Medicines

All CCGs in England purchase medicines which are made available for GPs to prescribe and community pharmacies to dispense. The prescribing of medicines and ensuring the right medicines are available at the right time for patient populations is very important for CCGs.

As medicine evolves, safer, more effective and better value medicines become available which reduce harm, can improve patient outcomes and help deliver value for money which helps towards managing finite NHS resources.

NHSCC is working in collaboration with NHS England to reduce ineffective medicines prescribing in primary care, an area of work known as low priority prescribing (LPP). The aim of the LPP working group is to have a national, evidence-based approach to reducing prescription rates for certain medicines in primary care.

These medicines fall into three categories:

  1. Products of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns;
  2. Products which are clinically effective but where more cost-effective products are available, including some products that have been subject to excessive price inflation; and
  3. Products which are clinically effective but due to the nature of the product are deemed a low priority for NHS funding.

The first ‘wave’ of products was put forward in 2017 after careful consideration and consultation with policy makers; clinicians; GP; members of the public; patients and their representative groups; NHS staff and various medical Royal Colleges. This resulted in national guidance for CCGs to support them to fulfil their duties as responsible commissioners and guide them to use their resources in order to gain maximum value for the health of their local population. This guidance has since been updated to include further products this year and the full guidance can be found on the NHS England website.

The second ‘wave’ of medicine products focussed on over the counter medicines (OTC). In the year prior to June 2017, the NHS spent approximately £569 million on prescriptions for medicines which can be purchased over the counter from a pharmacy and other places such as supermarkets. A further consultation was launched to look at how CCGs, therefore the NHS, could make savings on OTC products using the below two criteria:

  1. health conditions which are self-limiting meaning they do not need treatment and will heal on its own
  2. health conditions which can be treated by self-care, such as taking rest or seeking help from a local pharmacy.

Following consultation in 2018, guidance for CCGs was published setting out when OTC medicines should not routinely be prescribed in primary care. This can be found here on the NHS England website.

Resources

Items which should not routinely be prescribed in primary care: Guidance for CCGs – June 2019

Guidance on conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs – March 2018

RMOC Operating Model Guidance – October 2019