Dr Fradd, an architect of the current GMS contract, said pressure on commissioners to make NHS savings meant radical ideas were needed, such as scrapping free prescriptions for medicines available OTC.
Such ideas may be supported by many clinical commissioning groups (CCGs), but could not be introduced without national action, he said.
Speaking to GP magazine at the Proprietary Association of Great Britain (PAGB) annual conference, Dr Fradd argued that the reformed NHS left ‘one big gap’ by not providing a way for CCGs to talk with a single voice to government.
He said there needed to be ‘a national body that brings all those views together’.
‘There’s one big gap in how commissioning works, which is how CCGs’ voice becomes a national voice that feeds back to government,’ he said.
‘That’s not something that should go through the college or through the NHS Alliance or through the BMA,’ he said. ‘This is something that should be a commissioning voice pure and simple going back to government.’
‘Let’s have a clinical commissioning annual conference where we can put policy decisions that should go back to government,’ he added. ‘At the moment, the government is not getting that voice back in the opposite direction.
Dr Fradd said that important issues ‘would come out of so many CCGs’.
‘If in general we all voted and said we want to the government to introduce charges for over-the-counter medicines, it would happen,’ he said.
In his speech to the PACG conference, Dr Fradd said financial pressure would lead the NHS ‘to look at co-payments in a much broader sense’. ‘Where I would be going would be look at revision of the blacklist,’ he said.
The current NHS blacklist is set out in Part XVIIIA of the NHS Drug Tariff and has not been updated since it was compiled in 1985. It was originally drawn up to include treatments that were deemed to be too expensive to justify NHS funding, not necessary or which had no medicinal use.
Dr Fradd asked: ‘Is there any reason why drugs that are available OTC should be available on reimbursable, free prescriptions?’
He added: ‘I think we are going to be looking outside the box at co-payments and that, I’m quite certain, will be a national government initiative and not something down to local agreements and policy.’
In May 2010, a GP magazine poll found half of GPs wanted the 'blacklist' of therapies that cannot be prescribed on the NHS expanded, in order to save money.