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GPC warning ignored as CCGs roll out bans on GPs prescribing OTC drugs

CCGs are imposing bans on GPs prescribing drugs available OTC just days after NHS England began a consultation on the issue, despite warnings that GPs refusing to prescribe medicines their patients need could be in breach of their contracts.

Prescribing restrictions for GPs (Photo: JH Lancy)
Prescribing restrictions for GPs (Photo: JH Lancy)

West Lancashire CCG has announced that 'low clinical value' treatments and gluten-free products 'will no longer be available on prescription' in the area from 4 September 2017. Lincolnshire's four CCGs have also imposed a similar ban since late 2016.

West Lancashire CCG said the move came on the recommendation of its medicines optimisation committee and clinical executive committee, with support from local GP practices.

GPC clinical and prescribing policy lead Dr Andrew Green has condemned the move, warning that CCGs do not have the power to ban GPs prescribing medicines that patients need.

If faced with upsetting their CCG or complying with GMS requirements GPs ‘should upset their CCG every time’, he told GPonline.

West Lancashire CCG plans to ban GPs from prescribing drugs that fall into four categories: treatments for minor ailments, treatments of uncertain clinical benefit, non-clinical products and gluten-free products.

Prescribing ban

The move comes days after NHS England opened a consultation on plans to ban GPs from prescribing drugs available OTC, which runs until mid October.

The GPC has warned that GPs would be in breach of the GMS contract and could get into legal trouble by following the orders and refusing to prescribe patients treatments they have told them they need.

West Lancashire CCG acknowledged its decision ‘will be an adjustment’ for some patients, but said it wanted to encourage people to self care and take responsibility for their health.

Its spend on low clinical value items and gluten-free products amounted to £461,000 last year, not including dispensing fees, it said.

If saved, this money could instead fund an additional 12,805 GP appointments, 4,079 A&E attendances or 4,044 MRI scans, the CCG said.

OTC drugs

Nicola Baxter, head of medicines optimisation at NHS West Lancashire CCG, said: ‘As a CCG, our commissioning decisions and policies are based on five key principles. This means that we will only commission treatments or services which are appropriate, effective, cost-effective, ethical and affordable.

‘To meet increasing demands for costs of healthcare we are reviewing what we currently commission in accordance with these principles.’

She added that feedback from surveys held with the public indicated a strong local backing for most of the proposals, with some concerns raised over the prices of gluten-free items for patients on low incomes.

‘While we understand this will be an adjustment for those patients who have come to rely on gluten-free foods on prescription, shop-bought items are still affordable and there is also of course the option to buy naturally gluten free products such as rice and potatoes.’

GMS requirements

Dr Green said: ‘We support measures to encourage patients to self-care, however CCGs have no power to ban GPs prescribing medicines that patients need.

‘West Lancashire GPs need to ensure that they comply with their GMS contractual requirements, and if faced with upsetting their CCG or placing themselves in breach of the regulations they should upset their CCG every time.

‘This situation well demonstrates the difficulties that local decisions will cause GPs, which is why we are calling for any rationing decisions to be made by politicians who can then carry responsibility legally and politically for any consequences.’

Regarding the ban on gluten-free foods, he added: ‘I am amazed that any CCG feels able to make any decision regarding gluten-free foods, given that NHS England has decided this should not be done until the results of the national consultation are known.

‘It is true that gluten-free foods are more available than they were, but they remain expensive and beyond the reach of poor patients. An FP10 is an inefficient way to supply gluten-free foods, so we would support alternative ways to continue NHS provision for eligible patients.’

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