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  Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead...
Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
More inWhite Papers  

a pharmacist dispensary shelves imageDecember 1 2017

The first group of products that which should no longer be ordinarily prescribed on the NHS in England has been approved by the NHS England Board.

A consultation over this summer proposed limiting the prescribing of treatments of low value or effectiveness, and/or which can be purchased over the counter. NHS England is now advising clinical commissioning groups and GPs that the following should no longer be routinely prescribed:

  • homeopathy – “no clear or robust evidence to support its use”;
  • herbal treatments – “no clear or robust evidence to support its use”;
  • omega-3 fatty acid compounds – “essential fatty acids which can be obtained through diet, low clinical effectiveness”;
  • co-proxamol – it has had its marketing authorisation withdrawn due to safety concerns, and patients should be ‘deprescribed’ coproxamol;
  • rubefacients (excluding topical NSAIDS) – “limited evidence”;
  • lutein and antioxidants – used to treat the eye condition age related macular degeneration, “low clinical effectiveness”;
  • glucosamine and chondroitin – “low clinical effectiveness”.

NHS England will also commence a new detailed consultation in 2018 on which self-limiting conditions should be included in the programme to limit prescribing of OTC products. This could affect paracetamol, cough mixture and cold treatments, eye drops, laxatives and sun cream lotions.

Gluten-free items were not part of the consultation, but an announcement on their availability on NHS prescription is expected in due course.

Announcing the Board’s decision, NHS England said: “The NHS could save around £190 million a year by cutting such prescriptions for minor, short-term conditions, many of which will cure themselves or cause no long-term effect on health,”.

Sandra Gidley, Chair of the Royal Pharmaceutical Society’s England Pharmacy Board, said that NHS England had “listened to the strong representation made by the Royal Pharmaceutical Society and others to take a patient-centred view on a number of the medicines included in the consultation.”

The Society welcomed the proposals “to restrict prescribing of medicines where there are safer or more effective alternatives to ensure the NHS can continue to gain best value from the medicines it funds.” However, the proposed new consultation on restricting OTC medicines prescribing was of “great concern,” she said.

“We remain very concerned that the upcoming proposals on restricting prescribing of cost-effective and safe OTC medicines will end up exacerbating existing health inequalities and cause ill health amongst our most vulnerable and deprived communities, who cannot afford to pay for treatments,” she said. “Such a move would also violate Principle 2 of the NHS Constitution, which clearly states that ‘Access to NHS services is based on clinical need, not an individual’s ability to pay’ and would fundamentally alter the relationship between patients and the NHS.”

National Voices, the coalition of 160 health and care charities, has also raised concerns regarding the proposed restrictions on prescribing OTC medicines. “This would include treatments dispensed to the millions of people who qualify for free prescriptions, such as those on Jobseekers Allowance or Employment and Support Allowance, older people, children, pregnant mothers, and people living with cancer,” it said.

Don Redding, Director of Policy at National Voices, added: “If taken forward, these plans could mean that some treatments are only available to those who can afford them. This would risk adversely affecting those people who currently get free prescriptions, which includes some of the most vulnerable in our society and those who are ‘just about managing’.

“Yes, there are difficult decisions for the NHS to make, but the rationing of treatments should not be targeted at those most in need, and those already living on a financial knife-edge.”

He said the organisation had “noted NHS England’s commitment to meaningfully engage patient groups to understand these unintended consequences and we look forward to working with them.”

Links:
NHS England announcement      
NHS England Board Paper setting out the proposals for the initial list and summarising consultation responses     
NHS England - Items which should not be routinely prescribed in primary care      
RPS comment    
National Voices comment             

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