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