Commissioning

Commissioners call on DH to ‘blacklist’ ineffective treatments

NHS England has launched guidance detailing 18 items which should not routinely be prescribed in primary care.

However, following the announcement NHS Clinical Commissioners (NHSCC) has also called for seven treatments to be ‘blacklisted’ from medical practice for being ineffective.

A joint clinical working group considered the responses to a consultation which ran between July and October this year.

Following its board meeting last week, NHS England agreed that the 18 items should no longer be routinely prescribed, which the board estimated would save the NHS up to £141m a year.

Included in the list are some painkillers, such as immediate-release fentanyl, licensed for the treatment of breakthrough pain in adults with cancer who are already receiving morphine.

The working group felt that the small number of patients that this is applicable to does not justify current prescribing volumes.

Dietary supplements, such as omega-3 fatty acids, can be obtained from diet and “there is no good quality data for their use,” according to the board.

Two antidepressants, dosulepin and trimiparine, were included due to toxicity and cost effectiveness respectively.

Travel vaccines were included as they were felt to be a “low priority for NHS funding.”

Homeopathy and herbal medicines were also included due to “the lack of robust evidence of their clinical effectiveness.”

Of those who responded to the consultation, 65% were supportive of proposed criteria to assess items which are available over the counter, which could save an estimated £190m a year by cutting prescriptions for minor, short-term conditions.

NHSCC has also called for the Department of Health to go a step further and blacklist seven of the treatments: homeopathy, herbal treatments, omega-3 fatty acid compounds, rubefacients, lutein & antioxidants and glucosamine & chondroitin due to a lack of evidence supporting their effectiveness, and co-proxamol due to safety concerns.

The move also builds on changes made in March this year that saw NHS England stop prescribing low-value medicines that are easily available over-the-counter. 

Dr. Graham Jackson, NHSCC co-chair said that the guidance would support clinical commissioners in prioritising effectively and ensuring the best value.

He continued: “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.”

Simon Stevens, chief executive of NHS England, called the NHS “one of the most efficient health systems in the world,” but said that more should be done to “make taxpayers’ money go further.”

He continued: “The NHS faces the toughest funding squeeze in its history, and we need to make some hard-headed decisions about what we can and can’t afford.

“The NHS should simply not be paying for treatments where there is no robust evidence they work.

“It is also right that we look at cutting prescriptions for medicines that patients can buy for a fraction of the price the NHS pays.”

Top Image: alvarez