NHS England has today launched a consultation which proposes to rein in prescriptions for some ‘over the counter’ products such as dandruff shampoo and drops for tired eyes, diverting up to £136 million into frontline care.
The consultation will not affect prescribing of items for chronic (long term) conditions or where minor illnesses are symptomatic or a side effect of something more serious.
The full consultation document gives further information about the list of 33 minor illnesses which has been identified by a national joint clinical working group which are either self-limiting or suitable for self-care.
Ending routine prescribing for minor, short-term conditions, many of which will cure themselves or cause no long term effect on health, could free up funds for frontline care.
Over the counter products currently prescribed include remedies for dandruff, indigestion, mouth ulcers and travel sickness. The NHS each year spends:
• £4.5m on dandruff shampoos – enough to fund a further 4,700 cataract operations or 1,200 hip replacements every year.
• £7.5m on indigestion and heartburn – enough to fund nearly 300 community nurses.
• £5.5m on mouth ulcers – enough to fund around 1,500 hip replacements.
If patients were to self-care for these three conditions alone, it would save the NHS £17.5 million allowing funds to be diverted to other areas.
Some of the products currently can be purchased over the counter at a lower cost than that which would be incurred by the NHS – for example, a pack of 12 anti-sickness tablets can be purchased for £2.18 from a pharmacy whereas the cost to the NHS is over £3 after including dispensing fees, and over £35 when you include GP consultation and other administration costs. Similarly paracetamol is an average of four times as expensive when provided on prescription by the NHS.
The over the counter medicines proposals for consultation include stopping the routine prescribing of products that:
• Have low clinical value and where there is a lack of robust evidence for clinical effectiveness, such as probiotics, vitamins and minerals.
• 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 sore throat or coughs and colds.
• 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, such as indigestion, mouth ulcers and pain relief.
NHS England and NHS Clinical Commissioners have worked closely with GPs, pharmacists and patient groups to develop and refine the list of conditions for which prescribing could be restricted, as well as where exceptions may apply.
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 illnesses and need clinical advice.
Local pharmacies provide NHS services in the same way as GP practices – and pharmacists train for five years in the use of medicines before they qualify as clinical health professionals.
A pharmacist will assess symptoms and consider any long-term conditions, and the medicines that the person is taking, before providing a recommendation. They will either:
• Support/advise in the decision to self-care.
• Sell an OTC medicine (which doesn’t need a prescription or visit to a GP) that will help relieve symptoms and make the person more comfortable.
• Signpost to the right medical care if the pharmacist considers the condition is serious enough to warrant further medical help.
These savings form a key building block of the NHS’s 10 point efficiency plan contained in the Next Steps on the NHS Five Year Forward View, published in March 2017, and support the ambition to ensure greater value from the NHS’ £17.4 billion medicines bill, through improving health outcomes; reducing waste, over-prescribing and over-treatment; and addressing excessive price inflation by drug companies.
The consultation on items which are available over the counter and should not routinely be prescribed in primary care will run until 14 March 2018.
In support of the consultation, there will be a series of four national face to face engagements events for patients and the general public. The dates and times of these events will be published on the NHS England website in early January 2018. In addition, there will be a series of online events (webinars) taking place throughout the consultation period for representatives of patient groups and charities. Details of the webinar times and dates will be published on the NHS England website.
Subject to the outcome of the consultation, guidance on OTC medicines is likely to be published by NHS England and CCGs will be asked to consider its implementation in their communities, ensuring they take into account their legal duties to advance equality and to reduce health inequalities. The proposed guidance would not remove the clinical discretion of the prescriber in deciding what is in accordance with their professional duties.