Senior GP questions 'legality' of CCGs scrapping prescription items

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James Kingsland GP NAPC CCG minor ailments
Dr James Kingsland: We need to be careful that we do not ration care

Senior GP James Kingsland has questioned the "legality" of clinical commissioning groups (CCGs) scrapping items from prescriptions to save money.

Responding to reports of individual CCGs stopping the routine prescribing of certain treatments, such as over-the-counter medicines and gluten-free products, from prescriptions, National Association of Primary Care president Dr Kingsland told C+D that “there is a question about some of the legalities”.

He claimed there is case law concerning patients challenging the availability of certain treatments in different areas across the country, so “we need to be careful...to make sure not to ration care”.

Watch C+D's interview with Dr Kingsland, recorded at the Pharmaceutical Services Negotiating Committee’s conference in Manchester on November 1, below.

Recent examples of prescription cuts

In August, Professor Azeem Majeed of Imperial College London reported Dudley CCG to the advertising regulator for a poster stating "prescriptions for self-care medicines are no longer available from your GP”. Professor Majeed told C+D “CCGs have no power over the prescribing of drugs by GPs – that power lies with the Department of Health”.

C+D reported last month that East and North Hertfordshire and Herts Valley CCGs are the latest to limit routine prescribing for minor ailments and scrap gluten-free products from prescriptions.

NHS England’s prescription agenda

In June, C+D hosted a roundtable debate with representatives from pharmacy, commissioning and Coeliac UK to discuss NHS England’s plans to scrap a range of products and services from prescriptions.

You can listen to the full debate in the podcast below.

9 Comments
Question: 
Is your CCG considering scrapping products from prescriptions?

David Kent, Community pharmacist

I wrote to the chair of my CCG pointing out that the CCG was breaking NIHCE guidelines in refusing to sanction Vit D for clinically diagnosed deficiency and also for recommending that a proprietory drug be prescribed as the two generic ingredients individually even though that approach cost more than the proprietory.  I was not even given the courtesy of a reply.  Shame on you Dr MO Abadi and Enfield.....CCG

Charles Whitfield Bott, Pharmacist Director

Anyone done any scripts for Freestyle Libre?

Caroline Jones, Community pharmacist

Instead of a Blacklist; maybe there should just be a list of what is prescribable - if it's not on the list you can't get it free! I still see examples of patients getting prescribed Cranberry capsules etc.  I also think that when dentists recommend Sodium Fluoride T/P it should come out of their budget, as should creams and eye drops recommended by chiropodist a and opticians!

Valentine Trodd, Community pharmacist

Agreed. It seems like the 'Blacklist' has difficulty keeping up!

Valentine Trodd, Community pharmacist

Maybe we need a triage system in surgeries manned by a nurse perhaps, redirecting minor issues to a minor ailments service in the community pharmacy? Oh, wait they scrapped that too...

Ben Merriman, Community pharmacist

The only way to enforce prescribing policies such as these is to add the medicines concerned to the Black List, something DH must do. CCGs can issue guidelines but ultimately, a prescriber is able to prescribe any medicine it in the blacklist and any device listed in IX of the Drug Tariff, regardless of what a guideline says.

Rubicon Mango, Academic pharmacist

Maybe if GP's across the country didn't overprescribe and give drugs like they are candy. Since qualification I am shocked at the number of items I see prescribed in community per patient. Polypharmacy in the long run actually causes more damage to the NHS and its financial budgets.

Gerry Diamond, Primary care pharmacist

Well the point is people need to catch on to themselves that there is a finite drugs budget in each CCG and its ridiculous to expect GPs to provide unlimited paracetamol, ibuprofen, shampoos and other self care items in general. I'm afraid people should but these items as they are available at reasonable prices and I think people just fill up their medicines cabinets with rubbish. xxx

Meera Sharma, Community pharmacist

Agreed - I think healthcare professionals and patients need to wake up to the fact that there isn't any unlimited reserve of mmoney in the NHS, and the amount there is better spent on the cancer treatments and more critical/LTC as opposed to prescribing aveeno, oilatum and calpol which are easily available from over the counter. While I realise there are financial constraints - these constraints are being experienced by everyone in their daily lives (food, clothing, school uniforms etc.) in some form or another, so it's not really an excuse to prescribe low-value items.

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