NHS England has published proposals to blacklist prescriptions for “ineffective, over-priced and low value treatments” for common conditions.

A public consultation has been launched on new guidelines which state that 18 therapies – including homeopathy and herbal treatments – should no longer be prescribed on the NHS. Simon Stevens, NHS England’s chief executive, described homeopathy as “at best a placebo and a misuse of scarce NHS funds”.

Other therapies listed among the 18 include travel vaccines, immediate release fentanyl and lidocaine plasters.

The proposals also cover over 3,200 commonly prescribed products, many of which are sold over the counter in pharmacies, “often at a significantly lower price than the cost to the NHS”, says NHS England. The NHS spends around £645 million a year on these medicines, including painkillers, antifungal creams, earwax removal liquid and eczema preparations.

The consultation proposes initial action to limit prescribing products for minor self-limiting conditions, which currently cost £50-100 million a year, NHS England estimates. They include cough mixtures and cold treatments, eye drops, laxatives and sun creams.

NHS England also supports restricting the availability of gluten-free foods on prescription, which costs £26 million a year and is currently subject to a separate Department of Health consultation.

Simon Stevens said: “We are taking practical action to free up funding to better spend on modern drugs and treatments.”

Sir Bruce Keogh, NHS England medical director, added: “We need to end unnecessary expense to give us a bigger therapeutic bang for the NHS buck so we cut the fat and build the therapeutic muscle.”

Society gives cautious welcome

The Royal Pharmaceutical Society welcomed the consultation, saying ineffective and unsafe medicines should not be prescribed on the NHS. “Removing homeopathy, which has no scientific or pharmacological basis, from NHS supply is long overdue,” it commented.

However, the Society has “serious concerns” in relation to the proposed restriction on prescribing clinically effective medicines to treat common conditions such as head lice or athlete’s foot. This move would fundamentally alter the principle that care is free at the point of delivery and as such should be legislated for by Parliament and not implemented by clinical commissioning groups, it said.

RPS England board chair Sandra Gidley commented: “We would encourage people with minor health problems to self-care with the support of a pharmacist and to buy medicines where appropriate and affordable to the individual. However, expecting everyone to pay for medicines for common conditions will further increase health inequalities and worsen the health of patients who cannot afford them.”

A blanket ban on prescribing items available to buy will not improve individual quality of life or health outcomes in England, she maintained.

“Those on low incomes will be disproportionately affected. They should not be denied treatment because of an inability to pay. Longer term costs to the taxpayer of increased ill health, subsequent GP consultations or visits to A&E must also be taken into account as a result of medicines not having been prescribed.”

In order to reduce pressure on already overworked GPs, as well as out-of-hours and A&E services, people with minor health problems should be treated via NHS pharmacy minor ailment schemes, Ms Gidley said.

“These schemes enable patients to be treated for minor ailments at no cost from the pharmacy, if they already receive free prescriptions. Such schemes already operate in Scotland and Wales and should be made available across England as soon as possible.”

The consultation closes on October 21.

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