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NHS England's prescribing blacklist didn't bring in predicted savings

Headlice treatments were among those blacklisted by NHS England
Headlice treatments were among those blacklisted by NHS England

Pharmacists are unsurprised that NHS England’s blacklist of over-the-counter (OTC) products has saved less than a quarter of the predicted savings.

NHS England published guidance in March 2018 advising GPs to “curb prescribing” of OTC treatments for certain conditions (see a full list below). Instead, it wanted GPs to encourage these patients to manage their ailments themselves, which it estimated “may save up to £136 million, once all discounts and clawbacks have been accounted for”.

But recently appointed pharmacy minister Seema Kennedy admitted in a written response to a parliamentary question last week (April 8) that the total spend for OTC medicines for the 12 months to January 2019 had fallen just £25.9m to £449.4m, when compared with the previous year.

“This saving does not account for the potential impact to the NHS from a reduced number of GP appointments, for which no assessment has been made,” she added.

Contractors unsurprised

Contractors told C+D they were unsurprised the OTC blacklist had not brought in the desired savings, and that the switch had not led to an increase in OTC sales in their pharmacies.

Amish Patel, owner of Hodgson Pharmacy in Longfield, Kent, said £25m was “still a big saving at the end of the day”.

“I do worry that people may be going without,” he added. “Personally, I haven’t seen my OTC sales go up.”

Mr Patel’s team had to counsel a “small handful of patients” about the prescribing changes for the first couple of months. “But after that, I can’t think of any situations where I’ve had a patient say [they] can’t afford it or are moaning.”

Martin Bennett MBE, owner of Wicker Pharmacy in Sheffield, said the limited savings recouped by NHS England “didn’t surprise me much”.

“There’s a lot of people that [GPs] have to make exceptions for,” he pointed out.

“I’ve not had a lot of people complaining about it,” added Mr Bennett, who attributed the lack of additional retail revenue to patients “looking for somewhere they can buy [their OTC product] at the absolute cheapest price, which will not be us.”

35 conditions NHS England is restricting prescribing for

  • Acute sore throat except where "red flag" symptoms are identified
  • Infrequent cold sores of the lip – except where "red flag" symptoms are identified and or the patients immunocompromised
  • Conjunctivitis – except where "red flag" symptoms are identified
  • Coughs and colds and nasal congestion – except where "red flag" symptoms are identified
  • Cradle cap (seborrhoeic dermatitis – infants) – except if "causing distress to the infant and not improving"
  • Haemorrhoids – except where "red flag" symptoms are identified
  • Infant colic – except where "red flag" symptoms are identified
  • Mild cystitis – except where "red flag" symptoms are identified
  • Mild irritant dermatitis
  • Dandruff
  • Diarrhoea (adults)
  • Dry eyes/sore (tired) eyes
  • Earwax
  • Excessive sweating (hyperhidrosis)
  • Headlice
  • Indigestion and heartburn
  • Infrequent constipation
  • Infrequent migraine
  • Insect bites and stings
  • Mild acne
  • Mild dry skin
  • Sunburn
  • Sun protection  except for "Advisory Committee on Borderline Substances (ACBS)-approved indication of photodermatoses (ie where skin protection should be prescribed)"
  • Mild to moderate hay fever/seasonal rhinitis
  • Minor burns and scalds "However, more serious burns always require professional medical attention"
  • Minor conditions associated with pain, discomfort and/fever (eg aches and sprains, headache, period pain, back pain)
  • Mouth ulcers
  • Nappy rash
  • Oral thrush
  • Prevention of dental caries
  • Ringworm/athlete's foot – except where "lymphoedema or history of lower-limb cellulitis" is identified.
  • Teething/mild toothache
  • Threadworms
  • Travel sickness
  • Warts and verrucae

Source: NHS England: Conditions for which OTC items should not routinely be prescribed in primary care: Guidance for CCGs, March 2018

In June 2017, C+D brought together industry leaders to discuss what NHS England’s plans to scrap certain treatments from prescriptions could mean for pharmacists, patients, and the wider NHS. Listen to the debate in full below:

How have your patients been affected by NHS England's prescribing restrictions?

Leon The Apothecary, Student

Is it possible to get a comment from a GP, I'd love to hear their thoughts on the matter.

Uma Patel, Community pharmacist

The DoH has passed the buck to GP's by not Black Listing the items. So the GP's and us the 'under utilised' pharmacist end up explaining the government policy to irate patients.

There will be minor savings. The saving of GP's time (to play more golf) was not part of the original estimate. Poor new minister, she had to gloss over the Chief Pharmacist's another gaffe

Female Tech, Pharmacy technician

Get them all on the blacklist, until then GPs will give in, because the entitled brigade will make their lives miserable. I don't blame GPs for wanting an easy life. We all know how abusive patients can get.

Edward H Rowan, Locum pharmacist

Prescribing these items won't be stopped until they're on the blacklist. Nothing much has been added to that since about 1988. GPs won't take any notice of the NHS just asking them nicely not to prescribe these things, the only thing they will take notice of is when it's forced upon them, and probably they'll want paying as well.

Reeyah H, Community pharmacist

As a contractor, I’ve definitely seen an increase in OTC sales. Not to the point I’m going to get rich (the government has made sure of that!), but products like Vitamin D supplements, head lice treatments etc are selling more. 

Lucky Ex-Boots Slave, Primary care pharmacist

Patients simply don't want to pay because most are "entitled" to free scripts! General practice has been getting all sorts of additional moaning and complaints because of this otc guidance. Don't get me wrong I do think this is good initiatives to save money but to make it work there must be a clear cut e.g. to put all those otc meds on the actual blacklist while lifting the restrictions on otc licence. But again do the nhs and minister have the balls to do this? No.

C A, Community pharmacist

It's not a blacklist. It is guidance and should be viewed as such, so it is unsurprising it has been ignored, and consequently unsurprising that the savings haven't been as great as predicted.

That said, not all CCGs have fully implemented it, and the savings may increase given further time. 

I'm also not surprised that pharmacies are not seing an uplift, as it shows the value patients sometimes seem to place on things that aren't free.

Leon The Apothecary, Student

It makes sense that the expected savings were not met. From my experience, many prescribers simply ignore the advice. I still see a ton of OTC items being prescribed. If the guidelines were enforced we would see a much different picture I wager.

Adam Hall, Community pharmacist

This is bad news for pharmacy - a reduction in income due ot reduced prescribing but no corresponding uplift in pharmacy sales

C A, Community pharmacist

Less work though... if you exclude the time taken to explain it to patients, oh wait.

N O, Pharmaceutical Adviser

So is this a good news or bad news??? Are we supposed to be happy or sad??? This article has no conclusion!!!

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