• NHS England and NHS Clinical Commissioners draw up lists of products facing prescribing limits
  • Products deemed ineffective, unnecessary, inappropriate or unsafe are listed
  • Consultation over changes will last until October

NHS England is to consult over limiting the prescription of “low value” products costing £141m a year including homeopathy and herbal medicines.

Products feature on the list because of low clinical effectiveness, where there is a lack of robust evidence over their effectiveness, or there are “significant” safety concerns.

The list also includes products considered clinically effective but where there are more cost effective alternatives available.

Seven travel vaccines not currently available on the NHS, but that are sometimes prescribed and administered in error because of confusion over vaccine eligibility, are also listed.

NHS England and NHS Clinical Commissioners are working with the country’s 209 clinical commissioning groups to ensure prescribing resources are used effectively and CCGs get the best value from medicines.

NHS England medical director Professor Sir Bruce Keogh and chief finance officer Paul Baumann presented a paper to the organisation’s board on Friday about the savings drive.

It said: “It is vital that the NHS achieves the greatest value from the money that is spends and we know that across England there is significant variation on what is being prescribed and to whom.”

Guidelines have been developed for the products considered “relatively ineffective, unnecessary, inappropriate or unsafe for prescription on the NHS”.

The 10 items of low clinical effectiveness, which cost the NHS £49m a year, are

  • Co-proxamol.
  • Omega 3 fatty acid compounds.
  • Lidocaine plasters.
  • Rubefacients.
  • Dosulepin.
  • Glucosamine and chondroitin.
  • Lutein and antioxidants.
  • Oxycodone and naloxone.
  • Homeopathy items.
  • Herbal medicines.

Seven items, costing £89m, which are clinically effective but where more cost-effective items are available are:

  • Liothyronine.
  • Doxazosin MR.
  • Perindopril Arginine.
  • Fentanyl immediate release.
  • Tadalafil once daily.
  • Trimipramine.
  • Paracetamol and tramadol combination product.

Gluten-free foods, which cost £26m to prescribe, have been subject to a separate consultation by the Department of Health that concluded last month. Restrictions have already been introduced by 112 CCGS, with 18 stopping the prescribing of all gluten-free foods.

More than 1bn items of prescriptions were dispensed in primary care last year, costing £9.2bn, with more than 90 per cent exempt from prescription charges.

The NHS England board paper said: “NHS England’s view is that, at best, homeopathy is a placebo and a misuse of scarce NHS funds, which could be better devoted to treatment that works.”

NHSCC and NHS England have also identified the need for action on over the counter medication, with the NHS spending £645m on medicines that could be purchased from pharmacies, supermarkets or petrol stations.

The consultation will ask for views on identifying which of the 3,200 products available over the counter, or which are considered relatively ineffective, should be recommended as “not generally prescribed”.

More than £50m a year is spent on medicines used to treat minor or self-limiting conditions such as common colds, which will also be part of the consultation.

NHS England’s board approved consultation, with its recommendations put to CCGs, patients, clinicians, professional and other bodies between July and October.

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