National changes to treatments available on prescription

NHS England has agreed plans to save hundreds of millions of pounds each year by recommending that low value treatments, including fish oil, herbal remedies and homeopathy no longer be provided on the NHS nationally.

It is also launching a consultation on curbs to prescriptions for some ‘over the counter’ products such as paracetamol.

Nationally, GPs issued 1.1billion prescription items at a cost of £9.2billion 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 is issuing 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.

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 Fiona Armstrong, local GP and Chair of Swale CCG said: “In north Kent we estimate that £2.6million could be saved by reducing prescriptions for low cost over the counter medicines. We want to make sure that we make the best use of public money and our precious NHS resources in Swale. Over the last year we have been promoting our Meducate campaign in association with Healthwatch, and have been speaking to many local residents at our local engagement roadshows to hear their views.”

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.

Meducate, let’s get smarter about medicines in north Kent

In partnership with Healthwatch Kent and with Dartford, Gravesham and Swanley CCG, we have drawn on feedback from patients and clinicians to create the Meducate campaign, which aims to raise awareness of how we could make better use of medicines in our area and support our local NHS services.

The campaign encourages all of us to get smarter with antibiotics, over the counter medicines and medicines waste.

Antibiotics – The message about antibiotics is simple – they are only effective on certain bacteria and not viruses like colds and the flu.

We all should avoid requesting antibiotics to treat these types of infections as they are ineffective and can often reduce the power of the immune system if used too often. More widely, overuse can also cause bacteria to become more resistant to medicines and harder to combat with antibiotics in the future.

Stocking up ‘just in case’ creates waste –  It’s great to be prepared and order your prescription medicines in plenty of time to ensure you don’t run out – but your medicines are tailored to you, and repeat prescriptions should only be requested as and when needed and not stockpiled in large amounts for a rainy day. It is worth making sure you only tick the boxes for the items you really need each time.

Any medicines that are not used, or pass their use-by date are unsafe to take and cannot be recycled or given to someone else – so they often end up in the waste bin. It is estimated that this could be costing the local NHS around £2.7million per year in north Kent, which could be better spent in providing more healthcare services for local patients.

Over the counter medicines – i.e. remedies that can be bought at a supermarket or pharmacy, account for around £2.6million of prescription costs across north Kent.

This means that the equivalent cost to the NHS for around 60,000 GP appointments, or approximately 100 extra nurses) is spent on prescriptions for common ailments that may not need prescription medicines. Items including normal dosage paracetamol and ibuprofen are readily available at very low cost via local pharmacies and supermarkets.

We could all help our local NHS by being smart about where we get our remedies for cold symptoms, sore throats, minor aches and pains and digestive problems, and where medically appropriate – not asking for prescriptions for over-the-counter treatments helps save an enormous amount NHS time and resources.

Read more about the campaign on the CCG website:

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.

It has 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.