New commissioning guidance launched on prescribeable items of low priority for NHS funding

Today at the NHS England board meeting, new commissioning guidance was approved in relation to 18 items covered in our joint consultation on items which should not be routinely prescribed in primary care.

A joint clinical working group considered the responses to the consultation which ran between July and October this year and agreed that the recommendations for the 18 products consulted on should either remain unchanged (13 products) or be modified or clarified in five cases (including liothyronine, travel vaccines, lidocaine plasters and Immediate Release Fentanyl).

The board agreed that the 18 items should no longer be routinely prescribed. It is estimated that this could save up to £141m per year.

We are also calling on the Department of Health to blacklist seven treatments:

  • Homeopathy – no clear or robust evidence to support its use
  • Herbal treatments – no clear or robust evidence to support its use
  • Omega-3 Fatty Acid Compounds (fish oil) – essential fatty acids which can be obtained through diet, low clinical effectiveness
  • Co-proxamol – pain killer which has had its marketing authorisation withdrawn due to safety concerns
  • Rubefacients (excluding topical NSAIDS) – warming muscle rub products, limited evidence
  • Lutein and Antioxidants – used to treat the eye condition age related macular degeneration , low clinical effectiveness
  • Glucosamine and Chondroitin – used for joint pain, low clinical effectiveness.

Graham Jackson - board meetingResponding to the approval of the new guidance Dr Graham Jackson, NHSCC co-chair and clinical chair of NHS Aylesbury Vale CCG, said: “The guidance launched today, which resulted from work we initiated on behalf of our members, will support clinical commissioners to prioritise effectively and make sure they are getting the best value for their medicines spend. We were pleased by the volume of responses to the consultation, which gave an opportunity to take into account and reflect the views of public, patients and clinicians and key stakeholders in the final guidance.  We need to carry on having these honest open conversations on what the NHS can and should provide with the funding it has, so that we can continue to deliver high quality care.”

The full commissioning guidance can be seen on the NHS England website. CCGs will be expected to have ‘due regard’ to this guidance in formulating local polices and making decisions about implementation.

Read more about the impact this will have for CCGs in a joint letter between Dr Graham Jackson, NHSCC co-chair and Dr Bruce Warner, NHS England Deputy Chief Pharmaceutical Officer, who co-chaired the clinical working group.

Simon StevensNHS England chief executive Simon Stevens said: “The NHS is one of the most efficient health services in the world but that must not deter us from doing more to make taxpayers’ money go further. Every pound of waste saved is a pound that can be reinvested in new treatments and better care so, as the NHS faces the toughest funding squeeze in its history, we need to make some hard-headed decisions about what we can and can’t afford.

“The NHS should simply not be paying for treatments where there is no robust evidence they work. It is also right that we look at cutting prescriptions for medicines that patients can buy for a fraction of the price the NHS pays.”

Over the counter treatments

Also at the meeting the board noted the findings of the public consultation, where 65% of those who responded were supportive of proposed criteria to assess items which are available over the counter (OTC) for potential restriction.

It is estimated that the NHS could save around £190m a year by cutting such prescriptions for minor, short-term conditions, many of which will cure themselves or cause no long term effect on health. This will now be subject to an initial engagement process with representative bodies at a national level before commencement of a formal consultation early next year. NHS England and NHSCC are working with GPs, pharmacists and patient groups to develop and refine the proposals which will be consulted on in the New Year, in particular where exemptions may apply.

Find out more about these proposals.

30 November 2017