Region’s commissioners welcome national NHS prescriptions review, as concerns are raised over withdrawing gluten-free food
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Clinical commissioning groups (CCGs) in Norfolk and Waveney have welcomed a national review of the items available on prescription, as concerns are raised over the safety of withdrawing gluten-free food.
Travel vaccinations, gluten-free foods and omega-3 supplements are among the items which may no longer be available on the NHS under major cost-cutting plans.
NHS England will next month launch a consultation as it works to develop new national guidelines to stop GPs prescribing medicines and other items which are available over the counter for a fraction of the cost.
But some of the ten items initially being looked at have not been offered in this region for some time.
This included gluten-free items, which a spokesman for all five of the region's CCGs said were 'widely available nowadays from a variety of shops'.
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In West Norfolk, children were still able to get gluten-free products on prescription.
But Louisa Kiddell, director of the Norfolk Gluten Free Company and member of the Norfolk and Norwich Coeliac Group, said she was concerned about the elderly and vulnerable.
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Ms Kiddell said: 'They have mostly stopped giving items on prescription in Norfolk already, but people are finding it really difficult. For example, gluten-free bread is around six times the price of regular bread.
'But we are more concerned about the elderly or vulnerable people who need gluten-free items and may only be able to get to their local shop, rather than the big supermarkets who stock these things.'
She said while it was possible to live a gluten-free life without food products such as bread, when someone was told later in life they should avoid gluten they struggled to completely cut it out.
And if they could not easily access gluten-free alternatives, they would just revert back to normal products, putting their health at risk.
'It's not easy for them to change their habits,' she said.
She also said forcing people to buy their products rather than have them on prescriptions caused issues for families, who may be struggling with money.
'Families will often not just have one coeliac child, and children eat so much food.
'And of course they want what their friends have - it's not as easy to tell them they can't have a sandwich and have to have a salad instead.'
The new guidelines for CCGs will initially be developed around a set of 10 medicines deemed ineffective, unnecessary or inappropriate for the NHS.
These are thought to cost the service £128 million per year, NHS England said.
The consultation comes following a request by NHS Clinical Commissioners which identified 'significant areas' where savings of up to £400 million per year could be made.
Other items being looked at are:
A thyroid hormone used to treat certain thyroid conditions including hyperthyroidism.
Only small numbers of patients are found to benefit from the drug, which is generally more expensive than other forms of thyroid medication.
In 2016 the NHS reported that the treatment cost the NHS approximately £20.8 million per year.
Norfolk and Waveney CCGs recommend that GPs and nurses do not prescribe the drug, which a spokesman said costs £258.60 per 28 tablets compared to equivalent of levothyroxine of £1.66 per 28.
• Gluten-free foods
Around one in 100 people have coeliac disease, caused by a reaction to gluten, that can be treated by cutting the substance from a patient's diet.
Once diagnosed as coeliac by a doctor, patients in most parts of the UK can receive gluten-free staple foods from a pharmacy through a prescription from a GP.
Foods approved for prescription include bread or rolls, breakfast cereals, crackers and crispbreads, flour and flour-type mixes, oats, pasta and pizza bases.
The amounts of gluten-free staple foods a sufferer can receive each month are controlled by the National Prescribing Guidelines.
But across Norfolk and Waveney CCGs have withdrawn the food on prescription as it is widely available from shops. In West Norfolk this only applies to adults.
• Lidocaine plasters
Lidocaine plasters are a large sticking plasters that contain a local anaesthetic, which is absorbed into the skin when the affected area is covered.
They tend to be used when pain only affects a certain patch of skin, but can often be bought over the counter more easily and cheaper than the cost of a standard prescription.
In Norfolk and Waveney these are allowed, but a spokesman said this was 'only after certain other preparations have been tried first'.
Certain uses of the drug tadalafil, which is variously used to help alleviate erectile dysfunction and lower urinary tract infections, may also be phased out under the plans.
There are concerns that the drug is not as effective as other erectile dysfunction medications, such as sildenafil, sold under the brand name Viagra.
In Norfolk and Waveney clinicians are first asked to try sildenafil, but after that 10mg and 20mg doses are currently allowed.
Generally used in palliative care, fentanyl is a strong painkiller that comes as patches for terminally ill patients.
In many cases morphine is considered easier and cheaper to prescribe, and is just as effective for end-of life care.
NHS England estimates it spent just over £10 million on the drug last year.
The Norfolk and Waveney CCGs spokesman said: 'This is a very potent controlled drug analgesic. We ask prescribers that other products are used first.'
Co-proxamol is used for mild to moderate pain relief is a combination of two active ingredients, dextropropoxyphene and paracetamol, which is typically included as a lower 350mg dose compared with the standard 500mg dose of paracetamol when taken alone.
There is limited evidence suggesting co-proxamol is more effective at treating pain than a regular dose of paracetamol, for either acute or chronic use.
There have been previous concerns that the drug has been linked to suicides and poisonings and it was gradually phased out from wide use between 2005 and 2007.
In Norfolk and Waveney the drug was withdrawn for safety reasons in 2005, and the CCGs do not recommend prescribing.
• Travel vaccines
Vaccines for typhoid, hepatitis A and cholera and a combined jab for diptheria, polio and tetanus are usually available free on the NHS.
The health service offers the vaccinations free of charge because they protect against diseases deemed to present the greatest risk to public health if brought into the country by travellers.
Some countries require visitors to be vaccinated against diseases such as yellow fever or meningitis prior to arrival, while travellers to some parts of the world are advised to have inoculations against a range of other diseases, including tuberculosis, hepatitis B, Japanese encephalitis and tick-borne encephalitis.
These are not usually available on the NHS and can cost around £50 for each dose.
Practices in Norfolk and Waveney should charges for all vaccines except cholera, typhoid and hepatitis A, according to the CCGs, which are paid for by the NHS.
• Doxazosin MR
Doxazosin are a series of drugs used to treat hypertension, but doxazosin modified release (MR) tablets are only believed to be effective for a very small number of patients.
This form of doxazosin cost the NHS £7 million last year.
In Norfolk and Waveney, this is allowed but prescribers are 'expected to prescribe the most cost-effective version'.
A series of muscle rubs used to relieve skeletal-muscular pain are under review for their effectiveness compared with other forms of muscular pain relief.
Norfolk and Waveney CCGs recommend prescribing the most cost-effective brand available. A spokesman said: 'These products are easily available to purchase over the counter as part of self-care policy and we promote self-purchase.'
• Omega-3 and fish oils
Naturally-occurring oils from certain breeds of fish such as salmon and mackerel have typically been prescribed to promote a healthy heart for patients at risk of heart disease.
The fatty acid omega-3 usually comes in capsule form and has been used to help prevent irregular heartbeats and reduce the risk of clotting by making the blood less sticky.
Historic concerns about prescribing omega-3 stem from limited evidence suggesting the fatty acid is effective in capsule form, and little to categorically suggest what a recommended adult daily intake should be.
In Norfolk and Waveney, these are not recommended for prescribing.
There are suggestions that sun cream and paracetamol may also be scrapped following future reviews.
The review comes as Norfolk and Waveney CCGs are running a campaign asking patients to understand when their GP prescribes them a medicine which does exactly the same job as the one they are used to but is less expensive. GPs do so to make the best use of NHS resources, following the advice of medicines specialists.
Ian Small, prescribing lead, said: 'We welcome a national review of whether the NHS should be prescribing certain foods, supplements and medicines. Some brands are far more expensive than just-as-effective alternatives, and some are everyday medicines that people can buy more cheaply than it costs the NHS at a pharmacy as part of their self-care.'