Doctors must cut back on prescribing medicines, says the NHS
GPs have been told to cut down on prescribing medicines as the Department of Health tries to save money, it has emerged. A report has been drawn up for primary care trusts, GPs and new GP commissioning consortia listing 15 common drugs where savings can be made.
The list includes some of the most commonly prescribed drugs in the NHS including statins for high cholesterol, broad spectrum antibiotics for infections, obesity drugs and sleeping tablets.
The report gives advice to prescribe cheaper alternatives first, reserve them for severe cases, prescribe them for the shortest time possible and take patients off them after three months if the response has not been considered ‘adequate’.
Some of the guidance is controversial such as limiting the use of long-acting insulin in diabetics but in other areas will be welcomed including not using antipsychotics in dementia patients.
Doctors said patients’ needs must come first and no one should be denied drugs because of finances.
The National Prescribing Centre will issue a fuller report later in the year with more medicines but said the interim list has been issued ‘for early consideration’ and said it provides ‘real opportunities for maintaining or improving quality and enhancing value for money’.
The NHS is facing having to make £15bn to £20bn of savings over the next three to four years as large increases in funding come to a halt and demand continues to rise.
The report has been drawn up as part of a wider programme of changes to the NHS, instigated by the last government, called Quality, Innovation, Productivity and Prevention. It encourages NHS staff to come up with ways of saving money while improving care by preventing illness or complications, reducing hospital admissions, helping patients look after themselves and increasing efficiency.
In the foreword to the report Peter Rowe, chief executive of Ashton, Leigh and Wigan Primary Care Trust and National Lead on medicines use and procurement in the QIPP programme, said: “Some of the topics here improve quality but have little or no associated cost savings. “Others, when considered alone locally, can deliver relatively small cost savings, but when aggregated nationally and implemented with much less variation than currently, the savings become very significant.”
The document, highlighted by Pulse magazine, does not contain targets on how much of the drugs doctors should prescribe or say how much money could be saved.
Instead it refers to guidance by the National Institute for health and Clinical Excellence on individual medicines and disease areas but warns against ‘over-implementation’ of Nice recommendations. It also adds advice about cheaper alternatives and highlights where there is little evidence of benefit from newer, more expensive drugs.
For the drug orlistat for obesity, the report said, that patients should be taken off it if they have not lost more than five per cent of their body weight within 12 weeks. It added that there has been a rise in the use of orlistat recently and doctors should ensure a ‘balanced approach’ taking into account lifestyle changes as well as drugs.
For statins, used to reduce cholesterol to avoid heart attacks and strokes, it recommends that cheaper generic forms of the products are used more often.
Patients with asthma should have the dose of their inhaler reviewed and reduced every three months but this is not happening leaving people ‘over-treated’, it said. The report said: “Prescribing of high dose inhaled corticosteroids inhalers is increasing in both items and costs.”
Dr Bill Beeby, Chairman of the British Medical Association’s Clinical and Prescribing GP subcommittee, said: “Prescribing has been subject to regular audits for some time and a lot of good work has already been done in these areas. “We expect this to continue because GPs and pharmacy advisers are committed to improving cost-effective prescribing. “The needs of patients, however, must continue to be put first, as no one should be excluded from effective treatments merely on the grounds of cost.”
A Department of Health spokesman said: “Improving health outcomes for all NHS patients is the Department’s priority.
“The report by the National Prescribing Centre identifies treatments where there are opportunities to improve the efficiency of prescribing. This advice will improve quality of care to the patient while also achieving better value for the NHS.”
Passport giveaway opens UK back door: 2m more Hungarians will have right to work in Britain
This is pretty understandable from a Hungarian viewpoint. Hungary used to be a lot bigger than it was but got chopped back after WWII. So a lot of Hungarians found themselves in another country after the war. I would imagine that most of them will now move to Hungary proper rather than Britain. The big question is whether Romania will give passports to Roma (gypsies). They are a plague and a pestilence and giving them passports would certainly send them Westwards
Hungary is set to hand passports to millions of people living outside the EU – raising the prospect of a new wave of immigration into Britain. From next year, Hungary’s leaders will begin a huge passport giveaway to minority groups who have historic or ethnic ties to the East European country but live elsewhere.
Most of the beneficiaries live in impoverished countries on the fringes of Europe. Once they are given a passport, they will be entitled to full access to the rest of the EU – including Britain.
Similar passport handout schemes – which are legal under EU laws – are under way in Romania and Bulgaria. Together, it is estimated the three countries could add nearly five million citizens to the continent’s population, at a time when it is struggling to bounce back from a deeply damaging recession and financial crisis.
Although they have some control for Romanian and Bulgarian nationals, UK ministers are powerless to place restrictions on arrivals from Hungary. That means the potential impact on Britain of two million new Hungarian passports is much larger. Hungary was one of eight Eastern European nations which joined the EU in 2004.
But Labour ministers, unlike their counterparts in Germany and Austria, rejected the option of imposing work permit controls that would have limited the numbers coming here. That led to an estimated one million arrivals from Eastern Europe – despite predictions the number would be fewer than 20,000. The restrictions on Romanian and Bulgarian nationals will expire in 2013 – opening the door to the UK.
Critics called for limits on the number of new passports member states could hand out to those living outside their borders. Sir Andrew Green, chairman of the MigrationWatch think-tank, said: ‘The sheer scale of this risks getting out of hand. ‘When we granted equal access to EU citizens we had no idea that member states would be dishing out passports to anybody they could think of that had some previous link to their countries. ‘There has to be some limit to what member states are allowed to do in this respect.’
From January, Hungary intends to offer passports to millions of ethnic Hungarians living outside its borders. That includes 300,000 living in Serbia and 160,000 in the Ukraine, neither of which is a EU member.
Millions worldwide are eligible for EU passports – but those in prosperous nations rarely take up the option. It’s the world’s have-nots who are drawn to Europe – and the citizenships offered to outsiders are like winning the lottery. The average annual income in Serbia is around £3,700 a year, and the average Ukrainian worker earns just £1,500 annually.
Last month it emerged some 900,000 Moldovans with ethnic ties to Romania had applied for Romanian passports since the beginning of its scheme. Of those, around 120,000 applications have been approved and the remainder are being processed. The Romanian government claims it is simply giving back citizenship to people who were part of the country until 1940 when Moldova was invaded by Russia and annexed.
Romanian president Traian Basescu has said all Moldovans who think of themselves as Romanian – most of the country’s 3.6million population – should be able to ‘move freely both in Romania and the EU’.
Around 1.4million people living in Macedonia are eligible for Bulgarian passports, as are 300,000 Turks expelled from Bulgaria in the 1980s. Estimates put the total of all those eligible for EU citizenship from Hungary, Romania and Bulgaria at 4.7million. Were every one to take up the offer, it would increase the EU population – estimated at 500million – by 1 per cent.
A UK Border Agency spokesman said: ‘The new Government is determined to reduce net migration to the tens of thousands per year. ‘The UK Border Agency will continue to monitor closely any changes in the numbers of Romanians and Bulgarians coming to the UK.’
Anti-military bigotry in Britain
A soldier who had just arrived home from Afghanistan was refused service at a supermarket and told they didn’t serve people in Army uniform. Sapper Anthony Walls called into a branch of the Co-op for some beers after a gruelling 34-hour journey from Kandahar.
The 27-year-old, of 21 Engineer Regiment, said it was his ‘first hour back in the real world’ after dodging Taliban bullets for four-and-a-half months helping build ‘the most dangerous road in Afghanistan’. But when he arrived at the till he says he was met with a blank stare from the cashier who refused to serve him and called for her manager.
The manager told Mr Walls he ‘couldn’t do anything about it’ and refused to serve him while he was in uniform. The soldier – who was on his way to his three-year-old nephew Jack’s birthday party – walked out of the shop in New Addington, Croydon, in a daze. ‘I was deeply hurt,’ he said yesterday. ‘All I was thinking about was getting home to Jack in time to wish him a happy birthday.
‘It was great to be home after a difficult journey and I just thought I’d grab a couple of beers – a luxury I hadn’t had in a while. ‘But when I came to pay the cashier refused to serve me and rang her bell. A male supervisor came along and the cashier explained she was refusing to serve me because I was in uniform.
‘He looked at me and said “I can’t do anything about it”. I put the beer down and walked out. I was shocked.’
Mr Walls, who joined up when he was 17, said it was ‘tough’ in Afghanistan and that he had witnessed the death of one of his best friends, Sapper Daryn Roy, who died at the age of 28 in an IED explosion in May. He added: ‘Sometimes the only thing that keeps you going is the support and love from home.
‘I appreciate the Co-op cashier may have had her own opinions about the war, but we are just doing a job and laying our lives down for this country. A little respect and appreciation would be nice.’
Mr Walls’s sister Claire Lloyd, 33, said she was ‘disgusted’ at her brother’s treatment at the Co-op store on July 17.
The mother of four added: ‘I am so proud of Anthony. He works hard and willingly puts his life on the line every day. ‘Anthony and his colleagues are the unsung heroes of this country. They deserve the respect and civility extended to anyone else in a uniform.’
A spokesman at the Co-op’s headquarters in Manchester said the incident had been a ‘genuine mistake on the part of our two members of staff’ and apologised for how Mr Walls, who flew back out to Afghanistan this week, was treated.
The spokesman added: ‘This had nothing to do with anyone being against the war in Afghanistan. It’s a simple case of a misunderstanding of company policy.
‘Years ago we had a policy which meant we wouldn’t serve police officers in uniform, but that is no longer the case. The cashier thought she was doing the right thing.’ [Believe that if you like]
Coalition pledge on three-Rs as third of British pupils fail basic grade-school test
More than a third of pupils left primary school after 13 years of Labour without a proper grasp of the basics, it has emerged. Sats results published today showed 35 per cent of 11-year-olds in England failed to reach the standard expected for their age in reading, writing and mathematics. Scores in reading actually slipped for the second year in a row, despite the launch of a multi-million pound programme designed to help the worst performers catch up.
It means hundreds of thousands of children will start secondary education without “getting the point” from passages they read, using proper spelling and punctuation in writing and being able to employ the 10 times table.
Today the Coalition pledged a renewed focus on the core subjects amid claims too many children were failing to get the “fundamentals right”. Nick Gibb, the Schools Minister, said the Government would emphasise mental arithmetic in maths and prioritise back-to-basics methods of reading in English lessons.
A new reading test will also be introduced for all six-year-olds to pick out those struggling the most at the start of primary school.
Sats results soared when Labour first came to power but progress has practically stalled in recent years.
Mr Gibb said: “Despite pupils’ and teachers’ hard work one-in-five pupils are still not reaching the expected level in either English or maths and over a third are not achieving this level in reading, writing and maths combined. “We need to ensure government gives teachers the support they need to get the basics right.
“Getting the fundamentals right – being able to read and write and having a solid foundation in Maths – is crucial to a child’s success in secondary education and throughout their adult life.”
He added: “The Coalition Government is committed to promoting the use of systematic synthetic phonics in primary schools and to ensuring that pupils are fluent in arithmetic and basic maths by the time they move to secondary school. We will provide the help teachers need to do their job even better.”
But the publication of today’s results also prompted renewed controversy over the use of Sats tests to measure education standards. In an unprecedented wave of industrial action, more than a quarter of state schools in England – 4,005 – boycotted the exams this year amid claims they narrow the curriculum and force schools to “teach to the test”. Unions also said the high-stakes tests jeopardised teachers’ jobs. Figures show 155,000 out of 575,000 children failed to sit tests this year.
But the Coalition insisted the sample was large enough to proceed with the publication of national results.
For the first time this year, the Government published the results of teachers’ own assessments of pupils in the classroom alongside official Sats scores. Under the less formal system, 81 per cent of children made the grade in English and a futher 81 in maths – almost mirroring the Sats results.
Labour welcomed the publication which they said proved major reforms of primary education over the last 13 years had worked. When Labour came to power, only half of children gained good scores in English and maths.
Vernon Coaker, shadow schools minister, criticised the Coalition for failing to support Labour’s flagship policy of more one-to-one tuition for children falling behind in reading and writing between the age of seven and 14. “Around 100,000 more children now leave primary school secure in the basics than in 1997,” he said. “But there is obviously more to do, particularly in reading where the results are disappointing.
“These results show why the coalition’s cuts to the budgets of successful catch-up programmes like Every Child a Reader, which we were rolling out across the country, are so short-sighted and disastrous for educational opportunity.”
The Coalition insisted one-to-one tuition and the intensive reading scheme would continue for another full year, while more money was being earmarked for the poorest schools to run other similar programmes in the future.
According to Government guidance, to achieve Level 4 in reading children must display an understanding of ideas, themes, events and characters in texts and use inference and deduction.
In writing, pupils should be starting to use grammatically complex sentences. Spelling should be accurate, pupils should use joined up handwriting and sentences should contain full-stops, capital letters and other punctuation in the correct place.
Guidelines on maths say children should be able to multiply numbers up to 10 x 10 in their heads and add or subtract numbers to two decimal places.