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Plan to end wasteful prescribing could save £190m a year

Which treatments will prescribing ban hit?

A plan to reduce the number of prescriptions for ineffective, over-priced or low-value treatments could cut the NHS annual drugs bill by £190m.

NHS England is conducting a consultation (closing on 21 October 2017) on new guidelines for clinical commissioning groups (CCGs) that discourage the prescribing of 18 treatments. The guidance will recommend that patients be taken off some items; while other items will not be permitted for new patients. The treatments concerned are:

• co-proxamol

• dosulepin

• prolonged-release doxazosin

• immediate release fentanyl

• glucosamine and chondroitin

• herbal treatments

• homeopathy

• lidocaine plasters

• liothyronine

• lutein and antioxidants

• omega-3 fatty acid compounds

• oxycodone and naloxone combination

• paracetamol and tramadol combination

• perindopril arginine

• rubefacients (excluding topical non-steroidal anti-inflammatory drugs)

• tadalafil

• travel vaccines

• trimipramine

Gluten-free foods have also made the proposed ban list because they are now widely available in shops and supermarkets. GF foods on prescription cost the NHS £26m a year.

The proposed guidelines will also limit the prescribing of 3,200 items that are sold over the counter, often at a lower price than the NHS pays. This group includes treatments for minor, self-limiting conditions such as coughs, colds, constipation and excessive earwax. Sun cream lotions are also included.

It is expected that CCGs will incorporate the proposed guidance into their local policies, but the guidance does not remove a prescriber’s clinical discretion. The guidance recognises that prescription of some items is appropriate in certain circumstances.

Further information

NHS England: Items which should not routinely be prescribed in primary care: a consultation on guidance for CCGs(has a list of all the items and the rationale behind their inclusion; and a list of possible unintended consequences of the guidance)

NHS England: Items which should not be routinely prescribed in primary care: a consultation on guidance for CCGs