Some regular prescriptions currently accessible to those who need them may soon no longer be available from the NHS as part of multi-million pound savings.
The proposals aim to cut down on the amount of low priority items, which could see the health service save a total of £128 million.
The full list of the prescriptions at risk of being cut has been revealed and includes gluten-free foods, painkillers, omega-3 supplements and travel supplements.
A public consultation is currently underway, and is due to close within the next couple of weeks, and boss of NHS England, Simon Stevens has told our sister title, the Mirror , the cutbacks are purely money-motivated.
Mr Stevens said: "Part of what we are trying to do is make sure that we have enough headroom to spend money on the innovative new drugs by not wasting it on these kinds of items."
A number of the items at risk are cheaper to buy than the £8.60 prescription charge.
But, millions of people in England are entitled to free prescriptions, including the over 60s, under 16s, pregnant women or mothers who had a baby in the last year and those on certain benefits.
The complete list is as follows:
Gluten-free foods
Around one in 100 people have coeliac disease, caused by a reaction to gluten which can be treated by cutting the substance from a patient's diet. Once diagnosed as coeliac by a doctor, patients in most parts of the UK can receive gluten-free staple foods from a pharmacy through a prescription from a GP.
Foods approved for prescription include bread or rolls, breakfast cereals, crackers and crispbreads, flour and flour-type mixes, oats, pasta and pizza bases.
The amounts of gluten-free staple foods a sufferer can receive each month are controlled by the National Prescribing Guidelines.
Described as: Clinically effective but low priority.
Potential saving: £21.9 million.
Travel vaccines
Vaccines for typhoid, hepatitis A and cholera and a combined jab for diptheria, polio and tetanus are usually available free on the NHS.
The health service offers the vaccinations free of charge because they protect against diseases deemed to present the greatest risk to public health if brought into the country by travellers.
Some countries require visitors to be vaccinated against diseases such as yellow fever or meningitis prior to arrival, while travellers to some parts of the world are advised to have inoculations against a range of other diseases, including tuberculosis, hepatitis B, Japanese encephalitis and tick-borne encephalitis.
These are not usually available on the NHS and can cost around £50 for each dose.
Described as: Clinically effective but low priority.
Potential saving: £31.3 million.
Co-proxamol
Co-proxamol, used for mild to moderate pain relief, is a combination of two active ingredients, dextropropoxyphene and paracetamol, which is typically included as a lower 350mg dose compared with the standard 500mg dose of paracetamol when taken alone.
There is limited evidence suggesting co-proxamol is more effective at treating pain than a regular dose of paracetamol, for either acute or chronic use.
There have been previous concerns that the drug has been linked to suicides and poisonings and it was gradually phased out from wide use between 2007 and 2007.
Described as: Low clinical effectiveness.
Potential saving: £8.3 million.
Omega-3 and fish oils
Naturally-occurring oils from certain breeds of fish such as salmon and mackerel have typically been prescribed to promote a healthy heart for patients at risk of heart disease.
The fatty acid omega-3 usually comes in capsule form and has been used to help prevent irregular heartbeats and reduce the risk of clotting by making the blood less sticky.
Historic concerns about prescribing omega-3 stem from limited evidence suggesting the fatty acid is effective in capsule form, and little to categorically suggest what a recommended adult daily intake should be.
Described as: Low clinical effectiveness.
Potential saving: £5.6 million.
Doxazosin MR
Doxazosin are a series of drugs used to treat hypertension, but doxazosin modified release (MR) tablets are only believed to be effective for a very small number of patients.
This form of doxazosin cost the NHS £7 million last year.
Described as: Clinically effective but with a cheaper alternative.
Potential saving: £7.1 million.
Fentanyl
Generally used in palliative care, fentanyl is a strong painkiller in the form of patches for terminally ill patients. In many cases morphine is considered easier and cheaper to prescribe, and is just as effective for end-of life care.
NHS England estimates it spent just over £10 million on the drug last year.
Described as: Clinically effective but with a cheaper alternative.
Potential saving: £10.1 million.
Rubefacients
A series of muscle rubs used to relieve skeletal-muscular pain are under review for their effectiveness compared with other forms of muscular pain relief.
Described as: Low clinical effectiveness.
Potential saving: £6.4 million.
Liothyronine
Liothyronine is a thyroid hormone used to treat certain thyroid conditions including hypothyroidism.
Only small numbers of patients are found to benefit from the drug, which is generally more expensive than other forms of thyroid medication.
In 2016 the NHS reported that the treatment cost the NHS approximately £20.8 million per year.
Described as: Clinically effective but with a cheaper alternative.
Potential saving: £30.9 million.
Tadalafil
Certain uses of the drug tadalafil, which is variously used to help alleviate erectile dysfunction and lower urinary tract infections, may also be phased out under the plans.
There are concerns that the drug is not as effective as other erectile dysfunction medications, such as sildenafil, sold under the brand name Viagra.
Described as: Clinically effective but with a cheaper alternative.
Potential saving: £10.5 million.
Lidocaine plasters
Lidocaine plasters are large sticking plaster that contain a local anaesthetic, which is absorbed into the skin when the affected area is covered.
They tend to be used when pain only affects a certain patch of skin, but can often be bought over the counter more easily and cheaper than the cost of a standard prescription.
Described as: Low clinical effectiveness.
Potential saving: £17.6 million.
And the rest...
NHS England says several other treatments and medicines will be considered in "further work", with no date yet announced.
It's "in light of the financial challenges faced by the NHS," chiefs say.
These will be medicines which are of relatively low clinical value or priority, or are readily available ‘over the counter’.
- Treatment for coughs and colds
- Antihistamines including for hayfever
- Indigestion and heartburn medication
- Suncream
- Prolonged-release Doxazosin
- Herbal treatments
- Homeopathy
- Liothyronine
- Lutein and Antioxidants
- Oxycodone and Naloxone Combination Product
- Paracetamol and Tramadol Combination Product
- Perindopril Arginine
- Rubefacients
- Trimipramine
To take part in the consultation, which closes on October 21, 2017, you can read the full document online at https://www.engage.england.nhs.uk/consultation/items-routinely-prescribed/ .
