Changing the way we prescribe in Calderdale

Consultation document

Who are we?

Clinical commissioning groups (CCGs) are responsible for planning and buying (commissioning) healthcare. We are made up of your local GPs and other healthcare professionals.

In Calderdale we have a budget of £312million to buy health and care services such as: emergency care, hospital care, community care, GP and mental health services.

What is the consultation about?

We want you to have a long, healthy life and be active and independent for as long as possible. So we want to spend our money wisely to pay for newer treatments and support other services.

We spend more than £600,000 on lower value medicines and products. These are medicines and products that you can buy, without a prescription, from a pharmacy or supermarket, like:

Baby milks and infantile colic products

Multivitamins and vitamin D

Emollients (moisturisers) for minor dry skin conditions

Cosmetic products, including eflornithine for facial hair

Antifungal nail paints

Sunscreen products

By not prescribing these items we could spend this money on more effective treatments which have a more positive impact on patients’ health.

We also spend about £80,000 every year on prescribing branded medications instead of prescribing non-branded (generic) medicines.

Most medicines have two names, for example Nurofen is a brand name and the generic name is ibuprofen. Generic products contain the same active ingredient as the branded product and are just as effective as branded medicines.

We also spend about £120,000 every year on gluten-free (GF) foods for patients with Coeliac Disease which you can now get easily from supermarkets and pharmacies.

We want to know what you think about changing the way we prescribe:

Branded medicines

Lower value medicines and products and

Gluten-free foods.

Why do we need to change?

The NHS has a limited budget, but there is increasing demand for services. People are living longer and there are a lot more people with more long-term health conditions. This makes our job of commissioning, or buying, healthcare services for all our population more of a challenge. As a CCG we need to make sure we focus on value for money as well as quality. We also need to make sure we spend the money we have wisely and in the most cost effective way. Like all households and families we are all trying to work within our budget. Because of this we need to make decisions on what to buy so the funding is in place for the right services. As more medicines to treat more complicated medical conditions become available, the cost of the medicines budget goes up. The higher price of new medicines is often due to years of research in developing those medicines. Over the last year we have run a campaign to encourage people to buy some medication, such as paracetamol, for pain relief themselves. We have also been working on solutions to help us deliver services in GP practices and provide walk-in facilities, to take the pressure off A&E. However, if we are to work within the budget we have, we need to do more. This is why we are asking you for your views about our proposed changes.

How to have your say

After reading this consultation document, you can have your say by completing our survey:

Online: www.calderdaleccg.nhs.uk/prescribingsurvey

By post: Download a copy from our website (see below) or pick up a copy from your local GP practice and mail to:

Consultation - medicines and products

FREEPOST RLTG-JAYY-ZSRX

NHS Calderdale CCG

5th Floor F Mill

Dean Clough

Halifax HX3 5AX

For more information visit: www.calderdaleccg.nhs.uk

The closing date for the consultation is midnight 4 December 2017.

Unfortunately, we cannot accept any surveys after this date.

What have people already told us?

We have been talking to local people, the voluntary and community sector and key

stakeholders about how we spend our money in our engagement over summer 2017 –

‘It’s everyone’s NHS – and we’re not going to waste it’. You can view a copy of this report

at www.calderdaleccg.nhs.uk/key-documents/

Most of the people we spoke to agreed or strongly agreed with our ideas for reducing the

money we spend on prescriptions. They also felt that the NHS should only pay for the

most effective drugs and treatments.

You also told us:

• Stop prescribing anything that costs more on prescription if it can be bought without

a prescription

• Consider carefully the needs of people who are vulnerable

• Drugs should be prescribed on the basis of ‘effectiveness’

• Consider those who can’t buy large quantities and those on a low income

• Consider that some people over 60 can afford to pay

• Be consistent in the criteria for prescribing

• The NHS can’t be expected to fund everything

• Good value is important

• The NHS needs to reduce abuse of the prescribing system.

What are we proposing?

We are proposing to:

not routinely fund a range of lower value medicines and products on prescription

not routinely fund the prescribing of branded products unless there is a medical

reason

not routinely fund the prescribing of gluten-free products on prescription.

This will ensure that you receive the best and most effective care, whilst also helping the

NHS spend its money more wisely.

Lower value medicines and products

Lower value medicines and products are ones you can buy, without needing a

prescription, from a community pharmacy or supermarket. We are proposing that we will

not routinely fund the following products:

Sunscreens for skin protection from UV radiation.

Who may be affected? The majority of people who obtain sunscreens on prescriptions

Who would NOT be affected?

People who are prescribed highly specialised products, e.g. those patients with abnormal reaction to UV radiation, predominantly UVA radiation

Reason for change Effective sunscreen products are readily available

Cream for unwanted facial hair and other products that have a predominantly cosmetic action*

*This includes eflornithine which is a prescription-only treatment for the removal of facial hair. However, alternative non-prescription treatments are available.

Who may be affected? People who receive cosmetic treatments such as eflornithine on prescription

Who would NOT be affected?

No exclusions identified

Reason for change Cosmetic products are not normally funded by the NHS. Most people buy hair removal products or treatments themselves

Antifungal nail paints

Who may be affected? People who receive antifungal nail paints on prescription

Who would NOT be affected?

No exclusions identified

Reason for change Fungal nail infections are normally a cosmetic concern only and do not require any treatment. For a more severe nail infection, treatment with a medicine is needed as nail paints are not very effective and these will still be available on prescription.

Multivitamins, where no specific deficiency has been identified, including vitamin D

Who may be affected? People who receive vitamin supplements on prescription as a dietary supplement

Who would NOT be affected?

People who:

have been identified as having specific vitamin and

mineral deficiencies and require medical intervention to

treat the deficiency.

are receiving supplements following weight loss surgery

Reason for change Vitamin supplementation is only medically required when there is a proven deficiency.

Emollients (moisturisers), shampoos, bath and shower products for mild dry skin

Who may be affected? People who have mild dry skin and receive moisturising products on prescription

Who would NOT be affected?

People who are diagnosed with eczema and psoriasis and are prescribed emollients as part of their treatment.

Reason for change Mild dry skin is not a medical condition. The majority of people buy such products themselves.

Infant formula for lactose intolerance, soya and thickened infant formulas.

Who may be affected? Bottle-fed infants who are intolerant to cow’s milk or using thickened formulas and get these on prescription

Who would NOT be affected?

Infants diagnosed with cow’s milk protein allergy or children with rare metabolic disorders needing a special diet

Reason for change Most families purchase infant milks which are readily available from pharmacies and supermarkets. Vouchers for infant milks are available for low income families.

Colic treatments such as Infacol and Colief

Who may be affected? Infants and their families/carers who receive colic treatments on prescription

Who would NOT be affected?

No exclusions.

Reason for change There is poor evidence that these products are effective. Advice and reassurance are the recommended treatment for infant colic

Potential saving for the NHS in Calderdale: £500,000

Branded medicines

Most medicines available from the NHS are prescribed by their chemical (generic) name

rather than their brand name and this is usually recommended as the most cost-effective

way to provide treatments. There are certain circumstances when doctors are

recommended to prescribe a product by brand name for example certain medicines for

epilepsy and patients who may have an allergy to a colouring or preservative in a

particular brand.

Generic products contain the same active ingredient as the original branded product. They

have to go through a detailed safety and quality assessment and have to demonstrate that

they work just as well as the original product before they can be used in the UK.

Branded medicines can cost the NHS over 50 times more than the equivalent non-

branded products. It is estimated that we spend about £80,000 every year on prescribing

branded medications compared to the equivalent non-branded products where there is no

medical reason.

What we are proposing

We are proposing to not routinely fund the prescribing of branded products unless there is

a medical reason.

Who may be affected?

People who request a branded medicine when there is no medical reason to do so.

Who would not be affected?

People who have a medical need for a particular product for specific reasons, such as a

proven allergy to colourants and other ingredients.

To give you an idea of the different costs for branded and non-branded medicines we have

listed some examples below.

Commonly prescribed for: Branded item Generic item

High cholesterol Lipitor®

£24.64

Atorvastatin tablets

£1.07

Treating indigestion and ulcers Losec®

£16.70

Omeprazole

86p

Treating migraines Imigran®

£31.85

Sumatriptan

£1.29

Preventing blood clots Plavix®

£35.64

Clopidogrel

£1.25

Preventing recurrence of breast cancer Arimidex®

£68.56

Anastrozole

£1.00

Glaucoma Xalatan® eye drops

£12.48

Latanoprost eye drops

£1.43

Prices correct at September 2017

Gluten-free Foods

Since the late 1960s, the NHS has prescribed gluten free foods such as bread, flour,

cereal and pasta to help people with Coeliac Disease follow a gluten free diet.

When prescriptions were first issued for this it was because it was very difficult to find

gluten free foods. Now most supermarkets stock a wide range. Food labelling has also

improved so people can see what is in their food and can avoid gluten more easily.

Naturally gluten free foods are also widely available e.g. meat, fish, vegetables, fruit,

potatoes, rice, corn and most dairy products, and there are a wide variety of products now

on the market e.g. rice cakes, crackers etc. to allow patients to complement their gluten

free diets safely and obtain all their nutritional requirements.

In Calderdale we spend about £120,000 a year on gluten free foods on prescription.

The Department of Health has completed a 12 week national consultation this summer on

the availability of gluten free foods on prescription. The results of this consultation have

not yet been published but the CCG is keen to gather local people’s views to help us make

a decision.

What we are proposing

We are proposing to not routinely fund the prescribing of gluten free foods on prescription.

Who may be affected?

All people who receive gluten free foods on prescription.

Have your say

Now you have read the consultation document, please take the time to complete our survey and tell us your views. You can complete the survey online or by post. Make sure you have your say before the deadline of midnight 4 December 2017.

This document was produced by NHS Calderdale CCG.

For more information go to: www.calderdaleccg.nhs.uk