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Prescribing

Restrictions on prescribing OTC treatments rejected in Wales

Exclusive: The All Wales Prescribing Advisory Group says “numerous concerns” were raised about restricting the routine prescribing of over-the-counter medicines for some minor, self-limiting conditions, leading to the proposals being rejected in Wales.

Proposals to restrict the prescribing of medicines and other treatments that are available over the counter (OTC) will not go ahead in Wales.

The All Wales Prescribing Advisory Group (AWPAG), a Welsh government advisory body, said that “numerous concerns” raised as part of a consultation on whether to restrict prescribing of OTC medicines for some minor, self-limiting conditions had led to rejection of the proposals.

The proposals were identical to guidance adopted by NHS England in March 2018, which instructs clinical commissioning groups to restrict routine prescribing of products for 35 conditions, including cradle cap, haemorrhoids, head lice, indigestion, mild acne and “minor conditions associated with pain”.

Reponses to the Welsh consultation were published anonymously; however, one respondent, describing themselves as a “professional association and trade union representing and negotiating on behalf of all doctors and medical students in the UK”, said that “it is already an intrinsic part of a GP’s job to help patients to care for their own minor illnesses, and to explain the availability and proper use of [OTC] preparations … GPs must continue to treat patients according to their individual circumstances and needs, and that includes issuing prescriptions where there are reasons why self-care is inappropriate”.

Another respondent, who said they were from “the body which represents the vast majority of independent community pharmacy owners in all four countries in the UK”, said it “recognises the current financial pressures of the NHS” but was concerned by the “broad-brush methodology” being considered.

“It is recognised that NHS England has already begun implementing some of the policies mentioned in the AWPAG’s consultation and initial indications show that this is already beginning to have a negative impact on patients”, the respondent said.

A further response said “not only do these proposals represent an attack on the very principles of NHS Wales, they do not offer good value. I believe they will increase costs; disempower prescribers while placing increasing burden on them; put patient outcomes at risk; create and worsen inequalities in healthcare; and disadvantage the most vulnerable members of society.”

Although the proposed guidance will not be introduced, two items on the list of proposed restrictions — probiotics, and vitamins and minerals — may be included in future work on medicines identified as a low priority for funding in NHS Wales, the AWPAG said.

The AWPAG advised the All Wales Medicines Strategy Group Steering Committee, at a meeting held on 26 March 2019, that the draft guidance should not be progressed.

Earlier in April 2019, pharmacy minister Seema Kennedy said in a parliamentary response that spending by NHS England on OTC items fell by £25.9m in the period from March 2018 to January 2019 — far short of projected annual savings of up to £100m which were predicted when the guidance on routine prescribing of OTC products was issued by Simon Stevens, chief executive of NHS England.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206459

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