The NHS we are told today is spending £440m on painkillers. As we all know, whether we have a headache, backache, toothache or a trapped nerve, pain relief is a god-send. But when we can buy paracetamol at 20p a packet and lemsip at a couple of pounds, why on earth are doctors still prescribing these cheaply available over-the-counter medicines? In our Our health, our money, our say report a couple of years ago we estimated that it cost the NHS about £56 for someone to go to the doctor, get a prescription, go to the chemist and have it dispensed. In these times of scarce resources, this has to be a waste.
Meanwhile Wales are about to publish a White Paper which will set out a timetable for the introduction of presumed consent for organ donation. It will mean that unless you take the step of opting out, organ donation will be the norm if you die while your organs are still functioning well. This is a seismic change in approach. It changes donation to compulsion; it moves us from a position of trust to suspicion and supply will fuel demand for surgery from those who are aging, not necessarily ill. It also won’t solve the ethnic issue: many of those waiting for transplants are from BME communities and for a good tissue match they require an organ from someone with similar ethnicity, but there are religious taboos which mean no one from their community will donate.
Whilst suffering from organ failure when young is a tragedy, and we should be looking at all means to encourage donation, presumed consent assumes too much, doesn’t solve all issues and creates new problems.
With our UK ageing population joint pain is a common problem easily ameliorated by analgesia. There is good evidence of the “use it or lose it ” effect when it comes to joint function. The evidence shows that especially with Osteoarthritis, a little regular analgesia can reduce symptoms and rate of decline in function and subsequent immobility and increased care needs/costs.
Many prescriptions for paracetamol and other analgesia are issued on repeat to this elderly group, who would be impeded from regular analgesia purchase at the local pharmacy by the law limiting the supply to a maximum of 24 tablets. If an elderly patient were taking maximum paracetamol at 8 / day: this would only last 3 days requiring them to visit the pharmacy at least twice a week to purchase their pain relief, often near the end of the supply and therefore maybe impeded in mobility due to the very pain we aim to treat.
The £56 estimate for this groups is probably overkill as all elderly patients require one annual appointment at which multiple tasks are completed, repeat prescribing of analgesia being one of these tasks.
I would debate the suggested point that this analgesia is a waste; as above I have set out a case for cost saving based on regular analgesia reducing the need for increased care and decreased function and quality of life for what is an increasing ageing population. Imagine the care costs and earlier referrals for hip replacement and concurrent morbidity associated if many elderly patients couldn’t get hold of their regular analgesia – more so in winter with increased risk of fall and fracture! Surely this is a penny pinching response to a much larger problem of high costs for medications which could be negotiated nationally as the NHS is no doubt one of the largest single purchasers in Europe and probably worldwide?
I suggest what is needed is a national bulk purchasing agreement for these medicines so that perhaps items such as paracetamol which do not interact with most medicines but have beneficial effects when taken safely, could be issued without prescription to any UK patient over 60 or with proven OA with their entitlement certificate and that such issues would be subject to a lower prescription issue charge from the pharmacist as they are easily procured and dispensed via the new protocol.
As a GP in regard to other analgesia requirements I often will take the line that patients will and do use what is readily available in the shops and have usually already tried paracetamol / ibuprofen or both before they attend for most common pains. It is still cheaper to them to buy these in short supply than to pay a prescription charge.
Other branded medications which are more expensive at the top of the analgesia ladder should be considered for cutting rather that the cheap and easily used ones at the bottom.
Why not look at the expensive non generic medicines such as oxycontin and oxynorm; supposedly better for palliative pain relief with fewer side effects; why are we not promoting commencing with good old morphine unless poorly tolerated?