Posted 12 December 2017
NHS England has decided to stop covering 18 “low value” treatments, a move the government believes will generate £141 million in annual savings. The list includes seven that have also also been referred to the Department of Health for blacklisting: homeopathy, herbal treatments, omega-3 fatty acid compounds (fish oil), co-proxamol, rubefacients (excluding topical NSAIDS), lutein and antioxidants, and glucosamine and chondroitin.
[Items which should not be routinely prescribed in primary care: Consultation and Report of Findings. NHS England, Nov 30, 2017] https://www.england.nhs.uk/wp-content/uploads/2017/11/items-which-should-not-be-routinely-precscribed-in-pc-consultation-report.pdf
The NHS England and NHSCC led clinical working group developed guidelines regarding a list of 18 products which they considered to be ineffective, unnecessary, inappropriate or unsafe for prescription on the NHS.
The 18 items were categorised under three headings:
- Products of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns: Co-proxamol, Omega-3 fatty acid compounds, Lidocaine Plasters, Rubefacients, Dosulepin, Glucosamine and Chondroitin combination product, Lutein and Antioxidants combination product, Oxycodone and Naloxone combination product, Homeopathy, Herbal Medicines
- Products which are clinically effective but where more cost-effective products are available (this includes products that have been subject to excessive price inflation): Liothyronine, Prolonged-release Doxazosin, Perindopril Arginine, Immediate-release Fentanyl, Once Daily Tadalafil, Trimipramine, Paracetamol and Tramadol combination product
- Products which are clinically effective but deemed a low priority for NHS funding:
Travel Vaccines (Public Health England will be undertaking policy work on this).
The group also sought views generally on the potential restriction on prescription of over the counter medicines used for generally minor and/or self-limiting conditions. These included:
- Products that can be purchased over the counter, and sometimes at a lower cost than would be incurred by the NHS
- Products that treat a condition that is considered to be self-limiting and so does not need treatment as it will heal or be cured of its own accord, and/or
- Products that treat a condition which lends itself to self-care, i.e. that the person suffering does not normally need to seek medical care and/or treatment for the condition.
Herbal Treatments are currently available in the UK to help with minor health conditions that do not require medical supervision. This is a very wide category and includes things like St John’s Wort, Black Cohosh and Chinese medicines. Herbal Treatments can come in a variety of formulations, such as tablets, capsules, powders and sprays. These items can be bought over the counter. The inclusion of Herbal Treatments within this consultation is due to the lack of robust evidence of their clinical effectiveness.