NHS England’s latest attempt to reduce the availability of treatment to patients was ill-conceived and always doomed to fail.

Ever since the NHS founder, Aneurin Bevan resigned from cabinet over the introduction of NHS fees 1951, successive Governments have pushed against the principle that NHS treatment should be free at the point of use.

Experience around the world confirms that imposing even a relatively small charge is guaranteed to reduce the numbers of patients accessing a drug or treatment, especially the poorest, regardless of how much they might need the drug.

The latest attempt by NHS England to restrict GP prescribing of OTC medicines for ‘self-limiting’ conditions and make patients pay for medicines available over the counter (OTC), was recently revealed to have made just a quarter of the forecast £100m annual savings.

New pharmacy minister Seema Kennedy MP was forced to admit in a statement that spending on OTC medicines had not fallen as much as originally forecast.

Dr Andrew Green, BMA GP committee clinical and prescribing lead told The Lowdown the savings envisaged “were always ambitious, because GPs were already advising patients to buy over-the-counter medications where appropriate, but prescribing when they believed there was a need.”

He questioned whether other savings had been made by avoiding GP appointments being made, but the statement by Ms Kennedy revealed no assessment had been made of this.

Pharmacists reported no increase in the number of OTC sales in the past year, according to trade publication Chemist+Druggist.

Sandra Gidley, chair of the English Pharmacy Board of the Royal Pharmaceutical Society commented: “In practice GPs have taken a very pragmatic view on [these prescribing guidelines] and appear 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 added.

While some common drugs like paracetamol can be bought more cheaply over the counter than on prescription, only with a prescription can patients access more than two days-worth of paracetamol, meaning that this is still useful to those required to take it daily, especially if they are entitled to free prescriptions.

Measuring Impact

Pointing patients to pharmacy services, as opposed to their GP practice has always been justified with the claim that it will free up GPs to deal with more needy patients. This can be the case, if alternative services adequately meet need. The minor ailments scheme for example, provides OTC drugs free for those who need them, without prescription.

Minor ailment schemes availability is patchy in England: however they are commissioned across Scotland and Wales, where prescriptions are already free. A PricewaterhouseCoopers report published in 2016 showed minor ailments schemes in England were worth nearly £50 million, nearly twice what NHS England’s latest prescribing restrictions achieved.

So not only was it possible to save more money, it was possible to do so while ensuring treatment was free at the point of use. Most of these savings were from reducing GP appointments made by these patients.

This claim was further backed up by a study done across Scotland last year that demonstrated 85.9% of patients who accessed a pharmacy-based minor ailments scheme required no other NHS service, and just 6.4% of patients went on to see their GP.

A further study published in 2017 demonstrated the schemes were good at reaching those who needed them most, with just 8% of patients who used a minor ailments scheme in England saying they would have purchased the medicine over the counter if the scheme had not been available. Over half (61%) of consultations were for children under the age of 16, a group entitled to free prescriptions anyway.

Unnecessary meddling

Interestingly, the All Wales Prescribing Advisory Group, an advisory body to the Welsh government  withdrew its support for introducing similar prescribing guidelines in Wales, just days after the minister made her statement.

Does the existence of minor ailments schemes make the restriction of prescribing for OTC medicines unnecessary? The decision in Wales suggests some may think so. Either way, it is clear that any attempts to undermine the principle of providing treatment to NHS patients free at the point of use, will often result in driving up costs elsewhere.

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Hannah Flynn is a health and science journalist. She has written for the Guardian and worked on a number of leading national trade publications for healthcare professionals, including Chemist+Druggist and Nursing Standard.

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