General practitioner England

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Prescription cutbacks prompt calls for review

GP Prescriptions and notes

Doctors leaders have called for a ‘fundamental review’ of national prescribing recommendations to end a ‘confusing’ and ‘irritating’ post-code lottery for patients.

It comes as NHS England has announced plans to consider the future availability of suncream, cold remedies and gluten-free food on prescription.

The move could save around £400m a year and NHS leaders believe the ‘low-value’ medicines have little or no clinical value.

The review, which also includes some types of pain relief and travel vaccines, could result in a full ban on prescriptions or tighter restrictions on GPs.

BMA GP committee deputy chair Richard Vautrey said the answer to prescribing problems is a full review rather than creating more disparity been local areas and greater confusion.

Dr Vautrey said: ‘GPs have a long history of cost-effective prescribing compared with many other health systems around the world, but recently there has been increased frustration that CCGs (clinical commissioning groups) have been taking different approaches to prescribing restrictions.

'This has led to confusion and irritation for patients and potentially dangerous pressure to repeatedly change branded generics and implementing varying restrictions on particular items. This post-code lottery is unfair and there is a need for clear national arrangements that apply to all.

‘However, rather than tinkering with the system there needs to be a fundamental review so that all patients are treated fairly, no matter where they live, and GPs are not placed in an unacceptable situation of being pressured to limit prescribing when their patients are requesting prescriptions.

'Any new scheme needs to ensure that those who are eligible for free prescriptions should be able to obtain these products directly from a pharmacist rather than making an appointment with a GP.’

 

Top 10

The proposals contain a list of 10 products in total – with an alternative to Viagra, nerve pain-related plasters and fish oils also on the list.

A spokesperson for NHS England said: ‘The increasing demand for prescriptions for medication that can be bought over the counter at relatively low cost, often for self-limiting or minor conditions, underlines the need for all healthcare professionals to work even closer with patients to ensure the best possible value from NHS resources.’

Last year the BMA warned that GPs were being put at risk of contract breaches and confrontations with patients by ‘covert rationing’ of medicines by health managers.

The warning came after it emerged that two CCGs had curbed the prescription of medicines as part of cost-cutting measures.

In one case, NHS Stockport CCG advised GPs in the town against prescribing statins according to evidence-based guidelines issued by NICE (the National Institute for Health and Care Excellence).

The CCG advised GPs to prescribe the medicine to patients who have a risk of cardiovascular disease of at least 20 per cent.

NICE guidance says the drug should be considered for patients with a smaller risk – of 10 per cent or more – of developing the condition.

NHS Stockport CCG's decision would deny patients the chance to decrease the risk of getting a disease that ‘maims and kills one in three’, a spokesperson for NICE said.

The CCG also told its GPs to prescribe the drug simvastatin instead of the NICE-recommended but more costly astrovastatin.

In another instance of restricted prescribing, NHS Bristol CCG told GPs in the city last month to avoid issuing drugs and treatments that could be bought by patients over the counter in a bid to save £5.7m a year.

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