Today at the NHS England board meeting, our joint consultation on items which should not be routinely prescribed in primary care was published. In it are recommendations regarding 18 treatments which currently cost the NHS £141 million a year.
The publication of the consultation follows on from our work earlier this year, where we called for national support to release up to £128m of savings from ten identified products that could be considered low priority for NHS funding. We highlighted the potential to instead re-direct these funds to high priority areas including primary care and mental health.
Our work was referenced in the Next Steps for the NHS Five Year Forward View. We have subsequently worked with NHS England to refine the initial list and develop this consultation which will inform the drafting of national commissioning guidance in this area. A number of key stakeholders were involved in this through the establishment of a clinical working group, with members including the Royal College of General Practitioners and the Royal Pharmaceutical Society.
The items that are subject to the consultation fall into three categories:
“The NHS can and does provide high-quality care but our ability to continue to do so will be reduced if we can’t prioritise areas which will result in the best outcomes for patients, while at the same time getting the best value for our funds.
We need to have an honest conversation with the public, patients and clinicians on what the NHS should provide and this consultation around the medicines spend – an area with the potential to unlock huge resource – is an important part of that.
We are pleased to have worked with NHS England identifying products that could be considered low priority for NHS funding, for reasons including limited clinical effectiveness or the availability of cost-effective alternatives.
We now hope to hear from as many people and organisations as possible so that the final guidance can properly take these views into account and result in our member CCGs being given national support in prioritising medicines and services that makes the best use of the NHS pound.”
Homeopathic products are among those being considered in the consultation.
Simon Stevens, NHS England chief executive, said in a statement released by NHS England: “Rising demand coupled with finite public resources, means it’s right to examine carefully what should and should not be available on NHS prescription. Homeopathy is at best a placebo and a misuse of scarce NHS funds. A nationally coordinated, consistent and fair approach will deliver the twin benefits of better results for patients and clarity for NHS staff, alongside significant savings that can be reinvested into new medicines and treatments.”
We are also asking for views on the principles around prescribing items which are readily available over the counter, at supermarkets and other retailers, often at a lower price than the cost to the NHS. This relates to around 3,200 prescription items, such as paracetamol, cough mixture and cold treatments, and eye drops which currently cost the NHS around £645m.
A joint clinical working group of NHS England and NHSCC will use these views to inform their work developing new guidance on this area, which will be subject to a future consultation.
You can see a set of FAQs with more information on the NHS England website.
Items of relatively low clinical effectiveness
Co-proxamol (£9.002,824m) – 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 Fatty Acid Compounds (£6.317, 927) – Licensed for elevated triglycerides, but evidence is weak. NICE recommend against prescribing for primary prevention of CV events. Available from Superdrug for £4.99.
Lidocaine Plasters (£19.295m) – Licensed for treatment of post herpetic neuralgia, a complication of Shingles, but limited evidence. NICE do not recommend and alternatives are available.
Rubefacients (£4.301m) – Evidence available does not support the use of topical rubefacients (deep heat rubs and ointments). Available from Superdrug for £3.25.
Dosulepin (£2,651m) – Formerly known as dothiape it is an antidepressant that NICE has raised safety concerns over. Newer anti-depressants are available.
Glucosamine and Chondroiton (£444,535) –Nutraceuticals which are taken to improve pain associated with osteoarthritis but there is no evidence they work.
Lutein and antioxidants (£1,500,000) – Lutein and antioxidants (e.g. vitamin A, C E and zinc) are supplements taken for Age Related Macular Degeneration but there is no evidence they work.
Oxycodone and Naloxone (£5,062,928) – Oxycodone and Naloxone combination product is used to treat severe pain. Morphine is more effective.
Homeopathy items (£92.000) – The House of Commons Science and Technology Committee found homeopathy not evidence based and based on a placebo effect.
Herbal medicines (£100.009) – No evidence they work.
Items which are clinically effective but where more cost-effective items are available (this includes items that have been subject to excessive price inflation)
Liothyronine – (£34.802m) – Used for underactive thyroid. High cost and limited evidence. Most patients can have symptoms controlled on much cheaper Levothyroxine. Manufacturer has been subject of a Competition and Markets Authority investigation.
Doxazosin Modified Release (MR) (£7.769m) – Drug for hypertension. MR (modified release) version is more expensive than standard release with no clear benefits.
Perindopril Arginine (£529,403) Perindopril is an ACE inhibitor used in heart failure, hypertension, diabetic nephropathy and prophylaxis of cardiovascular events. A cheaper alternative with a longer shelf-life is available.
Fentanyl Immediate Release (£10.952m) – Used for breakthrough pain in palliative care. Little evidence it is more effective than morphine but it is much more expensive.
Tadalafil Once Daily (£11,474,221) – Similar to Viagra. No evidence that taking the low, 5mg, daily dose is more effective than taking a 20mg does dose when required.
Trimipramine (£19,835,783) – A tricyclic antidepressant (TCA). Newer alternatives are available.
Paracetamol and Tramadol Combination product (£1,980,000) – Paracetamol and Tramadol are widely available. There is no advantage in a single pill.
Items which are clinically effective but, due to the nature of the item, are deemed a low priority for NHS funding
Travel vaccines (£4.5million) – Seven vaccines – Hepatitis B, Japanese Encephalitis, Meningitis ACWY, Yellow Fever, Tick-borne encephalitis, Rabies and the BCG – are not supposed to be on the NHS but have been prescribed by practices in error. A further four travel vaccines ( Diptheria/Tetanus/Polio, cholera, Hepatitis A and Typhoid) currently available on prescription are now being assessed by Public Health England.
21 July 2017