The NHS is teetering on the brink.

In the last month alone there have been lurid headlines about clinical commissioning groups suspending all but the most urgent treatments for patients, restrictions on the use of statins, increasing limits on surgery for cataracts and hip and knee operations, A&E departments under threat of closure… the list goes on.

The advice given to GPs by Stockport CCG not to prescribe statins to patients who have a cardiovascular risk of between 10-20 per cent (the CCG wants to treat only when the risk is at least 20 per cent), going against NICE guidance, is particularly concerning.

It also starkly illustrates the scale of the financial crisis facing the health service when clinical decisions are based not on evidence-based guidelines but driven instead by NHS managers’ desperate attempts to balance the books. The BMA was quick to respond with a warning about “covert rationing”.

Maybe a more sensible approach to rationing comes from Bristol CCG, which in a bid to save money told GPs to avoid prescribing drugs that could be bought over the counter. No one is arguing that patients should not receive any medicine their GP considers necessary but, as PAGB points out in a recent report, if everyone with a self-treatable condition who attended a GP appointment or visited A&E were to practise self-care, it could save the NHS £2.3bn.

It is surely a no-brainer that, in these straightened times, the NHS places a much higher priority on self-care, with pharmacy advice at its centre.