NHS 'blacklisted' 36 conditions and bans prescriptions for treatment

NHS England has ‘blacklisted’ 36 health conditions which cannot be treated with prescriptions and must instead be bought over the counter. The list has been highlighted by the River View Surgery - which added that in many cases over-the-counter prices are cheaper than the NHS prescription.

It stated: “GPs issued 1.1 billion prescription items at a cost of £9.2 billion in 2015/16. The vast majority were appropriate but many were for medicines, products or treatments that do not require a prescription and can be purchased over the counter from pharmacies, supermarkets, petrol stations, corner shops or other retailers in some cases at a much lower cost than the price paid by the NHS.”

In 2018, NHS England issued guidance for conditions for which over the counter items should not routinely be prescribed in primary care. For this list of conditions the NHS has said the reason is because these conditions are:

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• considered to be self-limiting and so do not need treatment as they will heal or be cured of their own accord.

• considered to lend itself to self-care ie, the person does not normally need to seek medical advice and can manage the condition by purchasing OTC items directly.

GPs issued 1.1 billion prescription items at a cost of £9.2 billion in 2015/16. The NHS said the vast majority were appropriate but many were for medicines, products or treatments that do not require a prescription and can be purchased over the counter from pharmacies, supermarkets, petrol stations, corner shops or other retailers in some cases at a much lower cost than the price paid by the NHS.

The NHS aimed to save around £190 million a year by cutting such prescriptions for minor, short-term conditions, many of which will cure themselves or cause no long term effect on health.

At the time NHS England chief executive Simon Stevens, said: “The NHS is one of the most efficient health services in the world but we’re determined to make taxpayers’ money go further. The NHS should not be paying for low value treatments and it’s right that we look at reducing prescriptions for medicines that patients can buy for a fraction of the price the NHS pays.”

The following self-limiting, short-term illnesses and minor condition are included in NHS England guidance and should therefore not be issued with a prescription:

• Acute Sore Throat

• Infant Colic

• Mouth ulcers

• Conjunctivitis

• Infrequent Constipation

• Nappy Rash

• Coughs and colds and nasal congestion

• Infrequent Migraine

• Oral Thrush

• Cradle cap (seborrhoeic dermatitis) – infants

• Infrequent cold sores of the lip

• Prevention of dental caries

• Dandruff

• Insect bites and stings

• Probiotics

• Diarrhoea (Adults)

• Mild Acne

• Ringworm/Athletes foot

• Dry Eyes/Sore tired Eyes

• Mild Cystitis

• Sun Protection

• Earwax

• Mild Dry Skin/Sunburn

• Teething/Mild toothache

• Excessive sweating (Hyperhidrosis)

• Mild contact dermatitis

• Threadworms

• Haemorrhoids

• Mild to Moderate Hay fever/Allergic Rhinitis

• Travel Sickness

• Head Lice

• Minor burns and scalds

• Vitamins and minerals

• Indigestion and Heartburn

• Minor conditions associated with pain, discomfort and/fever. (e.g. aches and sprains, headache, period pain)

• Warts and Verrucae

The Board recommended that seven products be referred to the Department of Health to be formally considered for the blacklist:

• Homeopathy – no clear or robust evidence to support its use.

• Herbal treatments – no clear or robust evidence to support its use.

• Omega-3 Fatty Acid Compounds (fish oil) – essential fatty acids which can be obtained through diet, low clinical effectiveness.

• Co-proxamol – pain killer which has had its marketing authorisation withdrawn due to safety concerns.

• Rubefacients (excluding topical NSAIDS) – warming muscle rub products, limited evidence.

• Lutein and Antioxidants – used to treat the eye condition age related macular degeneration , low clinical effectiveness.

• Glucosamine and Chondroitin – used for joint pain, low clinical effectiveness.

• A joint clinical working group considered the responses to the consultation and agreed that the recommendations for the 18 products consulted on should either remain unchanged (12 products) or be modified or clarified in six cases (Liothyronine, Travel Vaccines, Lidocaine Plasters, Prolonged-release Doxazosin , Trimipramine and Immediate Release Fentanyl).