NHS England frees up millions of pounds which could be used for frontline services

NHS England has published guidance to free up to almost £100m for frontline care each year by curbing prescriptions for ‘over the counter’ medicines such as those for constipation and athletes foot

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

The guidance will not affect prescribing of over the counter items for longer term or more complex conditions or where minor illnesses are symptomatic or a side effect of something more serious.

The NHS each year spends:

  • £22.8m on constipation – enough to fund around 900 community nurses
  • £3m on athletes foot and other fungal infections – enough to fund 810 hip ops
  • £2.8m on Diarrhoea – enough to fund 2912 cataract operations

The new over the counter medicines guidance will curb the routine prescribing of products that are for:

  • A self-limiting condition, which does not require any medical advice or treatment as it will clear up on its own, such as sore throats, coughs and colds
  • A condition that is suitable for self-care, which can be treated with items that can easily be purchased over the counter from a pharmacy, such as indigestion, mouth ulcers and warts and verrucae.

Other over-the-counter products currently prescribed include remedies for dandruff, indigestion, mouth ulcers and travel sickness. Each year the NHS also spends 4.5 million on dandruff shampoos, £7.5 million on indigestion and heartburn, and £5.5 million on mouth ulcers.

NHS England chief executive Simon Stevens said: “Across the NHS our aim is to: ‘Think like a patient, act like a taxpayer’. The NHS is probably the most efficient health service in the world, but we’re determined to keep pushing further. Every pound we save from cutting waste is another pound we can then invest in better A&E care, new cancer treatments and much better mental health services.”

Dr Graham Jackson, co-chair of NHS Clinical Commissioners and clinical chair of Aylesbury Vale Clinical Commissioning Group, who also co-chaired the joint clinical working group for this work said: “Unfortunately the NHS does not have unlimited resources and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face. It is not good use of the NHS’s limited resources to issue prescriptions for products which are not clinically effective, or for conditions that will get better without treatment or whose symptoms can be managed with appropriate self-care.

“On a daily basis, CCGs are forced to make difficult decisions that balance the needs of the individual against those of their entire local population. We recognise that it may be difficult for some patients who have previously been prescribed these products, but it is right that we prioritise our spending on those that provide the best outcomes for patients. This new guidance provides clear direction to CCGs on where those priorities should lie.”

John O’Connell, chief executive of the TaxPayers’ Alliance, said: “It’s great news that NHS England will save a vast amount of taxpayers’ money by curbing prescriptions for basic items that are much cheaper to buy in the supermarket than they are to prescribe. Taxpayers should not be footing the bill for items like anti-dandruff shampoo or athlete’s foot powder, so cutting out wasteful spending like this will mean that precious resources can be focused on frontline services. Patients too must remember that these items are not “free” – the money comes out of taxpayers’ pockets, so NHS England should be applauded for this move.”

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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.

Once CCGs have adopted the new guidance locally, it will apply to everyone who is not covered by the general or condition-specific exceptions listed in the guidance document. In relation to the exceptions, it is important to highlight:

  • The guidance does not apply to people with long-term or more complex conditions who will continue to get their usual prescriptions.
  • People who receive free prescriptions will not automatically be exempt from the guidance.
  • For patients where the clinician considers that their ability to self-manage is compromised as a consequence of medical, mental health or significant social vulnerability; these patients will continue to receive prescriptions for over the counter items subject to the item being clinically effective.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: “Prescription costs are a massive expense for the NHS, and the College has always been supportive of plans to take safe, sensible measures to reduce these costs.

“However, we have previously expressed our concerns about blanket bans being imposed, and GPs losing their freedom to make decisions in the best interests of individual patients, taking into account the unique physical, psychological and social factors affecting their health.

“We are very pleased that NHS England have listened to our concerns and that GPs will retain the ability to use our expert medical judgement and clinical skills to prescribe medicines that are also available to buy over the counter in certain circumstances. It is also welcome that limitations will not affect patients living with longer-term and more complex conditions.

“GPs will continue to encourage patients who can afford to buy medication over the counter to do so, and advocate self-care for many minor, self-limiting conditions for which patients don’t often need to seek medical assistance, or obtain prescribed medication.”

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