• NHS England is planning “subsequent phases” to its current consultation on restricting access to surgical procedures
  • Source close to process says there will be “greater potential for disagreement”
  • Separately, there are also plans for further prescribing bans

NHS England plans to “rapidly expand” the number of medications and treatments it will restrict access to – beyond those which have already been announced or formally proposed.

In a board paper published this week, NHS England said that its recently announced plan to cut access to 17 treatments will be part of a “much wider, ongoing programme”.

It said: “We will consult on further interventions in phase two which will be launched in early 2019. Phase two will also include specialised services which are commissioned by NHS England.”

The consultation document for the first 17 interventions said this was a “relatively narrow” list to “develop proof of concept.” It added: “Through subsequent phases the programme could rapidly expand”.

It is not clear what other treatments will be included in phase two of the rationing programme, although NHS England is inviting proposals.

One source close to the process told HSJ: “The first round went for low hanging fruit for which there was less disagreement. Obviously the more you do and the further you go the more potential there is for disagreement.”

Jeremy Taylor, chief executive of National Voices, told HSJ: “The risk is that the programme morphs into a large scale efficiency programme, with the emphasis on cost cutting rather than patient benefit.”   

“If NHS England is going to push on with restrictions, then the choice of areas of treatment, the criteria for restriction, and how these are applied in practice are matters that need to be worked out through co-production with patients, charities and health professionals.”

The consultation document said the efficiencies made from restricting access to treatments will help commissioners meet elective performance targets and reduce outsourcing.

Prior to this programme, there have been various local initiatives to implement treatment restrictions.

A paper from 10 clinical colleges last month also recommended 50 treatments that might not be in patients’ best interests.

New medicine restrictions

NHS England and local commissioners are also planning a third phase of prescribing bans.

To date, clinical commissioning groups have stopped prescribing some over the counter medicines and medicines of low value, such as pain killers and gluten free food.

Julie Wood, chief executive of NHS Clinical Commissioners, told an audience at NHS Confederation conference last month that there will be a third consultation on restricting more medicines and medical devices.

Although Ms Wood gave no timeline for phase three, she said NHSCC had initially identified £400m of savings from drugs with limited effectiveness of which, she said, NHS England has to date implemented approximately £130m worth.

She said the third phase would “revisit” this list again as well as looking at “specials” which are unlicensed medicines mixed up by pharmacists which she said can be “incredibly expensive”.

Ms Wood said the consultation will also look at medical devices as well as prescriptions for non-pharmaceuticals such as SIP feeds, wound and incontinence dressings.