Agenda item

The Committee gave consideration to a report which provided information on the ‘Over the Counter Medicines Review’ and the related public engagement work designed to communicate and engage with the public on the proposed changes.  The Committee were invited to participate in the engagement work and give consideration to the questions being asked of the public as per the engagement survey.

NHS England had issued guidance to CCGs which described two items of limited clinical value and 35 conditions which might be self-limiting and therefore suitable for patient self-care.  Key aspects were encouraging self-care, the stopping of prescribing drugs of limited clinical effectiveness and where products were available over the counter for the treatment of minor conditions, these should not be routinely prescribed.  The guidance was condition based and outlined at Appendix 1 to the report.  Supporting people to self-manage common conditions could help reduce England’s 57 million GP consultations which cost the NHS approximately £2 billion.  The promotion of self-care and increasing the awareness to alternatives to making appointments would encourage patients to explore self-care in the future.  The GM Clinical Standards Board had previously adopted self-care as a priority area.  NHS Oldham was working with Stockport, Bury, Manchester and Wigan Clinical Commissioning Groups (CCGs).  

The CCG wanted views of local patients, the public and stakeholders on the NHS England proposals before deciding whether and how the products were removed from routine prescriptions locally.  Participants were asked to read supporting information and then complete the survey in order for an informed decision to be made.

NHS Oldham CCG had spent £2.2m on medicines that were available over the counter and it was recognised that much of the cost was attributable to long-term or complex conditions.  Removing medications for certain conditions from routine prescriptions would release money to treat conditions such as heart disease and diabetes.  The medications that were suggested for stopping routine prescription were for conditions that could be considered to be self-limiting or were suitable for self-care so that the person suffering did not normally need to seek medical advice and could manage the condition by purchasing directly over the counter. 

The policy had been written following a GM-wide public consultation and was in line with guidance from NHS England.

People with minor ailments could seek the right care and treatment after being signposted to community pharmacies where over the counter treatments could be purchased.  The CCG were aware that some individuals and families were unable to afford to pay for medication and as health professionals wanted to retain the power to prescribe from the list of recommended treatments as and when appropriate.

The CCG has taken into consideration the GM and NHSE consultation work, recommendations and guidance and had begun work to engage with the public.  Thirty responses had been received so far, the majority of which supported the recommendations.  The engagement period would last until 1^st April 2019.  The responses would be reviewed by the Clinical Committee and a decision made there or at the NHS Oldham CCG Clinical Commissioning Committee.

The Health Scrutiny Sub-Committee were asked to consider if the Committee supported the principle that the local NHS should not routinely prescribe for conditions which were self-limited or deemed suitable for self-care and what mitigating steps could be put into place to reduce the impact upon individual and families who where unable to afford to pay for medication.

Members were provided with the background on the consultation undertaken by the NHS.  CCGs had been asked to make local decisions outlined in the conditions.  It was a long list to consider and allowed exceptions for social reasons, i.e. situations where people were vulnerable.  Members were referred to the NHS England guidance and asked for their views and what allowances be made for social rationale.  Members were advised that the savings to the CCG were considerable.

Members asked and it was confirmed that 30 responses had been received from the general public which had been a questionnaire.  There had also been a national consultation.

Members asked if the policy applied to hospitals and concerns were expressed about hospital pharmacies and ‘trapped’ audiences and the prices at hospital pharmacies.  Members were advised of developing formal partnership arrangements with pharmacies.   Members were advised of the spend on drugs and most number of drugs.  The support from the Committee on putting pressure on local pharmacists was welcomed.  This could be addressed through a task and finish group approach and included in the work programme.

Members referred to change of behaviour, management of change and how information was publicised, what type of information was available in GP practices related to NHS Choices and promotion of self-care.  Members were informed that information was initially shared on social media.  Posters were recommended to be supplied to GP practices and pharmacies.  Members queried information provided to GPs and were informed it was intended to benchmark information and that unions had also written to GPs as well as a letter from the Secretary of State.  Members were informed of criteria to ensure patients were able to afford medications. It was discussed that there was some leverage with pharmacies as health care professionals as the first duty of care was towards patients.

RESOLVED that:

1.         The principle that the Local NHS should not prescribe for conditions that were self-limiting or deemed suitable for self-care be supported.

2.         A task and finish group be established to address local pharmacies and to look at how to highlight and promote changes in medication behaviour.