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a dispensary shelves imageJanuary 2 2018

Another consultation has commenced seeking views on restricting items which can be prescribed on the NHS in England.

NHS England’s consultation seeks views on ending routine prescribing of over-the-counter products for minor, short-term conditions. The proposals will affect those products which:

  • have low clinical value and where there is a lack of robust evidence for clinical effectiveness, such as probiotics, vitamins and minerals;
  • treat a condition that is considered to be self-limiting;
  • treat a condition which could be managed by self-care, where the person does not need to seek medical care or could visit a pharmacist.

OTC medicines could continue to be prescribed “for longer term or more complex conditions or where minor illnesses are symptomatic or a side effect of something more serious.”

NHS England estimates that limiting OTC prescriptions could save £136 million from the prescribing bill. It points out that, each year, the NHS spends:

  • £4.5 million on dandruff shampoos – enough to fund a further 4,700 cataract operations or 1,200 hip replacements every year;
  • £7.5 million on indigestion and heartburn – enough to fund nearly 300 community nurses;
  • £5.5 million on mouth ulcers – enough to fund around 1,500 hip replacements.

Dr Graham Jackson, NHS Clinical Commissioners co-chair, and co-chair of the clinical working group that developed the list of conditions under consultation, said: “This consultation is an important part of the ongoing work we are doing on behalf of local clinical commissioning groups alongside NHS England to ensure the NHS budget is spent effectively to deliver the best possible patient care and to encourage more people to self-care.

“It is important that we have an honest conversation with the public, patients and clinicians about what the NHS should and can provide with the constrained funds it has available. As a part of that, it is right that we review what is currently offered on NHS prescription that is also available over-the-counter so that we can prioritise our spending on those products that are the most clinically effective and provide the best outcomes for patients.”

This consultation runs until March 14 2018. The outcome of an earlier consultation was announced in November 2017.

Initial reactions to the announcement have raised concerns about how patients with low incomes will be proportionately more affected by the proposals.

Rachel Power, Chief Executive of the Patients Association, said: “At the time of its previous consultation, we warned NHS England that changes of this sort hold dangers for the relationship between GPs and patients. GPs will be asked to implement guidance involving a complex set of criteria and exceptions. Mistakes are bound to happen, and for some patients a GP appointment will come to feel more like a benefits assessment, where they wait to find out at the end whether they will receive support or not – and sadly we know there are major shortcomings with that system.

“We have always agreed that it is counterintuitive for the NHS to be paying pounds for something that the individual can buy for pence, as can sometimes – but certainly not always – be the case for over-the-counter medicines. But applying this principle to the complex needs of patients in the real world, without causing many to lose out for all sorts of reasons, will be extremely difficult.”

Don Redding, Director of Policy at National Voices, the coalition of health and care charities, warned that “the people who stand to lose out from these plans are those currently receiving free prescriptions because they cannot afford to buy treatments.

“We welcome NHS England’s decision to make people with long term conditions exempt from having to pay. That exemption needs to be extended to cover people who are financially vulnerable and would struggle to pay for treatments themselves.”

Professor Helen Stokes-Lampard, RCGP Chair, has made an initial response saying: “Where patients can afford to buy medication over the counter, we would certainly encourage them to do so. There are also many minor, self-limiting conditions for which patients don’t often need to seek medical assistance, or prescribed medication, and can dealt with through self-care.

“What remains imperative – and we will be making this clear in our consultation response – is that no blanket bans are imposed, and GPs will retain the right to make clinical decisions about prescribing appropriately for our patients based on the unique physical, psychological and social factors potentially impacting on their health.”

Links:
NHS England announcement       
NHS England ‘Conditions for which over the counter items should not routinely be prescribed in primary care: A consultation on guidance for CCGs’                   NHSCC comment               
Patients Association comment   
National Voices comment             
RCGP response  
Today’s GP coverage of initial consultation outcome and the products blacklisted in December for routine prescribing                  

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