NHS confirms low value treatment blacklist and plans OTC prescribing limits

GPs should no longer prescribe 18 'low value treatments', including fish oil, herbal remedies and homeopathy, and could face further restrictions on prescribing OTC medicines for self-limiting conditions in the new year, NHS England has said.

At its board meeting today, NHS England agreed plans to cut access to 18 ‘low value treatments’, which could save the NHS up to £141m a year. CCGs have been issued with new guidance on items that should not be routinely prescribed in primary care.

NHS England also announced that it will consult on plans to restrict prescribing of some OTC medicines in certain situations, which it said could save the NHS £190m a year and free up millions of GP appointments.

The consultation will include proposals to stop routine prescribing of OTC medicines for 34 conditions that are either self-limiting or conditions where patients could self care. This covers conditions including oral thrush, simple constipation, mild acne, mild hayfever and infant colic.

Prescribing limits

Board papers reveal that NHS England plans to review each condition and make a recommendation about whether a prescription for treatment should be issued.

Possible exceptions from the restrictions could be people who lack the appropriate level of cognitive capacity to independently purchase items OTC, people commonly refused the sale of OTC medicines because of contraindications, such as pregnant women, and patients whose condition has not responded sufficiently with a purchased OTC product.

The papers also say that exceptions could apply ‘where the GP believes that in their clinical judgment, exceptional circumstances exist that warrant deviation from the recommendation to self care'.

Read more
How a ban on prescribing drugs available OTC could affect GPs
> The 18 items on NHS England's prescribing blacklist

The consultation will also look at stopping prescribing products that can be purchased cheaper OTC than the cost that would be incurred by the NHS. Paracetamol is on average four times as expensive when provided on prescription by the NHS, compared with the price in pharmacies or supermarkets, NHS England said. It can cost around £34 for 32 tablets on prescription when dispensing and GP consultation fees are taken into account.

GPs have previously warned that banning prescribing of drugs available OTC could put GPs in breach of the GMS contract and leave them vulnerable to complaints. However, a poll carried out by GPonline earlier this year found that most GPs are in favour of the ban coming into effect.

Analysis by GPonline earlier this year found that 17.8m items in categories likely to be heavily affected by a ban on prescribing drugs available OTC were prescribed by GPs over the three months from April to June this year.

NHS England said it would be working with GPs, pharmacists and patient groups to refine the propsals and where exemptions may apply ahead of a consultation in the new year.

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. GPs will welcome any guidance to support us in facilitating this, where appropriate.

‘We're pleased that NHS England have listened to our concerns and for the reassurance that GPs will retain the freedom to prescribe and develop treatment plans based on the physical, psychological and social factors potentially affecting the health of the patient in front of us.

'The college supports efforts which encourage patients to self-care, and 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 some patients, often the most vulnerable in society, are not, and it is important that they are not alienated as a result of this guidance.

'There is also the issue of limited quantities of certain medications available over the counter, which GPs will need to consider for some patients.’

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