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Patients are denied high cost drugs by NHS trusts’ managers

Family doctors are being prevented from prescribing drugs for conditions such as diabetes, heart disease and osteoporosis as NHS managers attempt to make drastic budget cuts, an investigation has found.
Patients are denied high cost drugs by NHS trusts' managersPrimary care trusts are adding more medicines to their so-called “red lists” which means they can only be prescribed by a hospital consultant and not a GP.

The measure is designed to save money by restricting access to drugs that are often among the more expensive. It also means that many patients find it more difficult to obtain the most effective drugs free on the NHS, even though they have been approved by the medicines rationing watchdog Nice.

Patients’ groups described the disclosure as “outrageous” and “extremely worrying”.

Examples of medications moved to red lists include a class of diabetes drugs called gliptins; treatments for Parkinson’s disease; a drug that helps lower the risk of fractures in osteoporosis sufferers; and certain types of statins for those at greater risk of heart disease.

One health authority has added 32 drugs to its red list in the past year, while another said it intended to fine doctors who wrote letters requesting that such medicines be prescribed.

Last night, the Department of Health suggested that trusts should look to make savings elsewhere before trying to restrict access to drugs.

According to a survey carried out by Pulse, a magazine for GPs, 73 out of 134 primary care trusts which responded to Freedom of Information Act requests said they had put more drugs on red lists, or added new restrictions on GPs prescribing them, in the past year.

Drugs are prescribed using a “traffic lights” system. If a medication is deemed “green” then GPs are free to prescribe it; if it is “amber” they have to discuss prescription with a specialist; if it is “red” then only a specialist can do so.

Dr Bill Beeby, the chairman of the British Medical Association’s clinical and prescribing committee, said the status of drugs should be based solely on clinical grounds.

But he added: “There are lots of people who try to put drugs on these red lists on the basis of cost.”

With trusts under pressure to make savings estimated at £1.9 million each this year, the study suggests that increasing numbers are restricting access to drugs.

NHS Cambridgeshire has added 32 drugs to its red list over the past year, Pulse found, taking the total to more than 100.

NHS Warrington has added 25 “areas” of prescribing to its list, including the statins Crestor (also known as rosuvastatin) and Lipitor (atorvastatin).

The “areas” include drawing to a halt to “routine prescribing for longer than three months for patients who live abroad”.

NHS Derby City estimates that it will save £781,000 by “decommissioning” 13 drugs, including Intanza, a flu vaccine which uses a very short needle for those who dislike jabs, and Grazax, a grass allergy tablet.

Katherine Murphy, chief executive of the Patients Association, described the bans as “a real worry”. “What’s the point of Nice approving medicines if they are not being made available?” she said.

Barbara Young, chief executive of Diabetes UK, said: “People’s health must not be compromised with an attempt to cut costs. This would be a very short-sighted policy as complications of diabetes, such as kidney failure, are hugely expensive.”

Most drugs prescribed by GPs are so-called “generics”, meaning they are cheap versions of drugs that are no longer subject to a monopoly of production. However, there are no alternatives for some newer, more expensive drugs.

Dr Dermot Neely, an expert on statins at the charity Heart UK, said of the increased use of red lists: “It is an extremely indiscriminate and ill-advised policy, if it’s being used by PCTs to constrain costs.”

Studies show that switching from branded statins to generics results in more heart attacks and deaths, he added.

Richard Hoey, the editor of Pulse, said: “Many of the drugs approved by Nice or other national bodies are not only cost-effective, but are likely to recoup some of the price in the long-term by reducing rates of illness.

“These bans on prescribing drugs are therefore not only damaging to the care of patients, but quite possibly a false economy.” Although its budget has been protected, the NHS is committed to making efficiency savings of up to £20?billion a year by 2014.

Although the red list is only for guidance, GPs often feel pressured into following the advice because trusts hold the purse strings.