According to NHS figures, in the year prior to June 2017 the NHS spent approximately £569m on prescriptions for medicines which can be purchased over-the-counter from a pharmacy – or equivalent. To counter this, NHS England launched a public consultation on reducing prescribing of over-the-counter medicines for 33 minor, short-term health concerns
Healthwatch England asked the public to share their concerns over the proposals; Imelda Redmond, national director of Healthwatch England, shares their findings
The NHS is facing more demand and its resources are limited. To make savings, NHS England is proposing to remove products that are available to buy over-the-counter at the local pharmacy – products such as sun cream, eye drops and indigestion relief – from NHS prescriptions.
With just one week left to respond to these NHS proposals Healthwatch England asked the public to share their concerns and views on the proposed changes – to find out more about the impact these changes could have.
1 People raised concerns that those from low income backgrounds are more likely to lose out
People from low income backgrounds, and those requiring treatment for multiple conditions, are more likely to be financially affected.
- One in five respondents thinks they or their families will be financially affected if these items are no longer available on NHS prescription. However, of those respondents, two thirds identified as being on a low income.
- 37% of the people we spoke to think their wider community will be financially affected.
“There are some people in our community who would either not be able to afford the items (foodbank use is heavy in some areas) or would not know what to buy.” – Healthwatch survey respondent
If they can’t afford it on their own, people might be discouraged from buying over-the-counter products and seeking treatment. This could lead to complications or symptoms getting worse, which could cost the NHS more in the long run.
“Please consider the issue of false economy. Leaving relatively minor conditions untreated often leads to complications and/or a worsening of the condition, therefore eventually requiring more expensive treatment.” – Healthwatch survey respondent
2 People want to know what the NHS is doing to save costs elsewhere
While NHS England believes these changes could save up to £136m a year to spend on treatments for major illnesses, this figure doesn’t seem to take into account exemptions to the proposed changes. We would urge NHS England to provide a more accurate view of the potential savings, to be more clear about who would be affected and the impact these changes will have.
People who have spoken to Healthwatch have also asked to see what else the NHS is doing to save money on medications. They suggested that if the NHS is asking people to pay more for their medications then they expect to see the NHS doing its part to reduce waste.
3 More pressure on GPs could lead to inconsistencies
NHS England has outlined in the draft guidance that GPs will be able to take a patient’s ‘social factors’ into account when prescribing. Throughout the consultation process they have implied this means doctors will be able to continue prescribing these products to patients they believe can’t afford to buy them for themselves.
However, resources are stretched and GPs have limited time to spend with their patients; they may not be in the best position to assess a patient’s social circumstances and ability to afford over-the-counter products. Putting the burden of this decision on already stretched GPs could lead to inconsistencies in the treatment people receive across the country.
How can NHS England address people’s concerns?
After we shared what people told us in October last year NHS England made some changes to its plans to ensure that certain people will still be able to get these products on prescription, including:
- people with long-term health conditions;
- people receiving treatments that are only available on prescription;
- people with more complex or major conditions (including patients on immunosuppressants);
- people who may need help buying the right medication.
However, there are still some changes that could help to address the concerns people have shared with us:
- A revised assessment of how much could be saved with these changes, taking into account any exemptions where people will still be able to get these products on prescription. This figure must be clearly communicated to the public and progress against this savings target should be tracked and assessed to see if it’s working.
- Better communication about what measures the NHS is taking to do its part by being more efficient when purchasing and managing the use of medication.
- Clear guidance for doctors which includes a patient’s financial position in the list of ‘social factors’ they can take into account when prescribing.
- Evaluation of the impact of these changes. We want to see the effect on people from low income backgrounds and those with multiple conditions.
- A meaningful conversation with the public around better use of NHS resources and improving awareness of the different services available.
If we can take sensible measures to reduce prescriptions costs then, of course, we should do so. But we must not exaggerate the amount of money that can be saved and we need to ensure that careful consideration is given to ensure that particular groups of people are not disproportionately affected.