NHS England has reminded CCGs of their “legal duties to advance equality and have regard to reduce health inequalities” when implementing new guidance to limit routine prescribing of items described as “low value”.
Prescribers are also reminded that they retain clinical discretion to decide what is in accordance with their professional duties.
In an announcement on Friday NHS England announced the treatments that should no longer be routinely prescribed. For the new year it has also announced the widely-anticipated consultation to introduce prescribing restrictions for over the counter medicines.
The list of low value items now subject to routine prescribing restriction includes:
- Homeopathy – no clear or robust evidence to support its use
- Herbal treatments – no clear or robust evidence to support its use
- Omega-3 fatty acid compounds (fish oil) – essential fatty acids which can be obtained through diet, low clinical effectiveness
- Co-proxamol – pain killer which has had its marketing authorisation withdrawn due to safety concerns
- Rubefacients (excluding topical NSAIDS) – warming muscle rub products, limited evidence
- Lutein and antioxidants – used to treat the eye condition age related macular degeneration , low clinical effectiveness
- Glucosamine and chondroitin – used for joint pain, low clinical effectiveness
Modified or clarified guidance has also been issued for five items (liothyronine, travel vaccines, lidocaine plasters and immediate release fentanyl).
The OTC medicines consultation in the new year will propose stopping the routine prescribing of products described as follows:
- Can be purchased over the counter, and sometimes at a lower cost than that which would be incurred by the NHS – eg, paracetamol
- Treat a condition that is considered to be self-limiting
- Treat a condition which could be managed by self-care.
NHS England and NHS Clinical Commissioners are working with GPs, pharmacists and patient groups to develop and refine the proposals which will be consulted on in the new year, in particular where exemptions may apply. Examples given in the relevant NHS England board papers do not include patients served by dispensing GPs.
Further information and the full list of low value products is available online.
DDA analysis explains the implications for dispensing GPs of these proposals, including increased workload.