescription and appointment costs.

The report also claimed that for every £1 spent by the general public on OTC medicines, the NHS saves £1.90 in prescription and appointment costs, and the economy saves £5.40 in avoided workplace absences.

And by eliminating appointments for self-treatable illnesses, and instead encouraging patients to use OTC medicines, the NHS could save at least £1.7bn per year and workplace absences would be reduced, the report said.

Spending on OTCs could also bring a quality of life benefit for patients, with an estimated £4.50 quality of life return on every £1 an individual spends on OTCs, it suggested.

How do OTCs save the NHS money?

The report estimates that around 50 million people would seek treatment from the NHS if OTCs were not available, out of a total UK population of 67 million – 61 million of whom currently use OTC medicines. This is based on a 2022 US survey that suggests that around 82% of OTC users would seek professional healthcare if OTCs were not available.

Based on these figures, the report predicts that OTCs currently save the NHS £2.7bn per year in spending on prescriptions, plus an additional £2bn in 50 million saved GP appointments and £1.7bn in 12.6 million avoided A&E attendances.

And if just 0.01% of the 12.3 million antiseptic creams, liquids and sprays sold in the UK each year prevented a case of sepsis, this would result in 1,229 prevented sepsis cases and £4m saved in hospital costs.

The report also estimated that anywhere between 25 and 48 million GP appointments and five and 10 million A&E visits in the UK are for illnesses that are self-treatable – either by OTCs or other self-care.

And if patients were able to avoid a GP or A&E visit through OTCs and self-care, then the NHS could save between £1.7bn and £3.2bn per year, it suggested.

Could switching more medicines to OTC generate more savings?

If more medicines were accessible over the counter, the NHS could save even more money in prescription and appointment costs, said the report.

It said that there was potential for ‘significant impact’ in increasing access, use and NHS savings if a medicine was reclassified early – citing Nurofen (ibuprofen) and Imodium (loperamide) as successful switches in 1983.

‘In 2021-22, Nurofen had sales of £125m in the UK, whereas the NHS spent £24m on ibuprofen in 2021-22,’ the report said.

‘Similarly, Imodium sold £40m worth of OTC products, whereas the NHS spent just £11m on loperamide in 2021-22.’

But it added that the precise savings would depend on a range of factors including the demand for the medicine, the cost of the OTC medicine, whether patients would be willing to purchase an OTC rather than seeing a GP and getting a prescription, and whether GPs are encouraged to avoid prescribing OTC medicines.

For example, the report highlighted that when simvastatin was switched from POM to P in 2004, there was evidence of increased use among patients and a reduction in NHS prescriptions and/or appointments.

But when chloramphenicol and sildenafil were reclassified from POM to P, there was evidence of increased use post-switch but mixed evidence of savings in NHS prescriptions and appointments.

In particular, the report highlighted factors around usage that could change over time.

For example, when Viagra Connect (containing 50mg of Sildenafil) was reclassified from POM to P in November 2017, it resulted in increased use of the drugs with £4.3m worth of pharmacy sales within the first 12 weeks.

But NHS prescriptions also increased, possibly due to the high cost of the OTC medicine (£20) compared to the prescription cost (£9).

A 2021 study suggested that NHS prescribing patterns may also have been influenced by a perceived lack of privacy and long-term monitoring when accessing the medication in a pharmacy rather than a GP setting.

But the Frontier Economics report suggested that ‘it is also possible that the factors that previously discouraged Sildenafil users from switching away from NHS prescriptions are becoming less influential over time, leading to changes in consumer behaviour’.

Janet Morrison, chief executive of Community Pharmacy England, said that a commissioned Pharmacy First service in England would be key to enhance patient care as well as alleviate pressure on GPs and the NHS.

‘We firmly believe that a pharmacy first service, shaped to meet the evolving needs of the public post-pandemic, holds the key to improving patient access in primary care,’ she said.

‘Utilising the clinical skills of community pharmacy teams, including the increasing number of pharmacists that are prescribers, to help treat common conditions is the way forward. However, this is only feasible if the sector is adequately and sustainably funded.’

NHS England plans to launch a nationally funded Pharmacy First service in England before the end of 2023.

The service, backed by a £645m investment in community pharmacy, will allow pharmacists to supply POMs including antibiotics and antivirals where clinically appropriate, to treat seven common health conditions without the need for patients to visit a GP.

These medicines will be supplied under a Patient Group Direction (PGD) and include: sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections in women.

A recent report by Healthwatch England found that people are increasingly avoiding vital health and care services, including OTC medications, due to rising costs, and recommended that GPs should prescribe OTC medications for those who cannot afford them.

But some pharmacists have also advocated for a minor ailments service that would fund the cost of OTC medicines for those eligible.

Shilpa Shah, chief executive of Community Pharmacy North East London, told The Pharmacist that sending patients who could not afford OTCs back to the GP, only for them to return to the pharmacy with a prescription for the item, led to increased workload for everyone, caused ‘rigmarole’ for the patient and ‘feels like a waste of so many NHS resources’.

‘That's just sending people around the system for no reason, because the reason they were sent to us in the first place was because they were low acuity conditions,’ she said.

And a recent expert report assessing the government’s progress on community pharmacy in England raised concerns about the Community Pharmacist Consultation Scheme (CPCS), saying that people who are exempt from prescription charges ‘may not benefit from a service that refers them directly to community pharmacy if they then need to purchase medication over-the-counter from the pharmacy, rather than obtaining it on prescription free of charge’.