Interesting suggestion low cost for high volume treatments to be excluded… GPs will take no notice as their job is to put their patient “at the centre of their concern”.

Whilst several MPs are calling for the cost of a Cystic Fibrosis drug to be covered by the Health Services of the UK, for 3000 patients this would add up to £312,000,000 per annum, and over 10 years to £3 billion. This may well be affordable IF we all agree to stop funding the high volume cheap services, as proposed by anther group of in the media MPs today! Wales, and Scotland,  with free prescriptions, have an interesting decision to make on whether they will follow England in this useless advice. Giving the decision to each GP on whether or not to fund  cheap treatments, available over the counter, for “socially vulnerable” patients, without a definition, will mean most ignore the advice. Given that there is no official “rationing”, why does NICE not say to what level they will fund, and if it’s £20K per annum, provide that amount towards the treatment. Technology is advancing faster than the states ability to pay. We have to act… and ration overtly.

NHSreality suggests a threshold of 2 pints of beer and a packet of 20 cigarettes. If a service costs less than this (which will increase with inflation, and taxation) then the citizen should pay. This would apply to ALL citizens, including the elderly. If a person is on a very low income, and benefits, they should still pay, but regain the money in their next social security payment. This they would only lose the real time value of the money. An exception would be those living in their own homes, who would always pay. 

The first duty of a doctor is to put the patient at the centre of their concern. Not the country. That is the duty of politicians, and they have to ration, or even larger holes will appear in the safety net..

MPs call for fresh talks to end deadlock over cystic fibrosis drug BMJ 2018;360:k1337 21st March 2018

A raft of new precision medicines for cystic fibrosis is in the pipeline. But will they ever reach patients? Jacqui Wise reports

MPs attending a packed parliamentary debate on access to the cystic fibrosis (CF) drug Orkambi have criticised the National Institute for Health and Care Excellence’s (NICE) current appraisal system as not fit for purpose in assessing the value of precision medicines.1

Orkambi, which was licensed by the European Medicines Agency three years ago and is available in a number of European countries, costs £104 000 (€119 000; $146 000) per person per year. MPs speaking at the debate on 19 March called on health ministers to get around the table with NHS England, NICE, and the drug’s manufacturer, Vertex, to break the deadlock in negotiations.

The debate was held after an online petition gathered more than 100 000 signatures in just 10 days. Sixty MPs attended the debate, many of whom spoke passionately about constituents desperate to access the treatment…

Chris SMyth reports in the Times 30th March 2018: NHS (Note this is England) orders doctors to stop treating dandruff and coughs.

Patients must not expect the NHS to treat minor problems such as coughs, indigestion or dandruff, health chiefs have ruled, as they urged GPs to send people away without prescriptions.

Ending NHS prescriptions for ailments that will get better by themselves or with medicines bought over the counter has been estimated to free up £97 million a year to spend on nurses and hip replacements. NHS England approved the changes yesterday but said they would save £39 million less than planned after patients deemed “socially vulnerable” were exempted.

Patient groups said this would confuse people because the category does not include all those who get free NHS prescriptions, leaving it to GPs to decide case-by-case who is vulnerable enough not to pay for everyday medicines.

Simon Stevens, head of NHS England, said: “Every pound we save from cutting waste is another pound we can then invest in better A&E care, new cancer treatments and much better mental health services.” He has approved plans to end NHS prescriptions for 37 medicines and conditions that either do not need treating or which respond just as well to cheap high street remedies. These include cold sores, haemorrhoids, acne and hay fever.

The NHS spends £23 million a year on constipation remedies, which Mr Stevens estimates would pay for 900 community nurses, and £3 million on athlete’s foot, which would fund 810 hip replacements.

The NHS website has also been updated to tell people with these conditions to go to a pharmacist, not a GP.

After protests from patients’ groups that the poor would lose out, the ban will not apply to those “where the clinician considers that their ability to self-manage is compromised as a consequence of medical, mental health or significant social vulnerability”.

Matina Loizou, of the Prescription Charges Coalition of charities, said: “There are bigger issues that need to be addressed, including how confusing this is going to be for people who are exempt from paying for prescriptions but won’t necessarily qualify for this. Added to this, the overall saving for the NHS . . . will be a drop in the ocean.”

Sandra Gidley of the Royal Pharmaceutical Society said: “We remain concerned that the implementation might disadvantage patients on low incomes and people may be denied treatment because of their inability to pay.”

John O’Connell of the Taxpayers’ Alliance said: “Taxpayers should not be footing the bill for items like anti-dandruff shampoo or athlete’s foot powder, so cutting out wasteful spending like this will mean that precious resources can be focused on frontline services.”

Simon Stevens will set out a “game plan for the next five to ten years” after Theresa May asked for help in drawing up a long-term plan for the health service. There is a prospect of up to £20 billion of extra money over the next five years.