The NHS supplies millions of medicines to patients every year. Nationally there has been a move to review which medicines are prescribed to patients in order to make best use of NHS resources and in response to some medicines being widely and cheaply available over the counter.
A number of CCGs across the country have already either ceased funding gluten-free foods or put restrictions on the groups to whom gluten-free foods are available. The gluten-free food service in Milton Keynes costs £100,000 per annum, serving 300 patients with coeliac disease.
Gluten-free foods are currently available upon prescription for patients with coeliac disease. Today the availability of gluten-free foods has increased dramatically and they are found in almost all major supermarkets.
Under the CCG’s current policy, people with coeliac disease can obtain a wide range of gluten-free foods via an NHS prescription including: bread/rolls, bread mixes, crackers, pasta, pizza bases, breakfast cereals and oats
The CCG proposes to cease to fund the provision of gluten-free foods. The only exception to this should be if there are specific circumstances when a patient could be at risk of dietary neglect. In these circumstances the patient’s GP will be able to apply to the CCG with an Individual Funding Request.
The implementation of a policy will reduce variation between practices’ prescribing approaches, providing consistency for patients. It is expected that implementation of this policy could provide savings on prescribing of around £66,000 per annum.
Over the counter medicines are medicines such as painkillers, cough and cold remedies, antihistamines and some skin products.
The proposal is that the CCG stops funding (and GPs stop prescribing) over the counter medicines on NHS prescription for conditions that can be managed through self-care. This will encourage patients with minor ailments and self-limiting conditions to self-care or seek advice from community pharmacists and as a result this will free up much needed GP practice time to see more serious cases that do need their attention. Where a treatment is needed for a long-term chronic condition or there are legal restrictions on the amount of medicine that can be purchased over the counter, then the patient’s regular clinician will still be able to prescribe.
It is estimated that up to £1 million of medicines are wasted each year in Milton Keynes. At a time when the NHS is more financially challenged than ever before, patients, pharmacies and GPs have an important role to play in reducing the current level of drug wastage.
The CCG is proposing a number of changes to bring about greater efficiency and less wastage:
The CCG recognises the importance of ensuring that this change in policy does not prevent frail elderly and other vulnerable patients from getting the medicines they need, and will work with local GPs and pharmacies to ensure that implementation plans allow a degree of flexibility to safeguard this.
There is a national Drugs to Review for Optimised Prescribing (DROP) list of drugs and treatments which proposes that ‘treatments of limited clinical value are not used and medicines no longer required are stopped’.
As with over the counter medicines, there is wide variation in prescribing behaviour amongst GP practices with regard to items on this list and reducing this variation would lead to consistency for patients and reduce costs. The list includes vaccines for travel, branded products where generic forms are available, high cost medicines to lower cholesterol and some patches for pain relief.
The CCG proposes implementing restrictions on GP prescribing of items on the DROP list. This means:
Additionally, some patients may find that the medicines that they are used to taking will be changed to one that has the same active ingredient but a different name. In some cases the active ingredient will be changed to one that provides the same clinical effect but is less expensive for the NHS. These changes will provide savings of around £90,000 per annum.