This week, NHS England has published its initial thoughts on the consultation on items which should not be routinely prescribed in primary care, which could implement restrictions on over the counter medications for constipation. The Health Select Committee has resumed its inquiry into STPs, and leaders from the Royal College of Nursing have been criticised for having a positive reaction to the Budget. NHS England has also published a planning paper discussing waiting time standards and prescriptions.

NHS England board paper proposes restrictions to OTC medications for constipation

An NHS England board paper has confirmed that following the consultation on items which should not be routinely prescribed in primary care, a number of items will be removed from prescriptions to save £141 million per year. The paper also said a consultation will be launched on restrictions to prescriptions for some over the counter (OTC) products, either where they are products used to treat minor conditions; products used to treat both minor and non-minor conditions; and products used to treat non-minor conditions. The restrictions on products for minor conditions could save approximately £190 million per year.

‘Simple constipation’ is given as an example of a condition caused by a “lack of fibre in the diet [which] can be considered minor and treated with an OTC product” – although it acknowledges that constipation can sometimes be a side effect of other drugs or conditions, such as terminally ill patients using morphine. The paper concludes that “We therefore expect around 20% of OTC prescribing for drugs in this category to be for minor conditions. We do not propose restrictions on OTC prescribing for non-minor conditions.”

The paper stated that NHS England will publish draft guidance in January 2018 to consult with CCGs, patients, clinicians, professional and other stakeholder bodies. The outcome of this will be “a consistent, national framework, in the context of which local CCGs will be able to decide whether and how to implement the national clinical commissioning guidance, with due regard to both local circumstances and their own impact assessments.”

Health Select Committee resumes STPs inquiry

The Health Select Committee has resumed its inquiry into STPs which was launched earlier this year but cut short by the general election. The Committee specifies that it will be taking a national view of the STP process rather than commenting on individual plans, and will look at areas including:

  • How effective have STPs been in joining up health and social care across their footprints, and in engaging parts of the system outside the acute healthcare sector, for example primary care, local authorities, public health, mental health and voluntary sector partners? How effectively are they engaging local communities and their representatives?
  • Looking across all STPs, are there any major areas where the content of the plans needs to be tested for credibility and realism? Are there any major gaps? For example, are proposals in some plans to reduce bed capacity credible? Are the NHS efficiency estimates in STPs robust? Is the workforce available to enable the implementation of STPs? Is the timescale for the changes proposed in STPs realistic?
  • What public engagement will be necessary to enable STPs/ACSs to succeed, and how should that engagement be undertaken?

RCN leaders criticised for “positive” Budget response

Regional leaders from the Royal College of Nursing have criticised both the Chancellor for not going far enough to increase nurses’ pay in the Budget, and national RCN leaders for delivering an “underwhelming” response to the Budget. The regional leaders said in an open letter that the national RCN leaders should not have welcomed the Chancellor’s pledge to provide additional funding for a pay increase for NHS staff if it is agreed with pay review bodies, as the pay increase has not been finalised yet.

Health unions also warned that the Government risked a similar situation to the junior doctors’ contract dispute if the Health Secretary’s suggestion – that overall pay could be increased to the detriment of additional pay for weekend and overnight working – materialises. Jeremy Hunt made the suggestions during an interview with HSJ this week, which he said would introduce “modern professional pay structures” for the NHS. The head of health at Unison, Sara Gorton, said “If the government is expecting staff to pay for their own wage rise, it’ll be a very short set of talks indeed.”

NHS England planning paper discusses waiting time standards and prescriptions

NHS England has published a planning paper in response to the Budget, discussing the possibility of waiting time standards not being met as a result of the NHS’s funding settlement. The paper warned that difficulties in achieving enough efficiency savings to work with the funding available will mean that “the NHS will likely not be able to do everything being expected of it”. Building on previous statements that elective care waiting time standards are unlikely to be met next year, the paper says that while there will be “some difficult judgements about priorities” needed, NHS England leaders are not prepared for mental health, cancer and primary care services to be used as a “balancing item” to fund other services.