NHS treatments blacklist
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Procedures of limited clinical effectiveness
The NHS has produced lists of procedures of limited clinical effectiveness for many years, advising that they should not be carried out except in exceptional cases. Since the establishment of the National Institute for Health and Care Excellence in 1999 there has been a move to more robust processes, but such decisions always generate controversy. These lists are now decided by clinical commissioning groups in England, but rules differ in Wales, Scotland and Northern Ireland. Restrictions on one kind of treatment for a condition may lead to patients getting different, and possibly more expensive treatment. Treatments for back pain, tonsillectomy, in vitro fertilisation, varicose veins and cosmetic surgery commonly appear on these lists.
In the English National Health Service and NHS Wales the Blacklist (officially Schedule 1 to the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004) is a list published in Part XVIIIA of the NHS Drug Tariff denoting medicines and/or specific brands of medicines that cannot be prescribed on NHS medical prescriptions. If such a prescription is dispensed then NHS Prescription Services will refuse to refund the cost to the dispensing pharmacy. The list was established in 1985. No new items have been added since 2004.
Some brand name medicines on the blacklist can be dispensed against prescriptions for generic drugs (if the approved generic name is not itself included in the blacklist). For example, Calpol can be dispensed for a prescription for paracetamol suspension, but it is generally cheaper to dispense the generic form, and it is at the pharmacy's discretion to do otherwise.
A pharmacist is at liberty to dispense private prescriptions for such items, or to sell over the counter items without a prescription.
Review of homeopathic treatments
Following a threat of legal action by the Good Thinking Society campaign group in 2015, the British government has stated that the Department of Health will hold a consultation in 2016 regarding whether homeopathic treatments should be added to the Schedule 1 list.
In April 2017 it was proposed to restrict the prescription of 3,200 OTC drugs by means of official guidance from NHS England, and to add 18 treatments considered to have 'limited clinical value' – including homeopathy and herbal treatments – to the banned list. The 10 items of low clinical effectiveness:
- Omega 3 fatty acid compounds.
- Lidocaine plasters.
- Glucosamine and chondroitin.
- Lutein and antioxidants.
- Oxycodone and naloxone.
- Homeopathy items.
- Herbal medicines.
7 items which are clinically effective but not cost-effective:
- Doxazosin MR.
- Perindopril Arginine.
- Fentanyl immediate release.
- Tadalafil once daily.
- Paracetamol and tramadol combination product.
Dr Andrew Green, clinical policy lead on the British Medical Association general practitioners committee objected and demanded that any restricted items should be added to the banned list, so that it was clear that they could not be prescribed.  The Royal College of General Practitioners complained that "imposing blanket policies on GPs, that don’t take into account demographic differences across the country, or that don’t allow for flexibility for a patient’s individual circumstances, risks alienating the most vulnerable in society." National Voices said "The risk is that the NHS would be saying that it will not support poor people to treat their kids’ head lice, or to manage complications such as persistent constipation or the vulnerability of their skin to damaging sunlight."
The final recommendations covering 35 minor, short-term conditions were approved in March 2018, with an exemption for patients where the clinician believes they will struggle to self-manage because of medical, mental health problems or ‘significant social vulnerability’. As this does not change the regulations that govern GP prescribing it is still open to GPs to treat patients according to their individual circumstances and needs, including issuing prescriptions where there are reasons why self-care is inappropriate. 
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