NHS England agrees prescribing restrictions for low value meds and consultation on OTC products in New Year

NHS England agrees prescribing restrictions for low value meds and consultation on OTC products in New Year

November 30, 2017

NHS England has today issued 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.” It also decided a full consultation should be held in early 2018 on a proposal that the prescribing of over-the-counter (OTC) products, currently prescribed at NHS expense, should be restricted in the future.

Low value medicines

The announcement on low value medicines follows a consultation held earlier this year on a list of 18 treatments which were proposed as items which should not be routinely prescribed in primary care. Following consideration of the responses to the consultation, the NHS England Board has today agreed the following 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  • Co-proxamol – had its marketing authorisation withdrawn due to safety concerns;
  • Rubefacients (excluding topical NSAIDS) – limited evidence;
  • Lutein and Antioxidants – used to treat the eye condition age related macular degeneration, low clinical effectiveness; and
  • 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, guidance to CCGs and the full list of affected products

OTC medicines

Proposals for the consultation on OTC medicines 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;
  • treat a condition that is considered to be self-limiting, such as a common cold; and
  • treat a condition which could be managed by self-care.

NHS England says it will continue its work alongside NHS Clinical Commissioners to further develop these proposals, and identify scenarios where exemptions which may be necessary.

Commenting on today’s announcement, PSNC Chief Executive Sue Sharpe said:

“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. 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 winter 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.”

Alastair Buxton, Director of NHS Services at PSNC, commented:

“PSNC supported the NHS England and NHS Clinical Commissioners (NHSCC) proposals for restricting the prescribing of a group of 18 medicines which were considered not to be cost effective, as evidence-based clinical rationales were provided. However, in moving forward with this, PSNC emphasises the need for the development of clear communication materials for use at both local and national level to provide consistent messages for patients.

“Whilst the decision to issue guidance to prescribers and CCGs on the prescribing of low value medicines is clearly of importance to community pharmacy, it is the ongoing consideration of future restrictions on the prescribing of OTC products that is of greater significance. PSNC is concerned about a range of potentially unintended consequences and other issues that may occur as a result of these proposals, which we previously described in our response to the initial consultation. Of particular concern is the impact of any changes for those on low incomes, potentially leading to increased use of more expensive urgent care services and increased health inequalities.

“PSNC recommends that NHS England and NHSCC consider 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.”

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