Thursday, 6 April 2017

Yes to rational prescribing, NO to rationing

Yes to rational prescribing,
NO to rationing

The following article is kindly reproduced from March 4th Health Campaigns Together Newsletter

NHS England has resurrected a long-running debate on the prescription of a variety of drugs which have been confusingly lumped together as ‘low value’ items.

In an extraordinary claim, it declares it will: “work with clinicians and clinical commissioning groups to develop guidelines initially around a set of 10 medicines which are ineffective, unnecessary, inappropriate for prescription on the NHS, or indeed unsafe, and that together cost the NHS £128m per year.”

Apart from implicitly dismissing the decisions of thousands of GPs, the most pertinent point here is the amount a desperate NHS hopes to save by excluding large numbers of people from access to free drugs and treatment.

An NHS that was genuinely committed, as it claims to be, to developing proactive health care that could prevent the onset of more serious conditions would be seeking ways of making prescriptions free for all, as they are in Wales, Scotland and Northern Ireland, rather than forcing the sick and elderly to pay new charges.

For the last 20 years NHS managers have been trying to eliminate procedures, and now “products of limited clinical value (POLCV), collectively branded as ‘the droplist’. There is no disagreement that
drugs that are ineffective should not be prescribed – or even produced, although drug companies make huge profits from selling them.

Do it yourself care

This also fits in with the current rhetoric of encouraging patients to “self care,” and of course many community pharmacists’ businesses depend on sales of over the counter medicines, many of which (such as cough mixtures) are less than effective, and cheaper in supermarkets.

However the policy lumps together cheap, effective drugs such paracetamol, with useless ones such as cough medicines, and potentially less safe ones such as coproximol, which has not been available over the counter since 2005 but is often prescribed.

The vast majority of prescriptions are dispensed free of charge – for over-60s, children and under 18s in full time education, for pregnant women till a year after birth, for those on benefits and low income, and a few chronic medical conditions.

Thus, while at £8.60 per item it makes no sense for those who pay for prescriptions to get paracetamol or other low cost drugs that way, the large majority who don’t now pay for key items such as paracetamol would be compelled to pay.

This heavily discriminates against the poor and chronic sick, who already eke out an existence on unacceptably low income, and for whom all extra costs are a burden. The knock-on impact is likely to
be more problems for GPs and prescribers, with the risk that they are tempted instead to prescribe stronger medicines, especially if patients begin to insist on prescription only meds when they see the doctor.

Stronger alternatives are more toxic and dearer. Some are also unsuitable for older people seeking pain relief for arthritis and other chronic conditions (such as opioids codeine tramadol etc.) and combinations, which can lead to common side effects including confusion, constipation and belly ache, breathing suppression and dependency.

Other types of stronger painkillers such as naproxen, diclofenac or ibuprofen also have common side effects including ulcers, dyspepsia, bowel bleeding, raised blood pressure and risk of heart and kidney problems. However among the products also lumped in with the NHS England hit list is prescription of gluten free food for those diagnosed with coeliac disease.

Gluten free food is expensive for those who need it, and gluten does long term damage if those who are intolerant consume it. Just because a lot of other people feel gluten doesn’t suit them does not give an excuse to remove free scrips from coeliacs.

Safe clinical care means not prescribing ineffective items – not removing effective ones.

Health Campaigns

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