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HDA UK Media And Political Bulletin – 28 March 2017

Media Summary

Blueprint to save the NHS: Dramatic drive to cut costs unveiled that will see dolling out of painkillers scrapped and GPs ordered to crack down on health tourists
Daily Mail, Sophie Boriand, 28 March 2017

In a Daily Mail exclusive, Simon Stevens has announced that new national guidance is set to stop a number of items being ‘routinely’ prescribed on the NHS. The crackdown is part of a blueprint to be formally announced by Simon Stevens later this week to save the NHS up to £1billion in two years. These savings will go towards improving patient care and paying for lifesaving drugs. There will also be a drive to recover the costs of treating European Union citizens.

Stevens backs major £400m medicines savings drive
HSJ, Rebecca Thomas, 28 March 2017

Simon Stevens is backing plans to save hundreds of millions of pounds a year by cutting NHS spending on “low priority” prescriptions, including gluten-free products and medicines that can easily be bought over the counter. The project, due to be supported in this week’s Five Year Forward View “delivery plan”, will aim to drive down spending on medicines in four categories that cost the NHS an estimated £400m a year. The categories to be targeted are:

  • products of “low clinical effectiveness”;
  • products where there is a more cost effective alternative;
  • products that are clinically effective but deemed “low priority”; and
  • medicines which can be bought over the counter but are still sometimes prescribed, such as painkillers, antihistamines, suncream, and cough and cold remedies.

In an interview with HSJ, Julie Wood, chief executive of NHS Clinical Commissioners, said: “We need people to understand that this is about taking difficult relative prioritisation decisions.

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Blueprint to save the NHS: Dramatic drive to cut costs unveiled that will see dolling out of painkillers scrapped and GPs ordered to crack down on health tourists
Daily Mail, Sophie Boriand, 28 March 2017

Painkillers, cough remedies and gluten-free foods will no longer be available on the NHS. GPs will have to stop prescribing items that can be bought cheaply in supermarkets and chemists. Unveiling a major cost-cutting plan in the Daily Mail today, the head of the NHS says patients will also be expected to pay for their own indigestion pills, hayfever remedies and sun cream.

NHS chief executive Simon Stevens (centre) talks with staff during a visit to Consett Medical Centre in County Durham, northeast England

Simon Stevens says that free travel vaccinations will come to an end.

His new national guidance will say these should no longer be ‘routinely’ prescribed on the NHS. There will also be a big drive to recover the costs of treating European Union citizens.

The crackdown is part of a blueprint to be formally announced by Mr Stevens later this week to save the Health Service up to £1billion in two years. He wants to use the savings to improve patient care and pay for lifesaving drugs.

The reforms come as the NHS struggles to keep pace with the pressures of both a growing and ageing population.

Following one of the worst winter crises in its 69-year history, doctors and MPs are calling for an urgent debate on funding, with suggestions including a special ‘NHS tax’.

But Mr Stevens today puts the emphasis on efficiency.

His proposals include:

New health tourism rules for GPs to ensure they record all EU patients and enable the NHS to claw back money from their home countries;

Fresh bed-blocking targets for hospitals to free up a set number of beds currently occupied by elderly patients who should be at home;

Plans to ensure that NHS managers stop hiring expensive locum doctors who earn up to £200,000 a year.

In his interview today, Mr Stevens also suggests families can help take the pressure off the NHS by watching their children’s diets more closely and by ensuring their elderly relatives do not become isolated.

The chief executive of NHS, Simon Stevens has his blood pressure taken at Consett Medical Centre in County Durham

The chief executive of NHS, Simon Stevens has his blood pressure taken at Consett Medical Centre in County Durham

He suggests that parents should give their children carrots and apples when they get home from school rather than chocolate or cereal bars to help tackle childhood obesity.

The NHS is in the grip of a financial crisis exacerbated by having to foot the bill for increasingly expensive new drugs and operations for cancer, heart disease and other serious illnesses which were previously incurable.

But Mr Stevens believes hundreds of millions of pounds could be saved by the NHS simply ‘getting its own house in order’ and reducing waste.

He estimates up to £400million could be saved a year by instructing GPs not to hand out ‘low priority’ items.

But his proposed clampdown will prove particularly controversial for the one in 100 Britons with coeliac disease – an intolerance to wheat.

They will now have to pay from their own pockets for gluten-free food.

Mr Stevens says these products can now be bought in supermarkets and there is no longer a need for NHS prescriptions. And he says it is wrong for patients to be prescribed pizza bases, digestive biscuits and cakes.

His crackdown will also upset the one in ten patients eligible for free prescriptions – including the elderly, pregnant or those on low incomes.

Mr Stevens, who is chief executive of NHS England, says GPs hand out more than a billion prescriptions a year – a 50 per cent rise in a decade, costing £9.3billion.

But he says that the measures he unveils today will free up GP appointments as fewer patients need to book up slots to obtain a free prescription.

‘We’ve got to tackle some of the waste which is still in the system,’ he said.

‘The NHS is a very efficient health service but like every other country’s health service there is inefficiency and waste.

‘There’s £114million being spent on medicines for upset tummies, haemorrhoids, travel sickness, indigestion, that’s even before you get on to the £22million-plus on gluten free that you can also now get at Morrisons, Lidl or Tesco.

‘We will be backing them in new national guidelines that say those should not routinely be prescribed on the NHS.

‘Part of what we are trying to do is make sure that we make enough headroom to spend money on the innovative new drugs by not wasting it on these kind of items.

‘The price of gluten-free alternatives has come down substantially.

‘There’s no doubt that coeliac disease is an important medical condition that’s increasingly being recognised.

‘But when you look at the list of prescribable items it extends to digestive biscuits, pizzas and other products – there are legitimate questions to be answered.’

Mr Stevens will launch a consultation next month into new guidelines urging GPs to stop prescribing low priority items.

This will start off by looking at ten groups of medicines or products including gluten-free foods, omega 3 vitamin supplements and travel vaccinations.

It will also include some very strong painkillers for terminally ill cancer patients which health experts say are expensive and not necessarily effective.

As part of the consultation, GPs, medical experts and patient groups will all have the chance to air their views – including representatives of coeliac disease sufferers.

Once that stage is finished, officials will launch a second consultation looking at other items including paracetamol, cough and cold remedies, hayfever pills, travel sickness tablets and suncream.

The review was prompted by research by NHS Clinical Commissioners – a membership body for groups of GPs – which compiled a lengthy list of low priority items.

Several health trusts have already imposed their own bans within the last six months. Mr Stevens’ cost-saving measures – the NHS Delivery Plan – will be formally announced on Friday.

Stevens backs major £400m medicines savings drive
HSJ, Rebecca Thomas, 28 March 2017

Simon Stevens is to back plans to save hundreds of millions of pounds a year by cutting NHS spending on “low priority” prescriptions, including gluten-free products and medicines that can easily be bought over the counter.

The project, due to be supported in this week’s Five Year Forward View “delivery plan”, will aim to drive down spending on medicines in four categories that cost the NHS an estimated £400m a year. Commissioners said the NHS could not provide “anything you fancy from the sweet shop”.

The categories to be targeted are:

  • products of “low clinical effectiveness”;
  • products where there is a more cost effective alternative;
  • products that are clinically effective but deemed “low priority”; and
  • medicines which can be bought over the counter but are still sometimes prescribed, such as painkillers, antihistamines, suncream, and cough and cold remedies.

NHS Clinical Commissioners, which represents most clinical commissioning groups, has developed the project and sought national backing. Its first phase will focus on 10 medicines the NHS currently spends £128m a year on. These include gluten-free products and fentanyl – a strong pain medication usually prescribed for patients receiving palliative care (see box below).

Commissioners plan to develop plans for further phases of savings in the near future.

As well as trying to make rapid savings, NHSCC and NHS England are seeking to draw attention to the fact that, due to the huge financial constraints on the NHS, it is having to limit what it can offer.

In an exclusive interview with HSJ, Julie Wood, chief executive of NHSCC, said: “We need people to understand that this is about taking difficult relative prioritisation decisions.

Julie Wood: ‘We can’t spend the same NHS pound twice’
“It’s about saying that in all that [commissioners] have got to do we can either spend the NHS pound in this way on paracetamol, or we can spend it on something else we need to do in mental health or primary care because we can’t spend the same NHS pound twice.”

NHCC co-chair Graham Jackson said these types of funding decisions “are barn door obvious”.

“The NHS offer was always to provide clinically appropriate treatment, not anything you fancy from the sweet shop. Unfortunately, society has got to the ‘I want it because it looks nice and shiny’ attitude and we’ve got to turn that around,” he said.

NHSCC said the project is aimed at helping commissioners to make “difficult choices” related to medicines funding and will look to gain a “national consensus” on the issue, with one option being to “black list” certain products.

Ms Wood added: “We are working with colleagues across NHS England, getting them to understand why it is essential that CCGs do this if we are to liberate the resource currently being spent on these medicines.”

Consultation on next steps in relation to some areas is due to begin soon.

The changes are likely to prove controversial with some doctors and patient groups, for example those with coeliac disease who are wheat intolerant. There are occasional cases for others of the items targeted where it may be clinically justified to prescribe some of the medicines covered. NHSCC indicated that proper policies would need to be put in place for exceptional cases.

10 medicines in first phase of savings project

Products of low clinical effectiveness (total annual spend: £37.98m)

Co-proximal (£8.32m)
Omega three and fish oils (£5.65m)
Lidocaine Plasters (£17.58m)
Rubefacients (£6.43m)
Clinically effective products which have more cost effective alternative (total annual spend: £58.69m)

Liothyronine (£30.93m)
Tadalafil (£10.51m)
Doxazosin MR (£7.12m)
Fentanyl (£10.13m)
Clinically effective products that are deemed low priority (total annual spend: £31.35m)

Some gluten free foods (£21.88m)
Non-NHS funded travel vaccines (£9.47m)

HDA UK Media And Political Bulletin – 28 March 2017

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