NHS ban on 'wasteful' prescribing could harm poorest patients, GPs warn

Plans to ban GPs from prescribing drugs available over the counter (OTC) to save the NHS £190m per year could deny poor patients access to medication they need, GPs have warned.

NHS England has launched a plan to ‘drive out wasteful and ineffective drug prescriptions’, proposing measures it says will save the NHS over £190m a year.

A consultation on the plans, drawn up by GPs and pharmacists, suggests banning 18 treatments considered to have ‘limited clinical value’ – including homeopathy and herbal treatments – that are estimated to cost the taxpayer a combined £141m a year.

It also proposes a crackdown on GPs prescribing 3,200 OTC drugs – which it said patients can often buy for themselves at a significantly lower price than the cost to the NHS.

Prescribing costs

The consultation adds that there should be a limit on prescribing drugs for minor self-limiting conditions, such as cough mixtures, cold treatments, eye drops, laxatives and sun creams – which cost the NHS a combined £50-£100m a year.

But GP leaders and patient charities warned that a blanket ban on prescribing drugs otherwise available OTC could have terrible consequences for the poorest in society.

NHS England added that it supported DH plans to restrict the availability of gluten-free foods on prescription, which currently amount to £26m a year.

Simon Stevens, NHS England chief executive, said: ‘The NHS is probably the world’s most efficient health service, but like every country there is still waste and inefficiency that we’re determined to root out.

‘The public rightly expects that the NHS will use every pound wisely, and today we’re taking practical action to free up funding to better spend on modern drugs and treatments.’

Patient safety

RCGP chair Professor Helen Stokes-Lampard said: ‘Prescription costs are a significant expense for the health service, and so if we can take safe, sensible measures to reduce these costs then we should.

‘We know that a number of treatments are of little or no value, and are at best a placebo. We also know many other medications are available very cheaply over-the-counter and are much more readily obtainable than when they first became available on prescription, and both GPs and the public should be mindful of this.

‘If patients are in a position that they can afford to buy over the counter medicines and products, then we would encourage them to do so rather than request a prescription – but imposing blanket policies on GPs, that don’t take into account demographic differences across the country, or that don’t allow for flexibility for a patient’s individual circumstances, risks alienating the most vulnerable in society.'

Dr Andrew Green, GPC prescribing lead, said: 'The BMA’s GP committee recognises the need to prescribe in a cost-effective manner, but where prescribing is changed for any other reason than clinical benefit to the patient, the patient must be involved and the extra workload for GPs needs to be recognised.

'Any prescribing policy needs to include flexibility to allow GPs to continue to meet individual patient’s needs without having to negotiate bureaucratic hurdles.

Prescribing blacklist

'GPs have a contractual duty to prescribe drugs that their patients need, and pressure must not be placed on them to act in a way that may contravene those regulations. Where there are clinical reasons that drugs should not be provided on the NHS, such as for co-proxamol or homeopathic substances, then these should be added to the "blacklist" which formally prevents NHS supply.'

National Voices, a coalition of heath and care charities, said it had a number of concerns about the consultation process, which it criticised for not clearly detailing what the decision to clamp down on prescribing over-the-counter drugs would mean for patients.

As a result, it is ‘very difficult’ to understand the consequences of the move, which could negatively impact patients who would be unable to afford the remedies for persistent conditions themselves.

Stopping such prescriptions would introduce ‘ability to pay’ as a barrier to accessing treatments people need, it warned.

Don Redding, director of policy at National Voices, said: ‘Whilst some treatments are available to purchase over-the-counter, that does not mean that everyone can afford them.

‘The risk is that the NHS would be saying that it will not support poor people to treat their kids’ head lice, or to manage complications such as persistent constipation or the vulnerability of their skin to damaging sunlight.

‘NHS England point out that some of these treatments can be bought over-the-counter at a cheaper price than the NHS can prescribe them. That raises questions about NHS procurement and negotiations with industry. It is not a problem to pass on to the poorest patients.’

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