NHS England’s low value medicines consultation, supported by Midlands and Lancashire Commissioning Support Unit (MLCSU), resulted in the prescribing of some inappropriate or ineffective treatments being stopped, benefiting patients and reducing costs. Some of the proposals were amended in light of the evidence supplied by the patient, public and other stakeholder responses.

Background

NHS England wanted public and patient views and opinions on proposals to limit the prescribing of 18 products considered to be relatively ineffective, unnecessary, inappropriate or unsafe for routine prescription in NHS primary care.

Action

MLCSU’s communications and engagement (C&E) team and medicines management and optimisation (MMO) teams worked together to conduct the consultation in autumn 2017 and lead the analysis and reporting of consultation findings.

NHSE received a total of 5544 responses through the online consultation survey, and a further 195 written submissions by post or email. In addition, we held eight webinars for stakeholders, two face-to-face public and patient stakeholder events in London and Leeds, and three individual meetings with key stakeholder groups including industry, pain management and mental health.

We handled all of the responses, via the different channels. All open responses were read, and coded against themes identified in the responses. Answers to closed questions were graphed and charted. Specialist letters were summarised.

The responses to the consultation were presented to the NHS England board in a paper by Sir Bruce Keogh https://www.england.nhs.uk/wp-content/uploads/2017/11/05-pb-30-11-2017-items-which-should-not-be-routinely-prescribed-in-primary-care.pdf

Impact

The responses led to NHS England altering some of their proposals in light of the evidence supplied by the patient, public and other stakeholder responses.

For example, for Liothyronine the joint clinical working group recommended its prescribing for any new patient should be initiated by a consultant endocrinologist in the NHS, and that de-prescribing in ‘all’ patients would not be appropriate, as there were recognised exceptions. The recommendation would therefore be changed to advise prescribers to de-prescribe in all appropriate patients.

For further examples of how the consultation evidence impacted on the proposals and their amendment and adjustment see Sir Bruce Keogh’s paper.

I would like to thank the Midlands and Lancashire Commissioning Support Unit (CSU) who provided a high quality service to NHS England; their analysis helped us understand a wide range of views on our proposed prescribing guidance for ‘Items that should not routinely be prescribed in primary care: guidance for CCGs’. The insight provided by the teams at the CSU was first rate and ensured that the NHS England Board understood what the public, patients, clinicians and key stakeholders thought of our proposals.
Sir Bruce Keogh, Medical Director, NHS England