Restrictions on prescribing certain medicines for common conditions will exacerbate health inequalities and compromise fundamental NHS principles, the Royal Pharmaceutical Society has said. The RPS is calling for a greater focus on pharmacy minor ailments schemes instead.

The Society was commenting on the launch of an NHS England consultation on ‘Items which should not routinely be prescribed in primary care’. This consultation, which closes on 21 October, focuses on 18 items, including Fentanyl patches, homeopathy and travel vaccines. It also covers over 3,200 commonly prescribed products, such a painkillers, antifungal creams and eczema preparations, many of which are available over the counter at a lower cost than the NHS pays for them.

Cost saving

As P3 reported in March, the review is part of a cost saving initiative announced with the publication of the NHS Delivery Plan that could deliver efficiencies of around £400 million a year. NHS England chief executive Simon Stevens said that while the NHS "is probably the world's most efficient health service", there is still "waste and inefficiency that we're determined to root out".

Restrictions may be introduced

The RPS commented that although it welcomes the consultation, and in particular the inclusion of homeopathy in the category of ineffective and unsafe medicines, it has “serious concerns in relation to the proposed restriction on prescribing clinically effective medicines to treat common conditions, such as head lice or athlete’s foot”.

While NHS England’s position is that diverting money away from these treatments will help fund innovative new drugs, the RPS says such a move “would fundamentally alter the principle that care is free at the point of delivery and as such should be legislated for by Parliament and not implemented by Clinical Commissioning Groups”.

Minor ailment schemes: a solution?

RPS England Board chair Sandra Gidley said: “We would encourage people with minor health problems to self care with the support of a pharmacist and to buy medicines where appropriate and affordable to the individual.” 

“However, expecting everyone to pay for medicines for common conditions will further increase health inequalities and worsen the health of patients who cannot afford them. A blanket ban on prescribing of items to buy will not improve individual quality of life or health outcomes in England,” Gidley said.

She argued that a more effective approach would be to treat people via NHS pharmacy minor ailment schemes: “These schemes enable patients to be treated for minor ailments at no cost from the pharmacy, if they already receive free prescriptions. Such schemes already operate in Scotland and Wales and should be made available across England as soon as possible.”

Opinions from the health sector

Other bodies echoed the RPS’ warning, with professor Helen Stokes-Lampard of the Royal College of GPs saying that while “safe, sensible measures” to reduce costs were welcome, “imposing blanket policies on GPs that don’t take into account demographic differences across the country, or that don’t allow for flexibility for a patient’s individual circumstances, risks alienating the most vulnerable in society”. 

Rachel Power, chief executive of the Patients Association, said: “While there’s merit in looking at all of these issues sensibly, the fact that it’s happening now is yet another indication that the NHS does not have the financial settlement it needs from government to provide a comprehensive health service.”

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