NHSCC calls for national support to release up to £400m NHS spending to use on high priority areas

CCGs are asking for national support to release up to £400m of NHS spending to use in high priority areas such as mental health and primary care rather than spending it on products and medicines currently available on prescriptions which offer no or limited clinical benefit to patients or could otherwise be considered as lower priority for NHS funding.

Graham-JacksonDr Graham Jackson, co-chair NHS Clinical Commissioners said:

“We need to be honest with the population – the NHS can and does provide high quality cost effective care, but our ability to continue to do so will be restricted if we can’t prioritise those areas which will get the best outcomes for patients, whilst getting the best value for our limited NHS budget.

“The medicines spend is one where there is huge potential to unlock resources and redirect them to those higher priority areas like mental health and primary care. Through doing this we can deliver better outcomes for patients. The principles of this work will also support the much needed long term transformation of the NHS.

“We have identified an initial £128m worth of products to kick off those discussions with the aim of agreeing that CCGs can begin to reduce their spending on these at a national level. With that national level support there is more that we can do. We know that CCGs are keen to explore other products that promote the self-care agenda and where there are even more significant sums of money that could be released and used more effectively and efficiently for our patients and local populations.

julie-wood_websiteJulie Wood, Chief Executive, NHS Clinical Commissioners said:

“Clinical commissioners have always had to make difficult choices about prioritising how they spend their budget on services, but the finance and demand challenges we face at the moment are unprecedented. CCGs have been looking at their medicines spend, and many are already implementing policies to reduce spending on those prescribe-able items that have little or no clinical value for patients, and are therefore not an effective use of the NHS pound.

“The medicines spend is over £15bn and as such is the second largest spend after staffing costs and across England CCGs are currently spending up to £400m on prescribe-able products that could potentially be better spent on other NHS services.  NHSCC, with our members, has determined a number of categories and characteristics to help define those potential items of low priority for NHS funding, and through this work have identified 10 products which in the first instance could release up to £128m – these categories / characteristics includes:

  • drugs that have little or no clinical value and / or little robust clinical evidence;
  • costly pharmaceutical products that have an equally effective alternative at lower prices and;
  • products that could be argued are not a priority for NHS spend or are available over the counter cheaper than on prescription.

“This is not about cutting essential services or restricting access for patients to services they need, it is about allowing local clinical leaders to make the best and most efficient use of the money CCGs have available to spend in really challenging circumstances. Having national support from NHS England and the DH for those local decisions means there will be more consistency and reduce variation for patients.”

First 10 products to be considered as low priority for NHS funding

NHSCC has developed a number of categories or characteristics to help define potential items of low priority for NHS funding (some items potentially falling into more than one category) and have worked closely with NHS England to agree a first phase list of products.

The first phase is to look at items that our members consider to be of the lowest priority for funding in categories 1, 2 and 3 with a total spend £128.02m (spend figures based on information from the last 12 months). These are as follows:

  1. Products of low clinical effectiveness or where there is a lack of robust evidence of clinical effectiveness(£37.98m)
  • Co-proxamol (£8.32m) – Analgesic. The product was withdrawn in 2005 due to safety concerns and marketing authorisations cancelled at the end of 2007. There remains some prescribing of imported product at an inflated price.
  • Omega 3 and fish oils (£5.65m) – Licensed for elevated triglycerides, but evidence is weak. NICE recommend against prescribing for primary prevention of CV events. There are additional potential savings in terms of reduced GP appointments which are not included in potential £5.65 figure.
  • Lidocaine Plasters (£17.58m) – Licensed for treatment of post herpetic neuralgia, but limited evidence. NICE do not recommend.
  • Rubefacients (£6.43m) – The evidence available does not support the use of topical rubefacients (rubs and ointments) in acute or chronic musculoskeletal pain. Rubefacients should not be offered to treat osteoarthritis. There are additional potential savings in terms of reduced GP appointments which are not included in the £6.43m figure.
  1. Products which are clinically effective but where more cost-effective products are available (£58.69m) – this includes products that have been subject to excessive price inflation.
  • Liothyronine (£30.93m) – Used for underactive thyroid. High cost and limited evidence. Vast majority of patients controlled on much cheaper Levothyroxine.
  • Tadalafil (£10.51m) – An expensive alternative to Sildenafil (Viagra) with no evidence of superior effectiveness. Also licensed for treating lower urinary tract symptoms in men but this is not recommended by NICE except for clinical trials.
  • Doxazosin MR (£7.12m) – A 4th line drug for hypertension. MR (modified release) version is more expensive than standard release, and both are once a day. Very small number of patients may find benefit if postural drop with standard release.
  • Fentanyl (£10.13m) – Used for breakthrough pain in palliative care. Evidence of superiority vs. morphine is limited, but much more expensive.
  1. Items which are clinically effective but due to the nature of the product, are deemed a low priority for NHS funding (£31.35m) These include ACBS products such as gluten free foods – some gluten free products currently available on NHS prescription are considered by many to be luxury items rather than essential foods.
  • Some gluten free foods (£21.88m) – The range of GF foods readily and inexpensively available in supermarkets is now much greater than when prescribing of the food on the NHS was introduced in the 1960s. Many carbohydrate foods are naturally gluten free, such as potatoes, rice and some noodles. Cost to NHS greater than if bought direct by consumer.
  • Travel Vaccines (£9.47m) – Only a small number of vaccines are allowed on NHS but many practices still prescribe.

We know that CCGs are keen to explore other products, such as those for upset stomach, antihistamines, suncream, cough and cold remedies, heartburn and indigestion products, that sit within the self-care agenda where we believe a significant sum of money could be released.

There will be a need for flexibility in any local decision making to allow for individual patient needs to be taken in to consideration.

28 March 2017