Changes to prescribing policies in B&NES

We are making some changes to our local prescribing policy.  Like other NHS organisations across the country, we have been assessing the effectiveness, health benefits and value for money of some treatments.

As a result, following public consultation, we are advising local GPs to prescribe gluten-free products to only the most vulnerable people living with coeliac disease. We are also advising GPs not to prescribe two types of over-the-counter medicines – painkillers and antihistamines – when used for short-term, minor ailments such as mild hayfever, headache, coughs and colds.

Dr Ruth Grabham, Medical Director of the CCG and local GP said: “Demand for all local health and care services is rising, but we have a limited budget. This means we have to look very carefully at where we spend our money. Last year the CCG spent nearly £500k on painkillers and antihistamines and £112K on gluten-free products. We believe this money should be used to commission other services which would be of greater benefit for more patients.”

The prescribing decisions were made following a four-week period public engagement from 24 November to 21 December 2016. Both consultations were promoted via the media and social media.  Additionally we wrote to all patients with coeliac disease, via their GP, to seek their views on the plans.

Gluten-free prescribing

Historically, gluten-free foods were not widely available, and receiving them via prescription was often the only way that many patients could access them. However, today there is much more awareness of coeliac disease, gluten sensitivity and other similar conditions and gluten-free foods are much easier to get hold of, with an increasingly varied range of products available from supermarkets and online retailers.

The price paid by the NHS for gluten-free foods on prescription is much higher than the price of similar products found in supermarkets; this does not represent good value for money for the NHS.

  • 366 responses were received to the gluten-free survey.
  • 81 per cent of respondents said they understood the reasons for proposing to stop prescribing gluten-free products.
  • 63 per cent of respondents disagreed with the proposal with 30 per cent in favour.

Many respondents commented on the need to not impose a blanket policy and asked for key exemptions for certain groups. Some people raised concerns about the price of gluten-free products and the impact on older people, children and families on low incomes.

As a result of this feedback, we will be providing GPs with guidance to identify and support vulnerable people, such as those on low incomes, children and people with learning difficulties. GPs will continue prescribing gluten-free products where they are sufficiently convinced that a patient’s long-term health may be adversely impacted by the changes.

We will continue to support patients with coeliac disease in following a gluten-free diet and will be writing to all affected patients with information about nutritional resources.  It will also provide contact details for organisations where dietary advice can be obtained. We are exploring options to set up a diet and nutrition clinic where patients with coeliac disease can receive tailored support from dieticians, and will also be contacting local retailers and pharmacists to encourage them to extend their range of gluten-free products.

Over-the-counter medicines for short-term minor ailments

Paracetamol and other painkillers cost around 1p per tablet in supermarkets and community pharmacists compared to 3p per tablet through the NHS.  In addition, a significant proportion of GP surgery time is taken up processing prescriptions for minor ailments which could be managed by patients or their carers without the need for prescription medicines.

  • We received 93 responses to the engagement.
  • 98 per cent of respondents understood why we are proposing the policy change, and 86 per cent agreed or strongly agreed with it, with 13 per cent disagreeing or strongly disagreeing.
  • Many respondents said that the NHS should not be required to pay for these medicines as they are readily available, cheaply in many outlets.

A number of comments focussed on the need to avoid a blanket policy and to create some exemptions for certain groups, i.e. those taking painkillers for long-term conditions, for those on low incomes and for young children.

We have listened to the feedback and agreed that in certain exceptional cases GPs may deem it medically necessary to prescribe these treatments because the patient is highly unlikely to source the medicines and self-care independently.

The policy changes will be phased in from April 2017.