CCG stops funding painkillers on minor ailment prescriptions

Brighton and Hove CCG expects to see similar schemes rolled out across England
Brighton and Hove clinical commissioning group (CCG) has stopped funding prescriptions for paracetamol and ibuprofen for the treatment of short-term minor ailments.

The CCG launched a ‘HelpMyNHS’ campaign on Monday (January 9), which the organisation's chief pharmacist Katy Jackson said is designed to raise patients' awareness that they can “self-treat minor illnesses rather than seeking a prescription through a GP”.

“It costs the NHS four times as much to prescribe these drugs than it does for a patient to buy them,” Ms Jackson said.

As part of the campaign, posters and leaflets are being displayed in GP surgeries and pharmacies across Brighton. NHS services are also using social media to communicate the facts behind the change of prescription protocol to local people, the CCG said. 

It hopes stopping the funding will save the NHS half a million pounds, it stressed – enough to recruit "16 community nurses".

More than 100,000 prescriptions for paracetamol and ibuprofen were written last year in Brighton and Hove, "despite both medications being freely and cheaply available in pharmacies and supermarkets", it said.

"Historically, local patients have been prescribed paracetamol and ibuprofen for a wide range of conditions, including headaches, teething, sore throats and sprains," the CCG added.

The CCG is "leading the charge" and expects to see a "national trend [of] more NHS commissioners across England rolling out similar changes to prescription funding this year", it said.

CCG chair and GP David Supple pointed out that GPs would "of course still be able to prescribe these medicines in exceptional circumstances, such as when patients are experiencing long-term chronic pain or sensitivity".

The CCG told C+D that the scheme had been approved at Brighton's area prescribing committee meeting in June 2016, and the campaign documents make reference to the expertise of local community pharmacists.

LPC reaction

East Sussex local pharmaceutical committee (LPC) executive officer Vanessa Taylor told C+D the campaign was a “great scheme”.

However, the LPC would have "loved to have worked" more closely with the CCG to encourage community pharmacists to get involved and "get even bigger support", Ms Taylor added.

26 Comments
Question: 
Do you think more CCGs should copy this scheme?

Toni Orr, Community pharmacist

This subject obviously evokes some strong views by pharmacists and I understand how these opinions are formed, however nothing has changed my belief that stopping prescribing painkillers purely for the reason of cost is just plain wrong. I think my point about having an excellent core Minor Ailments Service in Scotland wasn't really anything to do with politics or the Barnet formula and it isn't really very constructive to bring that up. The MAS is a really good use of pharmacy within a health care team and has been invaluable in supporting communities as part of that team.
I think it's just sad that we're debating saving 16p on Paracetamol.

Shaun Steren, Pharmaceutical Adviser

Sadness is an emotional response. The counter-arguments have been based on reason, evidence and pragmatic reality. As such they have been avoided. 

This much repeated theme of inequality and persecution of the 'poor' is troubling. NHS funding is already highly progressive and redistributive and this reality ought to dampen the virtue signalling of those who, interestingly, profit from state intervention (whether that be through employment and/or profit). 

I would like to see much greater NHS funding (>10% GDP) and this from progressive taxation. However, I want to see simultaneous structural reform. Why? Well it seems to me that as funding increases much of the money ends up in the pockets of the professional/management class, who under the guise of 'helping' the 'disenfranchised', create questionable 'services' that ultimately benefit themselves.

Valentine Trodd, Community pharmacist

Where did you get 16p? According to the PJ, an 11 minute GP appointment costs the NHS £43 i.e. costs you and me, the taxpayer. We're talking about people who will waste the doctor's time i.e. yours and my money, rather than pay 32p for a box of paracetamol. They go to the doctor because they know it's free and they they'll get a script for something, which they won't have to pay for. The aim is to encourage these people not to waste the GP's time but rather to visit the pharmacy and consult with the pharmacist.

While we're at it, a token charge of say £5 per GP visit might also help with the encouragement process...

Farm Assistant, Community pharmacist

100% correct. I love giving people 32 paracetamol when they holding a pack of fags in the other hand. Another scheme designed by idiot bottom inspectors and human rights junkies. Anyway if you look at the demographics it will all have to change because quite simply the NHS is going to run out of money. Time for a radical overhaul but as long as politicians of every ilk are involved it will continue to be a mess.

Angela Channing, Community pharmacist

I think we're debating why people don't want to spend 49p on a box of paracetamol! I blame Tony Blair and New Labour who brought in a dependency culture, that everything will be done and provided by someone else, and it needs to stop! I'm not against the NHS at all, but we need to fund the big expensive things like cancer drugs, things that normal working or even non-working people can't afford themselves. If we can save money on the little things, like paracetamol, that people could buy themselves, then we can use the savings from it to fund the bigger expensive things.  Also, please explain, how, with your social inclusion policy in that bastion of socialism called Glasgow, that some men there have lower life expectancy than men in the Middle East or parts of the third world? Perhaps they drug and drink themselves to death and eat deep fried Mars bars because they are so happy with their wonderful life in Bonny Socialist Remaining Scotland?!?!?  ;)  2 words, my dear, Personal Responsibility, they need to start teaching it in schools in PSHE lessons. Either that or the NHS will die. 

 

Toni Orr, Community pharmacist

You make some good points but I have to say that I don't like being called "my dear". It just sounds like you think you have a moral high ground. I never mentioned Glasgow specifically and it would take someone with a greater knowledge of Scottish health economics to debate this stuff. The point I made was that the Scottish Minor Ailments Service overrides the costs of going to the gp and my limited understanding of the costs of this prescribing is that it is a very small part of the drugs bill. As such I think it's a an extremely useful service for patients. I'm not just talking about Paracetamol but anything for a minor ailment. It's so useful to be able to prescribe to patients for minor ailments and happily in Scotland this can continue.

Pam Adams, Primary care pharmacist

We need to be honest with people and give them the facts-the NHS is not a bottomless pit. Only patients who need long term treatment with these analgesics should get them from GP. Everyone else needs to buy them. Surgeries can warn patients in advance using posters, websites, newsletters-this should stop people making appointments just to get these drugs.

Brian Austen, Senior Management

GPs don't like to say "No" to patients. Some patients will request alternative painkillers and some doctors will prescribe alternative painkillers.

Ian Kemp, Community pharmacist

Absolutely right. The CCG must monitor the prescribing of tramadol, codeine, naproxen etc etc. Only if it can prove that prescriptions for these items have not increased can it show that this scheme is working, otherwise it is likely that it has caused more harm than good, both in terms of economics and patient care. Could C & D please find out what Katy Jackson's audit of this experiment looks like.

Toni Orr, Community pharmacist

Presumably gps wouldn't prescribe Paracetamol or ibuprofen in England because of the script charge. Here in Scotland we have an excellent core Minor Ailments Service which is part of a social inclusion policy which doesn't discriminate against poorer people and items should only given by the pharmacist if there is clinical need. My understanding is that the costs of prescribing under this service is such a small part of the overall drugs bill that it's not worth regulating. I don't agree with stopping prescribing anything if there is clinical need. Of course there are always people who will try to abuse a system but I always felt that it was my job to assess patients not discriminate against them. It's a slippery slope once you start to actively stop the prescribing of anything on the basis of cost alone. That's not a national health service.

Angela Channing, Community pharmacist

I'm sure if the Scottish had voted the other way in 2014, a lot of your "social inclusion policies" would be coming to an end when you realise that somebody somewhere has to stump up for everything and not rely on the Barnett formula to keep bailing you out. And it's not always "need", these days, it's more "want" to save their own money for booze, fags, and lottery tickets. I'm sorry if this sounds harsh, but as Pam says above, the NHS is not a bottomless pit, and the sooner Joe Public wakes up to this fact and starts taking some personal responsibility, the better. I also think some pharmacists should stop being so over-cautious and actually treat people with something, anything, to keep them out of the surgery for a few more days, I think a lot of pharmacists, particularly the new ones, are just too quick to refer everything to the GP.  In my opinion, they seem to be taught that it is their job to deny people access to OTC meds, without a full medical and in-depth interview! 

Shaun Steren, Pharmaceutical Adviser

1) You are talking about the relative 'poor'. The cost of paracetamol is minuscule (16 pence per day at maximum dose) relative to even the lowest income class. You are not discriminating against anybody. 

2) It is not a slippery slope whatsoever. If we take the most redistributive EU members, with the greatest level of state intervention, we see very significant levels of out-of-pocket expenses and demand control in healthcare. Countries such as France, Germany and Sweden (who all spend much more on healthcare) all have very substantial out-of-pockets expenses and demand controls, much more so than the UK. They also have vastly superior inequality results compared to the UK. 

3) The NHS has a design flaw - moral hazard. For it to survive it must reduce demand associated with the culture of 'rights without responsibilities'. The free at the point of care principle can be sustained for the most part but certainly not in absolutist terms. So in fact, the survival of the system rests not in ridiculous moralistic  exaggeration related to inequality but in reasoned pragmatism. I will let you decide which end of the spectrum 16 pence a day resides. 

Valentine Trodd, Community pharmacist

Presumably gps wouldn't prescribe Paracetamol or ibuprofen in England because of the script charge. 

I think you're missing the point - the very people abusing the system DON'T pay a prescription charge.

Meera Sharma, Community pharmacist

Agree with all the comments here - Pxing of these non-essential items is what is costing the NHS. I regularly come across babies being pxed Aveeno, without any clinical indication for it. Where's the sense in that when most CCGs are struggling to fund acute social care/hospital care?? If cost-savings are to be made across the board, then the public should be included as well. These items have come down in price considerably, there is no logic in having them on Px. As for other items, believe me, a lot of places are already exploring the items that are soon going to be taken off Pxs.

Aileen Watt,

Yes other ccgs should follow as paracetamol and ibuprofen cost 30 pence a box where I work it isn't going to break the bank

David Kent, Community pharmacist

When will the public realise that CCGs are cutting services to all sectors they control the funding for......except GP remuneration.

Jupo Patel, Production & Technical

Obselescence is the best word to sum up community pharmacy 

Jonathan Seggie, Pre-reg Pharmacist

unfortunately if people have to pay and they know they can get it free from the doctor thats where they will go. the MA scheme reduced doctors prescribing of these drugs and saving money

john thompson, Community pharmacist

A lot of pharmacists miss the whole point of Minor Ailments. It has little to do with the medicine cost but more to do with the professional cost of issuing the medicine. It is cheaper for the NHS if a pharmacist issues 30p of medication instead of a GP.

Shaun Steren, Pharmaceutical Adviser

The point is a culture of misusing the NHS. The issue is with GPs avoiding confrontation via the issuance of green slips. We are constantly avoiding any challenge to the rights without responsibilities culture. The very culture that will ultimately destroy the NHS. Are we truly suggesting that we should offer things for 'free' in order to bribe people from misbehaving in a much worse (expensive) way? Is that how degenerate our culture has become? 

The NHS ought not be responsible for the treatment of minor ailments, it is incredibly wasteful for it to be so. France, Germany, Scandinavia all have the expectation of people paying for OTC products without GP consultation. They all have GP demand suppression systems in place. The grossly exaggerated (and disengenous) moral inequality stance just doesn't hold up. In fact, it is being used as veil for profiteering by those who see the nanny state as a way to increase their bottom line. 

Shaun Steren, Pharmaceutical Adviser

Therefore the solution is for GPs to refuse to prescribe these items and tell patients to purchase them from a pharmacy. The solution is not to invent an expensive scheme which subsidises very low cost items. 

I do appreciate many people in the UK struggle with the concept of having to pay for anything, so let's give them some tough medicine and introduce them to the world of economic reality and personal responsibility. Shocking idea, I know. 

Angela Channing, Community pharmacist

I agree with everything you say Shaun. Too many people expect a free ride these days and to get everything for nothing. We could do with Jeremy Hunt doing a party political broadcast on every main channel and explaining what you have said, and also about how 1 in 3 people don't need to actually be in A and E.  There was a man on the TV today they interviewed who had gone with hip pain!  Now, to me, that isn't an accident and it isn't an emergency. When are people going to realise the clue is in the title!!  

And as for people moaning they can't get a GP appt. then maybe those surgeries should appoint pharmacists to do the medicine reviews/repeats and advanced nurse practitioners to triage all 'on the day' cases. A surgery near me has done this and it was a huge success.  Everybody gets seen by someone on the day as requested and filtered through the system to the most appropriate practitioner.  Result : patients much happier. Much less use of out of hours and A&E.  

 

Brian Smith, Pharmacy technician

Excellent news. Every CCG needs to do the same. The cost of these ridiculous schemes can no longer be justified. And it is regularly abused. Anyone working in a pharmacy will have dealt with people getting whatever they possibly can for "free". The worst case i know of personally was a group from a local camp site. They came in every week with various stories and issues. They went from pharmacy to pharmacy doing the same thing. I was a locum at the time. I came across these same people time after time. Their nice little scam ended with them flogging it on a car boot. This is an extreme case yes but an example of what goes on. Everyone can afford a bottle of generic analgesic and if they genuinely can't then they'd get it on script and the gp can make the decision. Any scheme that is open to so much abuse must be stopped. Next, as another person said, lets get rid of the rest of the items on script such as food, toiletries etc. Why do we all have to pay for others food?? Aqueous cream on a script?? It's madness. The government wants to find ways of saving money so start with script items. 

Valentine Trodd, Community pharmacist

Tip of the iceberg, but a start nonetheless... Next we need to tackle toothpaste, shower gel, shampoo, bread and to rationalise the vast array of mositurisers available on Rx. Hey, I love a bit of Aveeno as much as the next guy but I gotta pay for it. Also, I wonder where all the nicotine patches, gum, etc. on ebay is coming from?

Angela Channing, Community pharmacist

Exactly!  And since when over the last few years did dentists decide every other patient needs 4 tubes of Duraphat?! 

C A, Community pharmacist

God your dentists are stingy... the ones round here prescribe 6 at a time!

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