NHS prescribing overhaul must not create postcode lottery to cut costs, GPs warn

GP leaders have called for a 'fundamental review' of prescribing rules to ensure patients are treated fairly after NHS England said it would issue new restrictions on prescribing 'low-value items'.

The new guidance for CCGs will follow a review from next month. Initially, 10 ‘low-value prescriptions’, which could include gluten-free foods, will be targeted, which NHS England said are ineffective, unnecessary, inappropriate for prescription, or unsafe.

Further guidance could lead to restrictions on low-cost over-the-counter medicines such as treatment for coughs and colds, antihistamines, indigestion and heartburn medication.

In an interview with the Daily Mail, chief executive Simon Stevens said £114m was being spent on ‘medicines for upset tummies, haemorrhoids, travel sickness, indigestion, that’s even before you get on to the £22m-plus on gluten-free’.

NHS prescribing

National guidelines will be published to make clear that 'those should not routinely be prescribed on the NHS', he said.

NHS England wants to reduce spending on such items to free up resources for innovative new drugs and reduce pressure on GP appointments.

GPC deputy chair Dr Richard Vautrey told GPonline that doctors had been frustrated and patients confused by the current, potentially dangerous, postcode lottery in prescribing rules and there was a now need for ‘clear national arrangements’.

‘However rather than tinkering with the system there needs to be a fundamental review so that all patients are treated fairly, no matter where they live, and GPs are not placed in an unacceptable situation of being pressured to limit prescribing when their patient is requesting a prescription,' said Dr Vautrey.

Free prescriptions

He added: ‘Schemes need to be considered whereby those who are eligible for free prescriptions should be able to obtain these products directly from the pharmacist rather than making an appointment with a GP.’

Speaking to the BBC Today programme RCGP chair professor Helen Stokes-Lampard welcomed the announcement from Mr Stevens. ‘We do welcome these proposals, but cautiously,' she said. Restrictions on products for which there was no evidence, she said, would be standardising existing good practice. She said she thought there would not be a ‘blanket ban’ on products, which could introduce unfairness.

But she said ‘the world has moved on a lot’ since gluten-free foods were first put on prescription and they were now ‘readily available in every supermarket’.  

The college chair said people would have to accept that given the financial pressures on the NHS GPs would have to stop prescribing some items. 

‘Take indigestion remedies and haemorrhoid creams, at the moment these are things people frequently already buy without seeing a GP: they know what the problem is, they go and purchasing them anyway, but then sometimes GPs are put under pressure to prescribe things. The difficulty is when people don’t pay prescription charges, so they are entitled to free medication on the NHS. That is where the difficult conversations will come in, and that is what is not clear yet - is what we will do in those situations.’

Low-value prescriptions

‘GPs don’t want to be rationing,' she added, ‘I think it is time the country needs these difficult conversations, but we mustn’t jeopardise or put at risk the health of the vulnerable.’

Blackpool GP Dr Amanda Doyle, chair of the CCG representative body NHS Clinical Commissioners, which prompted NHS England’s consultation, told Today: ‘We are having to make quite difficult decisions at the moment. The NHS is in constrained financial circumstances, and what we are trying to do is prioritise our spend. We are currently spending hundreds of millions of pounds on things we would generally consider to be low priority for funding and we are looking at way of reducing that spending so we can direct the funding into things that take a higher priority.’

NHS commissioners, Dr Doyle added, were trying to provide the best care with the resources available, and that restricting the kinds of items proposed would not have a huge effect on clinical outcomes.

An NHS England spokeswoman 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.'

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