The NHS has ended 2017-18 with a deficit close to £1 billion. This has prompted the body responsible for GP budgets to issue controversial guidance that patients should be refused prescriptions for certain medical conditions.
NHS Clinical Commissioners has recommended that GPs stop prescribing drugs for 33 minor conditions including cold sores, heartburn and hay fever. They feel that people with mild, self-limiting conditions, should treat themselves with over-the-counter drugs bought from a pharmacy. The proposals could save the NHS upwards of half a billion pounds each year. The recouped money would then be used to fund services and treatments, such as breast cancer screenings and new drugs for dementia.
The guidance has also highlighted that over-the-counter drugs are actually cheaper for patients to buy than they are for the NHS to supply. The NHS faces additional charges, including dispensing fees, which add to the costs. But this all leaves GPs facing the challenge of convincing patients, many of whom are used to obtaining free prescriptions, that they should pay for their own treatment.
As well as debating what drugs should be prescribed, there is also much discussion about how prescription charges are paid for. Currently, anyone living in Northern Ireland, Wales or Scotland is entitled to free prescriptions. While in England, 10% of prescriptions items are paid for, with the rest being covered by payment exemptions. The money raised from payments was £555m in 2016-17.
In 2014, a government think tank suggested that even more money could be raised if everyone in the UK paid for their prescriptions. This would be regardless of age, location or illness. The limit for charges would, however, be capped at £104 per person per year. This led to concerns about health inequality.
Those on the most medicines would end up paying the highest fees. People may then be forced to choose which drugs to pay for, omitting others. Ultimately, this could lead to longer-term consequences on patient health and future costs to the NHS. The debate about re-evaluating prescription charges rages on, but, due to its politically charged nature, changes are unlikely to happen anytime soon.
The doctor will not see you now
All of these recommendations are delivered against a backdrop of other measures to save the NHS money. A drive to encourage the public to use their community pharmacy for minor conditions means that drug deregulation has become a key priority.
As of 2016, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has deregulated more than 90 prescription drugs meaning these can now be bought from a pharmacy without a GP visit or prescription. The most notable examples include pantoprazole (Nexium), a drug to treat heartburn and indigestion; sildenafil (Viagra), a drug to treat male erectile dysfunction; and sumatriptan (Migraitan), a drug to treat acute migraine.
For those concerned about a pharmacist’s lack of knowledge about a patient’s medical history, this has also recently changed. Pharmacists can now gain access to a patient’s medical notes, if given permission by the patient, allowing them to see a summary of the patient’s allergies, medical conditions and drug history. This has allowed pharmacists to have a better understanding of a patient’s health, meaning they can make more appropriate drug and lifestyle recommendations.
Overcoming the issue of drug wastage is another area that could help the NHS achieve significant savings. Estimates suggest that £300m worth of prescription drugs are wasted each year. But the potential losses are much greater, given the increased risk that patients could be hospitalised or die if not taking their medications properly.
Pharmacists are again helping to stem this loss, offering services that support patients on new medicines and helping those who are struggling with their drug regime. Also, many GP surgeries have started to employ clinical pharmacists to improve their prescribing.
While much is being done to bolster the NHS, even more radical changes may be needed to help it survive for future generations. The government needs to look to other healthcare systems around the world to find effective practices that could be adopted by the UK health system.