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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, so does not need treatment as it will heal/be cured of its own accord, such as sore throat or coughs and colds;
  • 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, such as indigestion, mouth ulcers and pain relief.

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 in the 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 last November.

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: “NHS England is proposing to draw a new line between when the NHS will help someone, and when citizens are required to fall back on their own private resources. This may or may not be a good idea, but it certainly shouldn’t be motivated by a funding crisis, as it clearly is today.

“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.”

Ms Power said that the Patients Association response will ask for NHS England to clarify “crucial issues such as what this means for patients who currently receive free prescriptions – it is not clear whether they fall within the proposed exception for ‘social vulnerability’, for instance.”

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.”

He added: “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.”

Alastair Buxton, Director of NHS Services at PSNC, said: “We are particularly concerned about the impact of any changes for those on low incomes. For these families the NHS provides a vital service which, if removed, could lead to increased use of more expensive urgent care services and increased health inequalities.

“PSNC recommends that NHS England considers how national coverage of pharmacy minor ailments services, potentially restricted to people and families that are currently exempt from NHS prescription charges on income grounds, may provide benefits for both patients and the NHS, whilst at the same time avoiding the unintended consequences of implementing a blanket restriction on prescribing OTC medicines for some of the most vulnerable groups within society.”

Mr Buxton also called for more support for community pharmacy. “As the NHS grapples with its funding crisis, it is becoming more important than ever that we develop support for self-care, so that people can manage their health without the need to visit their GP or hospital,” he said.

“Once again as it launches this consultation the NHS looks to community pharmacies to do this, promoting them as a first port of call and a place for patients to go for advice and self-care treatments. This is right, as pharmacies offer advice and treatment at convenient locations and long opening hours, without the need for an appointment.

“But those looking to transfer the burden from GP practices and urgent care towards pharmacy must acknowledge that without proper resourcing, community pharmacy will also not be able to manage. The current financial pressures facing community pharmacies mean their ability to soak up pressures on the health service is already faltering. Many are struggling to survive.

“Community pharmacies can do much more to help, but they are not an infinite resource. Without recognition and support community pharmacies will be unable to provide the safety net that the NHS so desperately needs and wants to rely on.”

Professor Helen Stokes-Lampard, Chair of the Royal College of General Practitioners, has issued an initial response to the consultation, 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             
PSNC response  
RCGP response  
Today’s Pharmacist coverage of initial consultation outcome and the products blacklisted in December for routine prescribing                  

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