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Low value script items targeted in NHS savings drive

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NHS England has confirmed it will be issuing new guidance restricting the future prescription of a range of low value medicines, in a drive intended to potentially save £400m.

The national commissioning body announced today that it would be leading a review of low value prescription items from April 2017 and introducing new guidance for clinical commissioning groups.

“All healthcare professionals [need] to work even closer with patients to ensure the best possible value from NHS resources”

NHS England

Its list includes travel vaccines, gluten-free foods and fish oil supplements, as well as potentially some more controversial items, including some painkillers.

The move follows analysis by NHS Clinical Commissioners, which represents CCGs, that identified significant areas where potential savings can be made, up to potentially £400m per year.

On the back of its findings, the organisation has requested that NHS England now set out a national approach that would, following consultation, be adopted by CCGs across England.

NHS England said its review would seek to address concerns over the justification for many low value prescriptions that absorb millions of NHS funding every year.

It will work with clinicians and CCGs to develop guidelines initially around a set of 10 medicines that are “ineffective, unnecessary, inappropriate” or “indeed unsafe” for prescription on the NHS and that together cost £128m per year.

In developing the guidance, the views of patient groups, clinicians, commissioners and providers across the NHS will be sought, said NHS England.

Further work will consider other medicines of relatively low clinical value or priority, or that are available over-the-counter and in some instances, at far lower cost, such as treatment for coughs and colds, antihistamines, indigestion and heartburn medication and suncream.

NHS England added that “careful consideration” would also be given to ensure particular groups of patients were not disproportionately affected.

An NHS England spokesperson: “New guidelines will advise CCGs on the commissioning of medicines generally assessed as low priority and will provide support to clinical commissioning groups, prescribers and dispensers.

“The increasing demand for prescriptions for medication that can be bought over the counter at relatively low cost, often for self-limiting or minor conditions, underlines the need for all healthcare professionals to work even closer with patients to ensure the best possible value from NHS resources, while eliminating wastage and improving patient outcomes,” they added.

According to the BBC, the first 10 “low value” medicines on the list to be reviewed by NHS England, plus their annual cost to the health service, are:

  • £30.93m on liothyronine to treat underactive thyroid
  • £21.88m on gluten-free foods
  • £17.58m on lidocaine plasters for treating nerve-related pain
  • £10.51m on tadalafil, an alternative to Viagra
  • £10.13m on fentanyl, a drug to treat pain in terminally ill patients
  • £8.32m on the painkiller co-proxamol
  • £9.47m on travel vaccines
  • £7.12m on doxazosin, a drug for high blood pressure
  • £6.43m on rubs and ointments
  • £5.65m on omega 3 and fish oils

However, the Royal College of GPs said it was against “imposing blanket policies” on primary care prescribing that “don’t take into account demographic differences across the country, or allowing flexibility for a patient’s individual circumstances”.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: “If patients are in a position that they can afford to buy over the counter medicines and products, then we would encourage them to do so without a prescription – but this isn’t the case for everyone.”

But she noted that the college was keen to work with NHS England to make the initiative a success.

“Prescription costs are a significant expense for the health service, and so if we can take sensible measures to reduce these costs then we should,” she said.

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