Some three thousand products have been named on a new blacklist of medicines, supplements, vitamins, ointments and remedies that can no longer be prescribed by GPs and dispensed on the NHS in Scotland.

The new Directions on Prescribing Controls 2024 regulation, that came into force last week, lists ‘drugs, medicines and other substances which may, or may not, be ordered for patients in the provision of primary medical services under a general medical services [GP] contract’.

The list includes many over-the-counter products, including many own-brand items sold by larger pharmacy chains.

Some products for people on restricted diets are also included.

The new rules are part of an NHS Scotland-wide programme to cut back prescribing of medicines and treatments which are of limited clinical value or cost more for the NHS to dispense than someone would pay to buy them in the pharmacy.

The move closes the door on prescribers writing prescriptions for items such as paracetamol in infant and child syrup suspensions when they are concerned about a person’s ability to pay the over-the-counter price.

Certain brands of bath and shower emollients and probiotics will also no longer be available through prescription, in a decision that appears to jump the gun on proposals that were put out to consultation earlier in the summer.

A consultation led by the Scottish government’s Effective Prescribing and Therapeutics Division on a narrower list of ‘medicines of low or limited clinical value’ closed earlier this month and analysis of the responses is yet to be published.

The package of changes proposed in the Achieving Value and Sustainability in Prescribing draft guidance would see a series of medicines taken out of routine use because of ‘low or limited effectiveness, safety concerns, or low value for money for NHS Scotland where there are more cost-effective items available’.

Stopping GPs from prescribing bath and shower emollients alone could potentially save the NHS in Scotland over £1.2m a year.

The expert group behind the guidance found significant variation in the spending on the same items in different parts of Scotland and are suggesting that a number of medicines should only be prescribed in exceptional circumstances.

They have also pointed to big variations in price for the same products made by different suppliers .

They use the cost of supplying items for people with diabetes to demonstrate how money is being wasted when prescribers choose high priced brands.

With 40 different types of blood glucose testing strips available, ranging in price from £5.45 to £16.40 for 50, prescribers are being asked not to use those costing more than £10 – with a suggestion that people with type 2 diabetes who are controlling their blood sugar levels effectively with diet and exercise shouldn’t need to self-monitor anyway.

Likewise, the group says the £600,000 spent on insulin pen needles could be reduced by putting a ceiling of £5 on the price paid for a batch of 100 needles.

The expert group found some were ten times the price of others – the cost of 100 ranging from £3.95 to £30.08.

 

Read more: Scottish government consults on medicines blacklist; UK joins forces to combat antimicrobial resistance; Study shows diet can hold diabetes at bay for years

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