Agenda item

Bob Bowes (Chair, NHS West Kent CCG) and Adam Wickings (Joint Chief Operating Officer, NHS West Kent CCG) were in attendance for this item.

(1)       The Chairman invited West Kent CCG representative, Dr Bowes, to update the Committee on the decision of the CCG governing body to amend its prescribing policy so that over-the-counter medicines would no longer be prescribed for minor ailments.

(2)       Dr Bowes apologised to the Committee that the process followed in developing the proposals had not been in line with that set out to the Committee at previous meetings.  He advised the Committee that it was important to note that the CCGs were not able to enforce changes to what GPs were and were not allowed to prescribe  due to GPs’ contracts with the General Medical Council.  However, Dr Bowes explained that the CCG was of the view that when made aware of the significant cost implications of prescribing over the counter medications, many patients were happy to purchase their own for short-term use for minor ailments.  He confirmed that this proposal would not dictate how GPs prescribed but that by highlighting the issue, it was hoped that it would lead to change in prescribing habits and that this would equate to around £300,000 worth of savings out of the £1.7m budget currently in use.  Providing clarification to the Committee, Dr Bowes confirmed that the proposal was a recommendation to GPs, rather than a directive.

(3)       Members commented on the importance of encouraging healthier lifestyles to minimise a reliance on regular medication.

(4)       Responding to questions from Members, Dr Bowes explained that approximately 80% of patients did not pay for prescriptions and that it was this patient group that may be asked to buy low cost, short term prescriptions over the counter as part of the proposal.  He reassured the Committee, that the free prescription patient group did not get this entitlement based on their financial situation in the majority of cases, so it was not expected that there would be any significant negative impact and he reiterated that when given the appropriate advice by GPs regarding purchasing over the counter medication, most patients were agreeable to this approach.  Dr Bowes advised the Committee that where patients did still require a prescription, based on medical assessment, appropriate prescriptions would still be issued.  He confirmed that the proposal would mean that where many consultations already involved doctors providing information leaflets to help patients self-manage, this could now also include a recommendation to purchase the relevant over-the-counter medication themselves.  Dr Bowes also highlighted the Pharmacy First scheme, which provided an alternative method of accessing free prescriptions without additional medical consultation.

(5)       In response to comments, Dr Bowes agreed that whilst people were using the Pharmacy First scheme, it still had a greater potential.  He recognised that it was important to ensure a balance between appropriate access to primary care for medical consultations and seeking pharmaceutical advice outside these care settings.  This helped relieve pressure of GPs and still allowed patients to access the help they needed.  Dr Bowes clarified that the Pharmacy First scheme involved pharmacists prescribing medication as appropriate, without the need for the patient to visit a doctor.  However, he noted that this would also mean that those who were advised to purchase their own medication but were unable to afford them could still obtain prescriptions via a pharmacist when appropriate.

(6)       Dr Bowes also addressed comments from Members regarding returned, unused medications and the provision of infant formula.  He advised that where a medical reason necessitated the prescribing of infant formula, this would still happen in line with normal prescribing practice.  He noted that many prescription formulas were more than standard formula, which should be taken into account.  In terms of returning medication, he explained that safety and the risk of tampering were crucial factors in the approach and it was a national level decision given the wide reaching implications.

(7)       Responding to comments, Dr Bowes and Mr Wickings explained that the target areas identified in the reports referred to the sampling undertaken as part of the equality impact assessment and clarified that there was no intention that the proposed scheme was going to be applied differently in different areas within the CCG.  The Committee requested that further information was provided regarding the patient sampling and engagement undertaken around the proposals and the CCG representatives agreed to provide this.

(8)       In response to a question regarding GP adoption of new practices and policies, Dr Bowes advised the Committee that there was a commitment at all levels within the CCG, including GPs, to identifying appropriate measures to save money to ensure good quality care could continue in the future in the face of significant financial challenges.  He also commented that the West Kent CCG health economy had recovered fairly well despite the challenges but this did not change the need to work hard on efficiency.  Mr Wickings reassured the committee that the recommendations from the CCG to GPs were developed in collaboration with GPs, so there was engagement and discussion prior to any notification or implementation of any proposals.

(9)       The Chairman summarised the discussion, noting that the Committee had requested the item as part of expressing its disappointment in not being consulted more fully as the proposal was developed.

(10)     RESOLVED that the Committee:

(a)       expressed disappointment about the lack of consultation by the CCG with the Committee about its review of prescribing policy for over-the- counter medicine for minor ailments;

(b)       proposed that a  joint protocol is developed which sets out how the Committee and its NHS counterparts will jointly reach a view as to whether or not a proposal constitutes a “substantial development” or “substantial variation.