Consultation on reining in prescriptions for ‘over the counter’ products

News from our partners NHS England

NHS England is further publicising a public consultation on proposals to rein in prescriptions for some ‘over the counter’ products such as dandruff shampoo and drops for tired eyes, freeing-up up to £136 million to expand other treatments for major conditions such as cancer and mental health problems.

Ending routine prescribing for minor, short-term conditions, many of which will cure themselves or cause no long term effect on health, would free up NHS funds for frontline care.

The consultation does not affect prescribing of items for longer term or more complex conditions, or where minor illnesses are symptomatic or a side effect of something more serious.

Over-the-counter products currently prescribed include remedies for dandruff, indigestion, mouth ulcers and travel sickness. The NHS each year spends:

• £4.5 million on dandruff shampoos – enough to fund a further 4,700 cataract operations or 1,200 hip replacements every year.
• £7.5 million on indigestion and heartburn – enough to fund nearly 300 community nurses.
• £5.5 million 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.

NHS England chief executive Simon Stevens, said:

“To do the best for our patients and for taxpayers it’s vital the NHS uses its funding well. This consultation gives the public the opportunity to help family doctors decide how best to deploy precious NHS resources, freeing-up money from the drugs bill to reinvest in modern treatments for major conditions such as cancer, mental health and emergency care.”

Dr Graham Jackson, GP, co-chair of NHS Clinical Commissioners and clinical chair of Aylesbury Vale CCG, said:

“It is important that we have an honest conversation with the public, patients and clinicians about what the NHS should and can provide with the constrained funds it has available. As a part of that, it is right that we review what is currently offered on NHS prescription that is also available over-the-counter so that we can prioritise our spending on those products that are the most clinically effective and provide the best outcomes for patients. This consultation is an important part of the ongoing work we are doing on behalf of local clinical commissioning groups alongside NHS England to ensure the NHS budget is spent effectively to deliver the best possible patient care.

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said:

“Where patients can afford to buy medication over the counter, we would certainly encourage them to do so. There are also many minor, self-limiting conditions for which patients don’t often need to seek medical assistance, or prescribed medication, and can dealt with through self-care.

“What remains imperative – and we will be making this clear in our consultation response – is that no blanket bans are imposed, and GPs will retain the right to make clinical decisions about prescribing appropriately for our patients based on the unique physical, psychological and social factors potentially impacting on their health.”

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 some common tablets are on average four times more 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. The Board of NHS England approved the launch of a public consultation on these proposals at its public meeting on 30 November.

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’s £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 and guidance document is available here: www.engage.england.nhs.uk/consultation/over-the-counter-items-not-routinely-prescribed/