As our series continues, we look at the role that pharmacies can play, and the ongoing battle over treatments for long term conditions such as ceoliac disease, which patients are required to manage through lifestyle.
Millions of pounds could be saved if more pharmacists prescribed medicines, the Royal Pharmaceutical Society has said.
But the organisations that represents thousands of pharmacists has warned few of its members have been involved in drawing up the Sustainability and Transformation Plans.
It comes as the NHS pushes for medics to slash overall prescribing. The society suggests hundreds of millions could be saved if more pharmacists were able to prescribe.
Neal Patel, pharmacist and spokesman for the RPS, said savings could be made if there were more prescribing pharmacists, freeing up GP time.
Complex patients with multiple conditions could be seen by pharmacists who could reduce the number of medications, in turn reducing the risk of adverse reactions between conflicting drugs and cutting emergency hospital admissions.
Mr Patel said: “When pharmacists look at patients all round, and at all the medicines they’re taking, the majority are prescribed for people with long-term conditions.
“It’s not unusual for people to have one, two, three or four conditions, with five or six drugs for each. It’s not hard to start to have 15 or 20 medicines you’re taking.
“You get side effects because of the combination is causing more harm than good, and suddenly because some of those started a long time ago, you might want to start reducing the side effects by reducing drugs.
“We look at a patient as a whole to start reducing the burden of the medicines they gave and a side effect to that, they reduce the chance of them going into hospital.’
Late last year the society revealed just 3,319 out of 54,500 pharmacists - six per cent - were trained to prescribe medicines.
New figures obtained by this newspaper from the General Pharmaceutical Council show this has increased to 3,782 in England.
In Scotland there are 891 and in Wales 293. Separate figures from the Pharmaceutical Society of NI say there are 313 in the country.
The figures come as STPs propose major savings on prescribing costs.
Separately, Mr Patel warned a quick switch to generic drugs could affect patients suffering from illnesses, including epilepsy, arthritis and irritable bowel syndrome.
Kidney transplant patients could also be at risk of their body rejecting the transplanted organ if the drug they are on is switched to a cheaper alternative, branded or generic.
“There’s a big cost differential between branded medicine, and if the medicine is exactly the same then the CCG should do what it can to reduce cost,” he said.
“There might be a clinical need for branded medicine if we swap it for a cheaper one, then it may not have the same effect.
“Some medicines, the bio-medicines, that have a specific effect on the body, you can’t just replace those with a generic medicine.
“If you start with a generic one then you need to stay with that and if a branded one then you need to stick with that.”
Meanwhile, many STPs suggest ‘social prescribing’ to move away from traditional clinical treatment.
The plan for West Yorkshire and Harrogate says: ‘We will stop medicalising issues and ensure people get the right support from the right professional.
‘We will look outside the clinical model to deliver a more holistic service to our local populations and achieve better outcomes; prescribing will not be the default position.’
In one case, changes proposed in the Cheshire and Wirral STP aim to improve ‘opportunities for community-based social prescribing’.
Meanwhile in Southampton, Hampshire, the mental health charity Mind is already offering gardening courses as treatment.
The 10-week courses run at Mayfield Nurseries are prescribed by GPs, and aims to ‘improve people’s’ wellbeing, confidence and self-esteem’.
The drive to save cash in the NHS is putting funding for treatments in direct competition, a charity has warned.
Proposals for cuts to prescription budgets across England are pushing NHS chiefs into axing food prescriptions for people with coeliac disease, Coeliac UK has said.
It comes as analysis of plans aiming to slash £22bn from the NHS reveals five areas’ plans alone hope to save £186m in prescribing costs.
An NHS report found last year the total community prescribing bill – not just for gluten-free food – for 2015 was £9,266.6 million, up from £8,852.6 million the year before.
Under national guidelines people who suffer from coeliac disease – a hypersensitivity to gluten – are supposed to be given gluten-free food, Coeliac UK says.
But around a third of England’s 209 CCGs, the bodies responsible for commissioning health services, have already instructed GPs to stop doing so.
A total of £1.2m was spent on prescribed gluten-free foods in the Greater Manchester area alone, between April 2012 and March 2013.
Norma McGough, director of policy, research and campaigns at Coeliac UK, warned ‘short term’ decisions are putting sufferers at risk.
She said: “With the STPs one of the problems is lots of things get put in the pot together.
“We know it’s almost like pitting one condition against another. It’s not ideal to do that.
“I know it’s about prioritising, but certainly with gluten-free prescribing, it’s being stacked against vitamin D supplementation.
“Having a situation where we’re comparing the sort of ongoing disease with vitamin D deficiency, it just doesn’t seem right.”
Data compiled by the charity reveals 39 CCGs in England have stopped prescribing food, except for in exceptional circumstances, such as for young children or deprived patients.
It means a postcode lottery has developed, with some neighbouring counties offering differing levels of support.
Around 150,000 people in the United Kingdom have been diagnosed with coeliac disease, according to research in 2014.
A further 500,000 extra could be living in the UK undiagnosed, Ms McGough said.
“Coeliac disease is not a choice, it’s a serious medical condition, when the body’s antibodies attacks its own body when gluten is eaten,” Ms McGough added.
“If you continue to eat gluten then essentially there will be a risk of complications with coeliac disease and then there are problems of osteoporosis, due to malabsorption of calcium, then there’s a rare risk of cancer.
“We understand the cost pressures for the NHS and obviously want to try to work with the NHS to make the cost efficiencies.’
Separately, Dr Tony O’Sullivan, co-chair of Keep Our NHS Public, has warned putting restrictions on prescriptions may force people to seek private care.
A former clinical director at Lewisham Hospital who has more than 40 years of experience in the NHS, Dr O’Sullivan, said: “The more restrictive the health service becomes, we’re going to make it more difficult for people.
“You won’t be able to have two cataract operations, you’ll have one eye not the other, you can have one hearing aid but not two.
“The more the waiting lists goes up for hip and knee replacements – certainly they’re making changes so that people who can will go privately.”
‘It’s a very difficulty situation, we completely understand the NHS is hard pushed for resources’
National charity Coeliac UK is strongly opposing the removal or restriction of gluten free prescriptions around the country for those battling coeliac disease, arguing that if the treatment for the condition was a drug, patients would not be facing this situation.
Clinical Commissioning Groups (CCGs) are responsible for the commissioning of NHS services at a local level including the prescribing of gluten-free staple foods.
There are 209 CCGs and currently around 60 per cent of CCGs are following the National Prescribing Guidelines with over a third now restricting what is available on prescription.
While some are still prescribing gluten free products for those with coeliac disease, others are restricting products, with some CCGs having already partially or completely withdrawing the prescriptions resulting in a postcode lottery.
In many other areas, the policy on gluten-free prescribing is currently under review.
Coeliac disease is a serious autoimmune condition caused by a reaction to gluten, a protein found in wheat, barley and rye.
Coeliac UK, believes any cuts to gluten free prescriptions will leave vulnerable patients with coeliac disease without support which will affect their ability to stick to the gluten free diet - the only treatment for the condition.
The potential serious long term health complications of not maintaining a gluten free diet include osteoporosis, infertility and, in some rare cases, small bowel cancer, conditions that could cost the NHS a lot more in the long run.
Sarah Sleet, chief executive of charity Coeliac UK, said: “It is a very difficult situation.
“We completely understand the NHS is hard pushed for resources at the moment.
“But for people with coeliac disease, it is a life long condition and the only treatment is a gluten free diet. Breads and flours are very much part of the British diet and it is difficult to substitute them with things such as potatoes and rice so you don’t eat any flour or bread.
“Simply switching to alternative carbohydrates such as rice and potatoes risks malnutrition with bread alone providing between 10 and 20 per cent of our most important nutrients such as protein, calcium and iron but potatoes and rice only providing a fraction of this.”
Gluten-free food staples such as pasta, are three to four times more expensive than comparable gluten-containing products, gram for gram but gluten-free bread is six times more expensive than regular gluten containing bread in the supermarket.
On top of this availability is limited in rural areas, discount supermarkets and small stores.