Restricting prescription OTC products produces much lower savings than promised

Despite promising up to £100m on savings when it published guidance to reduce prescriptions for over-the-counter medicines, NHS England only cut spending by £25.9m on the products in the year to January 2019.

Simon Stevens, chief executive of NHS England

NHS spending on over-the-counter (OTC) items in England fell by £25.9m in the year to January 2019, despite NHS England promising up to £100m of savings when it published guidance on reducing the number of prescriptions for OTC medicines.

The guidance for clinical commissioning groups (CCGs) was published in March 2018, meaning it was only in effect for nine months of the year, but the projected savings still fall well below the £100m savings that Simon Stevens, chief executive of NHS England, said would be achieved at the time that the guidance was published.

The figures were revealed by new pharmacy minister Seema Kennedy
 in a written answer to a Department of Health and Social Care question, published online on 8 April 2019.

“We are informed by NHS England that in the 12 months to January 2019, the total NHS spend in England on OTC items was £449.4m,” she wrote.

“This was a saving on total spend of £25.9m from the corresponding figure for the 12 months to January 2018, which was £475.3m.”

Kennedy added that the saving did not account for the potential impact to the NHS from a reduced number of GP appointments, for which no assessment had been made.

The NHS guidance limited the routine prescribing of OTC products for 35 conditions, such as indigestion, cradle cap, haemorrhoids, head lice, mild acne and “minor conditions associated with pain”.

A public consultation on the guidance led to concerns being raised by the Royal Pharmaceutical Society and other organisations about the effect that the prescribing restrictions would have on patients who could not afford to pay for them. 

NHS England responded to these concerns by including a number of exemptions in its guidance for patients whose ability to manage self-care is compromised because of “medical, mental health, or significant social vulnerability”.

This includes patients with financial difficulties, although exemption from paying prescription charges would not mean an automatic exemption from the restrictions introduced by the guidance.

An investigation carried out by The Pharmaceutical Journal
in October 2018 found that 64% of CCGs had implemented NHS England’s guidance or had similar pre-existing guidance to restrict the prescribing of OTC or ‘low-value’ medicines.

The investigation also revealed that 23% of CCGs said they were planning to implement the guidance later, or were “considering” implementing it.

In some areas, CCGs have made the decision to decommission their minor ailments service in response to the NHS England guidance.

Sandra Gidley, chair of the English Pharmacy Board at the Royal Pharmaceutical Society, said that GPs had taken a “very pragmatic view” of the guidance and have appeared to have carried on prescribing items if they believe the patient won’t be able to buy the item.

“It would be interesting to see if there are differences in prescribing patterns between areas with minor ailments schemes and those without,” she said.

Last updated
Citation
The Pharmaceutical Journal, April 2019;Online:DOI:10.1211/PJ.2019.20206432