Care Pathways

NHS England to cut low-value medicines from prescriptions

The NHS will no longer prescribe medicines which are easily available over-the-counter including, antihistamines and suncream in an effort to find extra savings for the struggling health service.

New guidelines coming into effect in April will advise CCGs nationwide to not prescribe certain low-value medicines which, NHS England hope, will save the service up to £400m a year.

Initially a set of 10 medicines which are “ineffective, unnecessary, inappropriate for prescription on the NHS or indeed, unsafe,” will not be prescribed by doctors, whilst guidance will support CCGs at a local level with decision making about what is prescribed on the NHS. These medicines include treatment for coughs and colds, antihistamines, indigestion and heartburn medication and suncream.

NHS England added that it would work with clinicians, CCGs and patients to develop the guidance and draw from a wide pool of opinions about the reform.

An NHS England spokesperson said: “New guidelines will advise CCGs on the commissioning of medicines generally assessed as low priority and will provide support to clinical commissioning groups, prescribers and dispensers.

“The increasing demand for prescriptions for medication that can be bought over-the-counter at relatively low cost, often for self-limiting or minor conditions, underlines the need for all healthcare professionals to work even closer with patients to ensure the best possible value from NHS resources, whilst eliminating wastage and improving patient outcomes.”

GPs welcome changes

Professor Helen Stokes-Lampard, chair of the Royal College of GPs (RCGP), said that the college was keen to work with NHS England and equivalent bodies in the devolved nations to make the changes a success.

“Prescription costs are a significant expense for the health service, and so if we can take sensible measures to reduce these costs then we should,” explained Prof Stokes-Lampard.

“Many medications are available very cheaply – and other products are much more readily obtainable than when they first became available on prescription, and both GPs and the public should be mindful of this.

“If patients are in a position that they can afford to buy over-the-counter medicines and products, then we would encourage them to do so without a prescription – but this isn’t the case for everyone.”

However, the RGCP chair stated that imposing blanket policies on GPs that don’t take into account demographic differences across the country, or allow for flexibility for individual patients, risk alienating the most vulnerable in society.

“We need to see more details of Simon Stevens’s full plans,” she explained. “But ultimately, general practice makes the vast majority of NHS patient contacts, for a small fraction of the overall budget - investing in our service is the most effective way of keeping the health service sustainable.

“Whatever cost saving measures are being floated, it is imperative that NHS England’s GP Forward View, which pledges £2.4bn extra a year for general practice and 5,000 more GPs by 2020, is implemented as a matter of urgency.”

Clinical Commissioners weigh in

Julie Wood, Chief Executive, NHS Clinical Commissioners said: “Clinical commissioners have always had to make difficult choices about prioritising how they spend their budget on services, but the finance and demand challenges we face at the moment are unprecedented.

"CCGs have been looking at their medicines spend, and many are already implementing policies to reduce spending on those prescribe-able items that have little or no clinical value for patients, and are therefore not an effective use of the NHS pound.”

Dr Graham Jackson, co-chair NHS Clinical Commissioners also added: “We need to be honest with the population – the NHS can and does provide high quality cost effective care, but our ability to continue to do so will be restricted if we can’t prioritise those areas which will get the best outcomes for patients, whilst getting the best value for our limited NHS budget.”

“The medicines spend is one where there is huge potential to unlock resources and redirect them to those higher priority areas like mental health and primary care. Through doing this we can deliver better outcomes for patients. The principles of this work will also support the much needed long term transformation of the NHS.”

NHS crack down 'disappointing' - say charity

However, one skin cancer charity has condemned NHS England for their decision, saying that medicines like suncream were vital for patients suffering from dehabilitating skin conditions.

Gill Nuttall, CEO of Melanoma UK said: "I speak to melanoma patients every day who are receiving life prolonging treatments in melanoma, some of whom suffer some terrible side effects, including extreme reactions to the sun. Sun screen has a very high clinical value to those patients.

"We fully appreciate that the NHS should not be abused in any way at all, and we know there are issues across the whole of the NHS, not just in prescription medicines, but we would urge NHS England to think very carefully before placing sun creams in their list.”

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