NHS treatments blacklist

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The NHS treatments blacklist is an informal name for a list of medicines and procedures which will not be funded by public money except in exceptional cases. These include but are not limited to procedures which the National Institute for Health and Care Excellence (NICE) has ruled of limited effectiveness and particular brand name medicines. In 2017 there was a proposal for 3,200 over-the-counter (OTC) drugs to be restricted and 18 procedures to be added to the list. This generated some controversy amongst doctors with some arguing that OTC should be blacklisted instead, and others believing the move did not take into account individual patient needs.

Contents

Procedures of limited clinical effectiveness

The NHS has produced lists of procedures of limited clinical effectiveness for many years, advising that they should not be carried out except in exceptional cases. Since the establishment of NICE in 1999 there has been a move to more robust processes, but such decisions always generate controversy. [1] These lists were decided by clinical commissioning groups in England, but rules differ in Wales, Scotland and Northern Ireland. [2] Restrictions on one kind of treatment for a condition may lead to patients getting different, and possibly more expensive treatment. Treatments for back pain, tonsillectomy, in vitro fertilisation, varicose veins [3] commonly appear on these lists.

Surgery

Research by the Medical Technology Group reported in 2019 showed that many clinical commissioning groups were restricting access to basic elective surgeries and treatments in various ways, including imposing body mass index thresholds for hip and knee replacements, or visual acuity limits for cataract surgery. [4]

In April 2019 NHS England issued guidance to NHS Trusts on the basis that the evidence shows that in most cases the benefits of these procedures did not justify the risk and opportunity cost involved.

Four procedures in Category 1 are only available in "exceptional circumstances":

For 13 procedures in Category 2 patients must "meet agreed criteria":

Warrington & Halton Hospitals NHS Foundation Trust introduced what they called the My Choice system in 2013, which enabled people to pay themselves for procedures the NHS would not provide for patients who had been denied varicose vein procedures. In 2019 it was expanded. The price list includes £8,500 for revision of knee replacement surgery, £7,000 for a hip replacement or hip resurfacing, and £2,000 for circumcision. [5] Warrington withdrew their advertisement after an outcry, but in July 2019 it was reported that other trusts with private patient units were still offering these procedures for people who would pay. NHS England sent out a message saying they "expect NHS trusts to be evidence-led in everything they do… The guidance therefore also makes it clear that we do not expect NHS providers to offer these interventions privately." They also said that further restrictions would be raised later in the year. Critics queried the logic of denying NHS trusts the opportunity to generate income. [6]

Medicines

In the English National Health Service and NHS Wales the Blacklist (officially Schedule 1 to the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004) is a list published in Part XVIIIA of the NHS Drug Tariff denoting medicines and/or specific brands of medicines that cannot be prescribed on NHS medical prescriptions. [7] If such a prescription is dispensed, then NHS Prescription Services will refuse to refund the cost to the dispensing pharmacy. The list was established in 1985. No new items have been added since 2004.

Some brand name medicines on the blacklist can be dispensed against prescriptions for generic drugs (if the approved generic name is not itself included in the blacklist). For example, Calpol can be dispensed for a prescription for paracetamol suspension, but it is generally cheaper to dispense the generic form, and it is at the pharmacy's discretion to do otherwise. [8]

A pharmacist is at liberty to dispense private prescriptions for such items, or to sell over the counter items without a prescription. [9]

Review of homeopathic treatments

Following a threat of legal action by the Good Thinking Society campaign group in 2015, the British government stated that the Department of Health would hold a consultation in 2016 regarding whether homeopathic treatments should be added to the Schedule 1 list. [10] [11] [12] In 2017 GPs were told not to prescribe homeopathic medicines, but there were actually 3,300 prescriptions for "homeopathic preparations" in 2018, which cost a total of £55,044. This was less than half the number prescribed in 2014. The British Homeopathic Association unsuccessfully challenged NHS England's decision to stop funding homeopathic remedies in June 2018. It is now proposed to add these remedies to the blacklist. [13]

National guidelines

In April 2017 it was proposed to restrict the prescription of 3,200 Over-the-counter drugs by means of official guidance from NHS England, and to add 18 treatments considered to have 'limited clinical value' – including homeopathy and herbal treatments – to the banned list. The 10 items of low clinical effectiveness:

7 items which are clinically effective but not cost-effective:

Dr Andrew Green, clinical policy lead on the British Medical Association general practitioners' committee objected and demanded that any restricted items should be added to the banned list, so that it was clear that they could not be prescribed. [15] The Royal College of General Practitioners complained that "imposing blanket policies on GPs, that don't take into account demographic differences across the country, or that don't allow for flexibility for a patient's individual circumstances, risks alienating the most vulnerable in society." National Voices said, "The risk is that the NHS would be saying that it will not support poor people to treat their kids' head lice, or to manage complications such as persistent constipation or the vulnerability of their skin to damaging sunlight." [16]

The final recommendations covering 35 minor, short-term conditions were approved in March 2018, with an exemption for patients where the clinician believes they will struggle to self-manage because of medical, mental health problems or 'significant social vulnerability'. As this does not change the regulations that govern GP prescribing, it is still open to GPs to treat patients according to their individual circumstances and needs, including issuing prescriptions where there are reasons why self-care is inappropriate. [17]

In 2017 the NHS spent £475.3 million on over-the-counter drugs, and, despite the promises of up to £100 million in savings, £449.4 million in 2018, a reduction of only £25.9 million. [18]

In April 2019 the All Wales Prescribing Advisory Group rejected the proposals for limiting the prescription of over-the-counter drugs. They plan to give further consideration to the prescription of probiotics, and vitamins and minerals. [19] [ needs update ]

See also

Related Research Articles

<span class="mw-page-title-main">Varicose veins</span> Medical condition in which superficial veins become large and twisted

Varicose veins, also known as varicoses, are a medical condition in which superficial veins become enlarged and twisted. These veins typically develop in the legs, just under the skin. Varicose veins usually cause few symptoms. However, some individuals may experience fatigue or pain in the area. Complications can include bleeding or superficial thrombophlebitis. Varices in the scrotum are known as a varicocele, while those around the anus are known as hemorrhoids. Due to the various physical, social, and psychological effects of varicose veins, they can negatively affect one's quality of life.

<span class="mw-page-title-main">Over-the-counter drug</span> Medication available without a prescription

Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescription. In many countries, OTC drugs are selected by a regulatory agency to ensure that they contain ingredients that are safe and effective when used without a physician's care. OTC drugs are usually regulated according to their active pharmaceutical ingredient (API) rather than final products. By regulating APIs instead of specific drug formulations, governments allow manufacturers the freedom to formulate ingredients, or combinations of ingredients, into proprietary mixtures.

<span class="mw-page-title-main">Medical prescription</span> Health-care communication from a physician to a pharmacist

A prescription, often abbreviated ℞ or Rx, is a formal communication from a physician or other registered healthcare professional to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historically, it was a physician's instruction to an apothecary listing the materials to be compounded into a treatment—the symbol ℞ comes from the first word of a medieval prescription, Latin recipere, that gave the list of the materials to be compounded.

<span class="mw-page-title-main">Prescription drug</span> Medication legally requiring a medical prescription before it can be dispensed

A prescription drug is a pharmaceutical drug that is permitted to be dispensed only to those with a medical prescription. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.

The British Homeopathic Association (BHA) is a British charity founded in 1902 by John Epps to promote homeopathy and advocate for its training and research. The BHA was re-branded in 2021 to Homeopathy UK. It supports the use of homeopathy within general and specialist healthcare, and provides a listing of homeopathic practitioners. From 1902, the BHA co-sponsored the Missionary School of Medicine, a school of medicine for medical missionaries. The charity also campaigns for more homeopathy in Britain's National Health Service (NHS).

The NHS Electronic Prescription Service is part of the NHS National Programme for IT of the National Health Service in England. It enables the electronic transfer of medical prescriptions from doctors to pharmacies and other dispensers and electronic notification to the reimbursement agency, NHS Prescription Services.

Charges for prescriptions for medicines and some medical appliances are payable by adults in England under the age of 60. However, people may be exempt from charges in various exemption categories. Charges were abolished by NHS Wales in 2007, Health and Social Care in Northern Ireland in 2010 and by NHS Scotland in 2011. In 2010/11, in England, £450 million was raised through these charges, some 0.5% of the total NHS budget. In April 2021 the charge was raised to £9.35 for up to a three-month supply of each item. In 2022, for the first time since 2010, the charge was not increased.

<span class="mw-page-title-main">Healthcare in the United Kingdom</span> Overview of healthcare in the United Kingdom

Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences have developed between these systems since devolution.

<span class="mw-page-title-main">National Health Service (England)</span> Publicly-funded healthcare system in England

The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the Brazilian Sistema Único de Saúde. Primarily funded by the government from general taxation, and overseen by the Department of Health and Social Care, the NHS provides healthcare to all legal English residents and residents from other regions of the UK, with most services free at the point of use for most people. The NHS also conducts research through the National Institute for Health and Care Research (NIHR).

Healthcare in England is mainly provided by the National Health Service (NHS), a public body that provides healthcare to all permanent residents in England, that is free at the point of use. The body is one of four forming the UK National Health Service as health is a devolved matter; there are differences with the provisions for healthcare elsewhere in the United Kingdom, and in England it is overseen by NHS England. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing and able to pay.

<span class="mw-page-title-main">Regulation and prevalence of homeopathy</span> Alternative medicine

Homeopathy is fairly common in some countries while being uncommon in others. In some countries, there are no specific legal regulations concerning the use of homeopathy, while in others, licenses or degrees in conventional medicine from accredited universities are required.

A formulary is a list of pharmaceutical drugs, often decided upon by a group of people, for various reasons such as insurance coverage or use at a medical facility. Traditionally, a formulary contained a collection of formulas for the compounding and testing of medication. Today, the main function of a prescription formulary is to specify particular medications that are approved to be prescribed at a particular hospital, in a particular health system, or under a particular health insurance policy. The development of prescription formularies is based on evaluations of efficacy, safety, and cost-effectiveness of drugs.

Electronic prescription is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, physician assistant, pharmacist, or nurse practitioner to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.

Health care rationing refers to mechanisms that are used for resource allocation in health care.

<span class="mw-page-title-main">Michael Dixon (doctor)</span> British general practitioner

Michael Dixon LVO, OBE, FRCGP, FRCP is an English general practitioner and current Head of the Royal Medical Household. He is Chair of The College of Medicine and Integrated Health and Visiting Professor at the University of Westminster.

There are approximately 88,000 pharmacies in the United States. Over half are located within drug stores, grocery stores, hospitals, department stores, medical clinics, surgery clinics, universities, nursing homes, prisons, and other facilities. The remaining pharmacies are considered to be independent or privately owned. The top 25 pharmacy chain stores represent about 38,000 pharmacy locations in the U.S. and employ about 149,000 on-staff pharmacists. California has 8,015 pharmacies, the most of any state. Texas, Florida, New York, and Pennsylvania round out the top five states for pharmacy locations. Nationwide, the number of community pharmacies increased by 6.3% between 2007-2015, and the number of pharmacies per 10,000 people (2.11) did not change. However, the number of pharmacies per-capita varies substantially across counties, ranging from 0 to 13.6 per- 10,000 people in 2015.

Pharmacy2U is an online pharmacy located in the UK. Pharmacy2U has been involved in piloting the electronic transfer of prescriptions in the UK. They manage NHS repeat prescriptions on behalf of patients. Pharmacy2U was founded by pharmacist Daniel Lee in November 1999. It launched to the public in June 2000.

<span class="mw-page-title-main">Good Thinking Society</span> Organization

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References

  1. ↑ "How the NHS places a value on life". BBC News. 21 August 2006. Retrieved 28 August 2017.
  2. ↑ "NHS Scotland to offer three cycles of IVF". Bionews. 27 March 2017. Retrieved 28 August 2017.
  3. ↑ "Varicose veins: Could a new 'superglue' end the pain?". Daily Mirror. 27 June 2013. Retrieved 28 August 2017.
  4. ↑ "CCGs restricting access to basic treatments". Health Service Journal. 20 March 2019. Retrieved 6 May 2019.
  5. ↑ "NHS operation fury as price list revealed - with patients charged up to £8,000". Birmingham Live. 19 June 2019. Retrieved 19 June 2019.
  6. ↑ "Exclusive: Trusts charging for ops restricted on the NHS". Health Service Journal. 8 July 2019. Retrieved 10 July 2019.
  7. ↑ "National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004". Legislation.gov.uk. Retrieved 12 April 2019.
  8. ↑ A, A. Applied Pharmaceutical Practice.
  9. ↑ "Medicinal products". Pharmaceutical Services Negotiating Committee. Retrieved 25 August 2017.
  10. ↑ James Gallagher (13 November 2015). "Homeopathy 'could be blacklisted'". BBC News.
  11. ↑ Damien Gayle (14 November 2015). "Homeopathy on prescription could be banned from NHS". The Guardian.
  12. ↑ "GPs could be banned from giving out homeopathy on prescription". Daily Telegraph. 13 November 2015.
  13. ↑ "NHS still spending £55,000 a year on homeopathy, despite ban". Telegraph. 5 April 2019. Retrieved 17 May 2019.
  14. ↑ "NHS England names 'ineffective' medicines for savings drive". Health Service Journal. 21 July 2017. Retrieved 28 August 2017.
  15. ↑ "DH 'blacklist' required to enable GPs to curb OTC prescribing, says GPC lead". Pulse. 21 April 2017. Retrieved 29 April 2017.
  16. ↑ "NHS ban on 'wasteful' prescribing could harm poorest patients, GPs warn". GP Online. 21 July 2017. Retrieved 25 August 2017.
  17. ↑ "NHS England issues guidance to curb over-the-counter prescribing". Pulse. 29 March 2018. Retrieved 31 March 2018.
  18. ↑ "OTC medication rationing only made a quarter of its targeted savings". Pulse. 17 April 2019. Retrieved 4 June 2019.
  19. ↑ "Restrictions on prescribing OTC treatments rejected in Wales". Pharmaceutical Journal. 24 April 2019. Retrieved 9 June 2019.
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