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Prescribing in Calderdale

Prescribing in Calderdale

In line with National NHS guidance, Calderdale CCG recommends that treatments for the following conditions are no-longer routinely prescribed:

  • Acute Sore Throat
  • Infrequent cold sores of the lip
  • Conjunctivitis
  • Coughs and colds and nasal congestion
  • Cradle Cap
  • Haemorrhoids
  • Infant Colic
  • Mild Cystitis
  • Mild skin irritation
  • Dandruff
  • Diarrhoea (Adults
  • Dry Eyes/Sore tired Eyes
  • Earwax
  • Excessive sweating
  • Head Lice
  • Indigestion and Heartburn
  • Infrequent Constipation
  • Infrequent Migraine
  • Insect bites and sting
  • Mild Acne
  • Mild Dry Skin
  • Sunburn due to excessive sun exposure
  • Sun Protection
  • Mild to Moderate Hay fever/Seasonal Rhinitis
  • Minor burns and scalds
  • Minor conditions associated with pain, discomfort and/fever. (e.g. aches and sprains, headache, period pain, back pain)
  • Mouth ulcers
  • Nappy Rash
  • Oral Thrush
  • Prevention of tooth decay
  • Ringworm/Athletes foot
  • Teething/Mild toothache
  • Threadworms
  • Travel Sickness
  • Warts and Verrucae

 

It is recommended that the following treatments are no-longer prescribed:

  • Probiotics
  • Baby milks
  • Infant colic products
  • Vitamin supplements
  • Emollients (moisturisers) for minor dry skin conditions
  • Cosmetic products, including eflornithine for facial hair
  • Antifungal nail paints
  • Branded medicines*
  • Sunscreen products

GPs will still be able to prescribe these treatments in specific circumstances. Exceptions where these treatments can be prescribed can be found in the Frequently Asked Questions (FAQ) below.

 

Why?

In 2017/18 the NHS in Calderdale spent spent more than £11 million pounds on treatment for common self-care conditions. That’s around £10.2 million on GP appointments and  £1.1 million on prescribing medicines.

By stopping prescribing of treatments for minor, short term conditions the NHS will:

  • Reinvest money which may have been spent on prescribing self-care medicines into other, higher priority areas that have a greater impact on patients.
  • Reduce spend on minor, short term conditions which the public can manage themselves
  • Free-up GP and practice nurse time, so they can treat patients with more serious health needs

More information can be found in the FAQ and Resources sections below.

 

Frequently asked questions

What are the conditions and treatments affected by this change to prescribing?

Items of limited clinical effectiveness:

  • Probiotics
  • Baby milks
  • Infant colic products
  • Vitamin supplements
  • Emollients (moisturisers) for minor dry skin conditions
  • Cosmetic products, including eflornithine for facial hair
  • Antifungal nail paints
  • Sunscreen products

Self-Limiting Conditions:

  • Acute sore throat
  • Infrequent cold sores of the lip
  • Conjunctivitis
  • Coughs and colds and nasal congestion
  • Cradle cap
  • Haemorrhoids
  • Infant colic
  • Mild cystitis minor conditions suitable for self-care
  • Mild skin irritation
  • Dandruff
  • Diarrhoea (adults)
  • Dry Eyes/Sore tired eyes
  • Earwax
  • Excessive sweating
  • Head lice
  • Indigestion and heartburn
  • Infrequent constipation
  • Infrequent migraine
  • Insect bites and sting
  • Mild acne
  • Mild dry skin
  • Sunburn due to excessive sun exposure
  • Mild to moderate hay fever
  • Minor burns and scalds
  • Minor conditions associated with pain, discomfort and/fever. (e.g. aches and sprains, headache, period pain, back pain)
  • Mouth ulcers
  • Nappy rash
  • Oral thrush
  • Prevention of tooth decay
  • Ringworm/athletes foot
  • Teething/mild toothache
  • Threadworms
  • Travel Sickness
  • Warts and verrucae
Does this mean the prescribing of over the counter items is banned?

No. This is a recommendation, and GPs are still able to prescribe treatments in certain circumstances.

Are there any exceptions?

Exceptions may be made where a clinician believes it is clinically appropriate to prescribe an over-the-counter treatment.

Specific examples of exceptions to this guidance include:

  • Patients prescribed an over the counter treatment for a long term condition (e.g. regular pain relief for chronic arthritis or treatments for inflammatory bowel disease).
  • For the treatment of more complex forms of minor illnesses (e.g. severe migraines that are unresponsive to over the counter medicines).
  • For those patients that have symptoms that suggest the condition is not minor (i.e. those with red flag symptoms for example indigestion with very bad pain.)
  • Treatment for patients with complex needs(e.g. immunosuppressed patients).
  • Patients on prescription-only treatments.
  • Patients prescribed over-the-counter products to treat an adverse effect or symptom of a more complex illness and/or prescription only medications should continue to have these products prescribed on the NHS.
  • Patients with a minor condition suitable for self-care that has not responded sufficiently to treatment with an over-the-counter product.
  • Individual patients where the clinician considers that their ability to self-manage is compromised as a consequence of medical, mental health or significant social vulnerability to the extent that their health and/or wellbeing could be adversely affected, if reliant on self-care.
Why have these changes been made?

Calderdale Clinical Commissioning Group has adopted the national NHS guidance which recommended that GPs do not generally provide these products on prescription because they are self-care treatments, widely available from pharmacies, shops and supermarkets. This is in addition to guidance following our Calderdale consultation on prescribing in 2017 which was issued in March 2018 and had already limited prescribing of certain low value medicines and products.

Your local NHS spends more than £1million prescribing medicines for minor,short term conditions.

In the year up to June 2017, the NHS in England spent approximately £569 million on prescriptions for medicines which could otherwise be purchased over the counter  from a pharmacy or other outlets, sometimes at a lower cost than that which would be incurred by the NHS.

These prescriptions include items for a minor condition:

  • That is considered to be self-limiting and so does not need treatment as it will heal or be cured of its own accord;
  • Which lends itself to self-care, i.e. that the person suffering does not normally need to seek medical advice but may decide to seek help from a local pharmacy for symptom relief and use an over the counter (OTC) medicine.

Or items:

  • For which there is limited evidence of clinical effectiveness.

By making this change the NHS can spend this money on treatments that have a greater impact on people’s health.

Has the NHS engaged with people who may actually be affected by this guidance?

Calderdale CCG carried out a public consultation on 'Changing the way we prescribe in Calderdale', which gathered public opinion and feedback about the CCG's proposals to change the way some medicines and product are prescribed by GPs in Calderdale.

This consultation ran from 16 October - 4 December 2017. Click here to view the results of the consultation

As well as this, NHS England carried out a public consultation on items which should not be routinely prescribed in primary care (21 July – 21October 2017). This included an online survey, a series of webinars for stakeholders and face-to-face public and patient stakeholder events at London, Leeds and Birmingham.

NHS England also held individual meetings with parliamentarians and members of the Proprietary Association of Great Britain and the British Association of Dermatologists. Targeted focus groups were held with key stakeholder groups including older people, individuals with learning disabilities, and Citizen’s Advice clients.

The findings of NHS England's consultation can be found here

What evidence was used in developing the proposals?
How much could the NHS save?

NHS England estimated that restricting prescribing for minor, short-term conditions may save around £100m once all exceptions, discounts and clawbacks have been accounted for.

Where will the savings be reinvested?

Any savings from implementing the proposals will be reinvested in improving patient care.

I have eczema and need to use regular moisturisers (emollients) to manage this, will I still be able to get them on prescription?

Yes. The CCG is only recommending stopping moisturisers (emollients) on prescription for mild dry skin. For patients with diagnosed skin conditions such as eczema they are still available on prescription. See exemptions for further details.

I am on a low income and currently get a ‘stay down’ infant formula from my doctor. I am worried about the extra cost.

Families on low income may be entitled to vouchers for baby milks/ formulas and vitamins, see www.healthystart.nhs.uk

I have been advised in the past to try colic treatments for my baby and have found them helpful. Where can I get them now?

These are still available to buy from pharmacies, supermarkets and shops in Calderdale, however there is little clinical evidence that they are effective.

Guidance on how to manage colic can be found on https://www.nhs.uk/conditions/Colic/

Local information can be found at www.healthyearlyyears.co.uk

I am worried about the cost of buying these products as I have always had them on prescription.

Most of these self-care treatments and products are available to buy in pharmacies and shops at a lower price than it costs the NHS to provide on prescription.

In many cases, there is little clinical evidence as to their effectiveness and the NHS making this change the NHS can spend this money on and treatments that have a greater impact on people’s health.

Where can I get advice on the best product to buy?

Your local Community Pharmacist is a fully qualified health professional who will be able to advise you on the best product to meet your specific needs.

I have tried to buy antifungal nail paint at my pharmacy and can’t as too many nails are affected – I can’t get it on prescription anymore, what do I do now?

See your GP who will assess the nail infection and can prescribe other treatments that are more evidence based if appropriate.

I have always preferred a certain brand of tablets; will (I no-longer be prescribed these? Will the replacement product work as well?

It is likely they will change unless there is a clinical reason for the brand being prescribed .

The colour, size or shape of a medicine may change depending on which company makes it. However, the medicine will have the same effect as your usual brand.

Generic  (unbranded) and branded medicines have the same active ingredients and the same medical effect. In the UK there are strict quality controls that must be met before a medicine can be prescribed, so generic and branded medicine will always be of the same quality.

Check with your pharmacist or GP if you have any concerns about using a particular medicine.

I have been told it is important for me to have the same brand of medicine. Will l I still be able to get it?

Yes, if there is a clinical reason why a particular brand is needed it will still be available for you. Your doctor is aware of the situations when this is recommended.

The CCG will also prescribe by brand where this is cost effective or recommended by local and national guidelines.

I use Eflornithine to help reduce excess facial hair associated with Polycystic Ovary Syndrome (PCOS) – I am concerned about not getting it.

There is little clinical evidence that Eflornithine is effective, and while you may have had some benefit from using it there may be more effective treatments for use in PCOS, so please discuss this with your GP.

How do I give feedback or make a complaint?

Patients should speak to their GP practice in the first instance if they have any concerns about the changes.

If you wish to raise a formal complaint specifically about the changes being made, contact the CCG via https://www.calderdaleccg.nhs.uk/contact-us/comments-and-complaints/

 

Resources and further information

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Print-ready information leaflet - Prescribing of over the counter medicines is changing 106.13 KB 6 downloads

Your GP, nurse or pharmacist will not generally give you a prescription for over...
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Patient information leaflet -Prescribing of over the counter medicines is changing 72.14 KB 5 downloads

Your GP, nurse or pharmacist will not generally give you a prescription for over...
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Easy read patient information leaflet - Prescribing of over the counter medicines is changing 3.17 MB 1 downloads

Prescribing of over the counter medicines is changing. This leaflet will explains...
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Information sheet - Prescribing of over the counter medicines is changing 42.62 KB 2 downloads

Your GP, nurse or pharmacist will not generally give you a prescription for over...
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    Consultation report: changing the way we prescribe in Calderdale (December 2017) 1.32 MB 20 downloads

    This public consultation gathered public opinion and feedback about the CCG's proposals...
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    Baby formulas and vitamins 0.00 KB 0 downloads

    Families with a low income can get vouchers for baby milks and also access vitamins...

       

       

      *Expensive brands of medicines will not normally be prescribed if a suitable cheaper, or ‘generic’ product is available.

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