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Update on items which should not be routinely prescribed in primary care

Medicine at a pharmacy

Following a consultation earlier in the year on medicines which can be considered to be of low priority for NHS funding, NHS England has now announced its recommended commissioning guidance for CCGs for certain low value treatments to no longer be provided on the NHS.

Last year 1.1 billion prescription items were dispensed in primary care at a cost of £9.2billion. In Hampshire and the Isle of Wight this figure is £299.4m on 34,300 items.  Across England there is a lot of variation in what is being prescribed and to whom. Often patients are receiving medicines which have been proven to be ineffective or in some cases dangerous, and for which there are other more effective, safer and cheaper alternatives.

For low value medicines, NHS England consulted on a list of 18 treatments, drawn up with GPs and pharmacists, deemed to be ineffective, over-priced and of low clinical value.

Of the 18, NHS England has agreed these treatments should no longer be routinely prescribed:

  • Homeopathy – no clear or robust evidence to support its use
  • Herbal treatments – no clear or robust evidence to support its use
  • Omega-3 Fatty Acid Compounds (fish oil) – essential fatty acids which can be obtained through diet, low clinical effectiveness
  • Co-proxamol – pain killer which has had its marketing authorisation withdrawn due to safety concerns
  • Rubefacients (excluding topical NSAIDS) – warming muscle rub products, limited evidence
  • Lutein and Antioxidants – used to treat the eye condition age related macular degeneration , low clinical effectiveness
  • Glucosamine and Chondroitin – used for joint pain, low clinical effectiveness

NHS England has also recommended relaxing the proposed guidance with regard to three of the products, which are:

  • Prescribing of Liothyronine for any new patient is to be initiated by a consultant endocrinologist in the NHS, and prescribers are being advised to deprescribe in all appropriate patients rather than all patients.
  • For Lidocaine Plasters, a specialist exemption for Post Herpetic Neuralgia is being introduced.
  • For Immediate Release Fentanyl, use in palliative care by a recognised multi-disciplinary team professional will be acceptable and appropriate patients will not have the medicine deprescribed at this point.

NHS England will now issue guidance to GPs and CCGs to remove ineffective, unsafe and low clinical value treatments, such as some dietary supplements herbal treatments and homeopathy, and restricting the use of a further 11. They anticipate that this will save up to £141 million a year across England.

Further information and the full list of products can be found here.

NHS England has also announced plans to launch a consultation on the prescribing of some ‘over the counter’ products.  Areas include those that:  

  • Can be purchased over the counter, and sometimes at a lower cost than that which would be incurred by the NHS – paracetamol is an average of four times as expensive when provided on prescription by the NHS, compared to when it is purchased in pharmacies or supermarkets. It can costs around £34 for 32 on prescription including dispensing and GP consultation fees
  • 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 a common cold.
  • 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.

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 conditions.

NHS Southampton City CCG will work with NHS England, GPs, pharmacists and patient groups to develop and refine the proposals which will be consulted on in the New Year.