NHS will publish national list of “low value” drugs to curb GPs’ prescribing costs

BMJ 2017; 356 doi: (Published 30 March 2017) Cite this as: BMJ 2017;356:j1613
  1. Gareth Iacobucci

NHS England is to publish a national list of “low value” drugs as part of a new drive to reduce GPs’ prescribing costs.

The proposals were unveiled just a week after The BMJ reported that locally driven plans from clinical commissioning groups (CCGs) to limit GPs’ prescribing of over-the-counter medicines had sparked debate among GPs and had prompted calls for national guidance.1

Announcing its plans on Tuesday 28 March,2 NHS England said that it would now issue national guidance to CCGs from April 2017 to ensure consistency in how policies are applied. It said that the changes could save the NHS £400m (€462m; $496m) a year that could be reinvested to benefit patients better.

The review will initially focus on 10 treatments that NHS Clinical Commissioners—the body that represents CCGs—estimates could save £128m a year.3 These products, which include lidocaine plasters for treatment of post-herpetic neuralgia, liothyronine for underactive thyroid, and gluten-free foods (see box), have been identified as ineffective, unnecessary, unsafe, or inappropriate for the NHS to prescribe.

After this initial phase NHS England will explore whether to restrict a wider range of medicines of relatively low clinical value or priority, or those that are readily available over the counter at lower cost, such as treatment for coughs and colds, antihistamines, and indigestion medicines.

It promised careful consideration to ensure that particular groups of people are not disproportionately affected and that best clinical practice is followed. Patient groups, clinicians, commissioners, and providers will all be consulted on the proposals.

NHS England said, “The review will seek to address the growing concern over the justification for many low value prescriptions which absorb millions of NHS funding every year, that could be spent on care which has a bigger impact on improving outcomes for patients.”

Graham Jackson, co-chair of NHS Clinical Commissioners, said, “We need to be honest with the population: the NHS can and does provide high quality cost effective care, but our ability to continue to do so will be restricted if we can’t prioritise those areas which will get the best outcomes for patients while getting the best value for our limited NHS budget.

“The medicines spend is one where there is huge potential to unlock resources and redirect them to those higher priority areas like mental health and primary care.”

Julie Wood, chief executive of NHS Clinical Commissioners, added, “This is not about cutting essential services or restricting access for patients to services they need—it is about allowing local clinical leaders to make the best and most efficient use of the money CCGs have available to spend in really challenging circumstances.

“Having national support from NHS England and the Department of Health for those local decisions means there will be more consistency and reduce variation for patients.”

Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said, “Prescription costs are a significant expense for the health service, and so if we can take sensible measures to reduce these costs then we should. Many medications are available very cheaply—and other products are much more readily obtainable than when they first became available on prescription, and GPs and the public should be mindful of this.”

Katherine Murphy, chief executive officer of the Patients Association, agreed that cost effective prescribing was important but said that it was important for the NHS to act carefully and ensure that patients who may have their medicines switched are “fully consulted and informed.”

Murphy added, “While some drugs can be purchased more cheaply over the counter than through prescriptions, for families on low incomes even this small extra cost could be difficult to meet.

“This is particularly true where people are living with long term conditions and need ongoing supplies of medicines, however low the nominal cost. We will want to be assured that this is taken into account and any harm mitigated.”

Ten “low value” products that could release as much as £128m

1—Products of low clinical effectiveness or where there is a lack of robust evidence of clinical effectiveness (£37.98m):

  • Co-proxamol (£8.32m)—analgesic

  • Omega 3 and fish oils (£5.65m)

  • Lidocaine plasters (£17.58m)

  • Rubefacients (£6.43m)

2—Products that are clinically effective but where more cost effective products are available (£58.69m); this includes products that have been subject to excessive price inflation:

  • Liothyronine (£30.93m)

  • Tadalafil (£10.51m)

  • Doxazosin modified release (£7.12m)

  • Fentanyl (£10.13m)

3—Items that are clinically effective but are deemed a low priority for NHS funding because of the nature of the product (£31.35m):

  • Some gluten-free foods (£21.88m)

  • Travel vaccines (£9.47m)


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