GPs issued 1.1 billion prescription items at a cost of £9.2 billion in 2015/16. The vast majority were appropriate but many were for medicines, products or treatments that do not require a prescription and can be purchased over the counter from pharmacies, supermarkets, petrol stations, corner shops or other retailers in some cases at a much lower cost than the price paid by the NHS.
The NHS could save around £190m 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.
Over the counter products currently prescribed include cough mixture and cold treatments, eye drops, laxatives and sun cream lotions. A detailed follow-up consultation on an initial list of conditions will be launched in the New Year.
This will also free up millions of GP appointments that are currently taken up with prescribing these medicines.
NHS England will now press ahead with guidance to GPs and CCGs to remove ineffective, unsafe and low clinical value treatments, such as some dietary supplements herbal treatments and homeopathy, and restricting the use of a further 11, saving up to £141 million a year.
These savings form a key building block of the NHS’s 10 point efficiency plan contained in the Next Steps on the NHS Five Year Forward View, published in March 2017. They will be redeployed into frontline patient care.
NHS England chief executive Simon Stevens said: “The NHS is one of the most efficient health services in the world but we’re determined to make taxpayers’ money go further. The NHS should not be paying for low value treatments and it’s right that we look at reducing prescriptions for medicines that patients can buy for a fraction of the price the NHS pays.”
Dr Graham Jackson, NHSCC co-chair and clinical chair of NHS Aylesbury Vale CCG, said: “The guidance launched today, which resulted from work we initiated on behalf of our members, will support clinical commissioners in their work to prioritise effectively and make sure they are getting the best value for their medicines spend.
“We were pleased by the volume of responses to the consultation, which gave an opportunity to take into account and reflect the views of public, patients and clinicians and key stakeholders in the final guidance. We need to carry on having these honest open conversations on what the NHS can and should provide with the funding it has, so that we can continue to deliver high quality care.”
The over the counter medicines proposals for consultation include stopping the routine prescribing of products that:
- Can be purchased over the counter, and sometimes at a lower cost than that which would be incurred by the NHS – paracetamol is an average of four times as expensive when provided on prescription by the NHS, compared to when it is purchased in pharmacies or supermarkets. It can costs around £34 for 32 on prescription including dispensing and GP consultation fees
- 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 a common cold.
- Treat a condition which could be managed by self-care, i.e. that the person does not need to seek medical care or could visit a pharmacist.
Some over the counter products currently prescribed are quickly and easily available in community pharmacies where the public can also ask for an NHS consultation with a pharmacist if they are unsure about what treatment they need for minor conditions.
NHS England and NHS Clinical Commissioners are working with GPs, pharmacists and patient groups to develop and refine the proposals which will be consulted on in the New Year, in particular where exemptions may apply.
Further information on these proposals can be found here: https://www.england.nhs.uk/wp-content/uploads/2017/11/05-pb-30-11-2017-items-which-should-not-be-routinely-prescribed-in-primary-care.pdf
For low value medicines, NHS England has consulted on a list of 18 treatments, drawn up with family doctors and pharmacists, deemed to be ineffective, over-priced and of low clinical value.
The Board has today agreed these treatments 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 (fish oil) – essential fatty acids which can be obtained through diet, low clinical effectiveness
- Co-proxamol – pain killer which has had its marketing authorisation withdrawn due to safety concerns
- Rubefacients (excluding topical NSAIDS) – warming muscle rub products, limited evidence
- Lutein and Antioxidants – used to treat the eye condition age related macular degeneration , low clinical effectiveness
- Glucosamine and Chondroitin – used for joint pain, low clinical effectiveness
A joint clinical working group considered the responses to the consultation and agreed that the recommendations for the 18 products consulted on should either remain unchanged (13 products) or be modified or clarified in five cases (Liothyronine, Travel Vaccines, Lidocaine Plasters and Immediate Release Fentanyl).
Further information and the full list of products can be found here: https://www.england.nhs.uk/medicines/items-which-should-not-be-routinely-prescribed/
- The new guidance supports the ambition to ensure greater value from the NHS’ £17.4 billion medicines bill, through improving health outcomes, reducing waste, over-prescribing and over-treatment, as well as addressing excessive price inflation by drug companies.
- In partnership with NHSCC, NHS England appointed a joint clinical working group to review the available clinical evidence, and develop commissioning guidance for public consultation. Membership includes GPs and pharmacists, CCGs, Royal College of General Practitioners, National Institute for Health and Care Excellence (NICE), Department of Health, the Royal Pharmaceutical Society and others.
- The consultation ran from 21 July to 21 October 2017 and the final commissioning guidance has been published today. CCGs are now being asked to consider its implementation with prescribers in primary care (GPs, pharmacists, nurses and others), ensuring they take into account their legal duties to advance equality and have regard to reduce health inequalities.
- The commissioning guidance is addressed to CCGs to support them to fulfil their duties around appropriate use of prescribing resources. The guidance does not remove the clinical discretion of the prescriber in deciding what is in accordance with their professional duties.
NHS England: High quality care for all, now and for future generations