Your views on proposed changes to healthcare

The clinical commissioning groups (CCGs) in Kirklees spend more than £500 millioneach year to ensure people receive the healthcare they need. We are committed to delivering safe, high quality local health services, but must keep within our budget.

While the two CCGs in Kirklees have received an increase in funding, demand for services and associated costs such as medicines, treatments and the staff needed to provide them have increased too. As a result, there is a gap between the cost of healthcare in Kirklees and the money available to pay for it.

The challenge we now face is how to invest the available budget in ways that most benefits the health of the whole population and represents good value for money.

The NHS budget is just the same as everyone’s household budget – we can only spend the money we have. When the bills get higher we have to tighten our belt and cannot always commission more services.

“Talk healthKirklees”is an open and honest discussion with local people about the things we could do to get better value from NHS spending.

This survey sets out four areas where proposed changes could happen.

The areas are:

  • Over-the-counter medicines
  • Gluten-free foods
  • Procedures for managing individual funding requests
  • Branded medicines

The CCGs are also planning to change the way people order repeat prescriptions.
We want to consult with you and gather your ideas and views before making any decisions. We would welcome any thoughts or suggestions you have aboutour proposals.
For more details please read our consultation document which can be accessed on our websites or

Survey

We want to consult with you and gather your ideas and views before making any decisions. We would welcome any thoughts or suggestions you have aboutour proposals.

General

  1. Which one of the following statements most closely matches your view? Please tick only one answer

The NHS should provide all drugs and treatments no matter what they cost
The NHS should provide only the most effective drugs and treatments, whatever they cost
The NHS should provide the most effective drugs and treatments only if they represent good value for money
I don’t know
  1. Please let us know if you have any ideas about how we could save money

Services / treatments where we are already making changes

Repeat prescription ordering

By April 2017, GPs in Kirklees will require patients who need repeat prescriptions to order their medicines online or via their GP practice. Repeat prescriptions will no longer be available through a pharmacy or other supplier.

The option to order medicines through a pharmacy or supplier ordering service will still be available for the most vulnerable patients e.g. those being supported by local authority carers and with little family support/involvement and those lacking mental capacity.

  1. Please tell us if you have any comments to make about this change

Services / treatments we are proposing to change

Over-the-countermedicines

GPs in Kirklees currently prescribe a wide range of medicines and products which are widely available in pharmacies and/or supermarkets. We are proposing that we will not routinely fund a range of products on prescription such as:

  • sunscreens for skin protection from UV radiation
  • soya and thickened infant formulas
  • infant formula for lactose intolerance
  • cream for unwanted facial hair and other products that have a predominantly cosmetic action*
  • camouflage products e.g. for port wine stain birthmarks
  • multivitamins, where no specific deficiency has been identified
  • emollients (moisturisers), shampoos, bath and shower products and fungal nail treatments for minor conditions which will get better on their own/have no long-term health impact, or for cosmetic purposes.

*This includes eflornithine which is a prescription-only treatment for the removal of facial hair. However, alternative non-prescription treatments are available over-the-counter.

  1. To what extent to you agree or disagree with the proposal about over-the-counter medicines?

Strongly agree / Agree / Disagree / Strongly Disagree / Don’t Know
Please explain your reason for the above answer
  1. The following items can be bought in most supermarkets and/or pharmacies. Do you think these items should be available on prescription?

Yes / No / Don’t know
Sunscreens for skin protection from UV radiation
Pain killers for minor aches and pains e.g. paracetamol
soya thickened infant formula and formula for lactose intolerance
Cough and cold remedies
Multivitamins
Tonics and health supplements
Lozenges, throat sprays, mouthwashes, gargles and toothpaste
Indigestion remedies for occasional use
Hair removal creams
Camouflage products e.g. for port wine stain birthmarks
Moisturisers and bath remedies for mild dry skin
Foods and food supplements, except where there is a clinical need

Gluten-free foods

We are proposing to not routinely fund gluten-free foods on prescription because:

  • Funding them is inequitable as many people who have special dietary needs, such as lactose-intolerance or diabetes, are not able to access food on prescription
  • It costs more for the NHS to supply gluten-free products on prescription than to buy from a supermarket
  • Other naturally gluten-free foods are widely available e.g. potatoes, rice, corn (maize)
  • Improved food labelling means people can see what to avoid in products
  • Many people prefer to buy their own gluten-free foods, due to the wider choice available in shops than on prescription.

  1. To what extent to you agree or disagree with the proposal about gluten-free foods?

Strongly agree / Agree / Disagree / Strongly Disagree / Don’t Know
Please explain your reason for the above answer

Individual funding requests

The CCGs in Kirklees fund a range of services, drugs or treatments because it is a national requirement or because we have identified a local need. However, there may be times when a particular procedure or medicine is not routinely available.

Our Individual Funding Request Policy is used when a drug or treatment is not routinely available in Kirklees. In such cases a GP, hospital consultant or other clinician can make a request for funding using the policy.

The majority of cases considered through this policy are cosmetic, which means that they are requested for reasons of appearance rather than because there is a clinical need. This could include for example, breast reduction or augmentation, “tummy tucks”, laser hair removal, removal of tattoos. Occasionally we receive requests to fund treatment or procedures where there is risk to life e.g. for a high-cost drug.

Last year, the CCGs in Kirklees received around 800 requests and just under half of these were supported.

We are proposing to change the criteria (reasons) for approving individual funding requests for a period of 18 months, during which time we will only consider funding in cases where:

  • the condition is immediately life‐threatening
  • undue delay would result in a real and imminent risk of harm i.e. death, infirmity or disability
  • the procedure needs to be performed within a strict time‐frame as otherwise delay would result in it becoming ineffective

As a result, it is likely that fewer individual funding requests will be received and/or approved through this process.

  1. To what extent to you agree or disagree with the proposal about individual funding requests?

Strongly agree / Agree / Disagree / Strongly Disagree / Don’t Know
Please explain your reason for the above answer

Over the next 18 months we intend to undertake a more detailed review of our policy and the procedures which are currently included in it, with a view to proposing further changes.

  1. Please give us your views on making further changes to the criteria or increasing the range of treatments that are only available via an individual funding request.

Branded medicines

Most medicines on the NHS are prescribed generically (i.e. by their chemical name) rather than their brand name. There may be occasions when some patients require a specific brand or version of the product e.g. because they have an allergy to colourants or other ingredients. There are some patients who request specific brands as a personal choice.
The names of medicines can often be confusing as the same medicine can sometimes be called different things. Many medicines have two names. Both medicines have the same clinical effect, but each separate manufacturer can give it a different name. It is similar to buying branded goods or a supermarket's own label – both products do the same job, but the supermarket's own version is usually more cost-effective.

The CCGs are proposing that requests for more expensive brands of medicines are not routinely supported in cases where there is no scientific evidence of a difference between products.

Unnecessary prescribing of branded medicines can cost the NHS up to 56 times as much as the equivalent unbranded (generic) products.

  1. To what extent to you agree or disagree with the proposal about branded medicines?

Strongly agree / Agree / Disagree / Strongly Disagree / Don’t Know
Please explain your reason for the above answer

About you

  1. Tick any of the statements that apply to you

I or someone I care for / look after currently receives over the counter medicines on prescription
I or someone I care for / look after receives gluten-free food on prescription
I or someone I care for/look after currently receives repeat prescriptions via a community pharmacy or other third party e.g. appliance supplier
I am a healthcare professional responding in a professional capacity
Other, please specify
Yes / No
  1. Do you currently pay for your prescriptions?

Pl

Equality monitoring

In order to ensure that we provide the right services and to ensure that we avoid discriminating against any section of our community, it is important for us to gather the following information. No personal information will be released when reporting statistical data and data will be protected and stored securely in line with data protection rules. This information will be kept confidential.

1. What is the first part of your postcode?
Example / HD6
Yours
Prefer not to say
2. What sex are you?
Male Female
Prefer not to say
3. How old are you?
Example / 42
Yours
Prefer not to say
4. Which country were you born in?
Prefer not to say
5. Do you belong to any religion?
Buddhism
Christianity
Hinduism
Islam
Judaism
Sikhism
No religion
Other (Please specify in the box below)
Prefer not to say / 6. What is your ethnic group?
Asian or Asian British:
Indian
Pakistani
Bangladeshi
Chinese
Other Asian background (please specify)
Black or Black British:
Caribbean
African
Other Black background (please specify)
Mixed or multiple ethnic groups:
White and Black Caribbean
White and Black African
White and Asian
Other mixed background (please specify)
White:
English/Welsh/Scottish/Northern Irish/British
Irish
Gypsy or Irish Traveller
Other White background (please specify)
Other ethnic groups:
Arab
Any other ethnic group (please specify)
Prefer not to say
7. Do you consider yourself to be disabled?
Yes No
Prefer not to say
Type of impairment:
Please tick all that apply
Physical or mobility impairment
(such as using a wheelchair to get around and / or difficulty using their arms)
Sensory impairment
(such as being blind / having a serious visual impairment or being deaf / having a serious hearing impairment)
Mental health condition
(such as depression or schizophrenia)
Learning disability
(such as Downs syndrome or dyslexia) or cognitive impairment (such as autism or head-injury)
Long term condition
(such as cancer, HIV, diabetes, chronic heart disease, or epilepsy)
Prefer not to say
8. Are you a carer?
Do you look after, or give any help or support to a family member, friend or neighbour because of a long term physical disability, mental ill-health or problems related to age?
Yes No
Prefer not to say / 9. Are you pregnant?
Yes No
Prefer not to say
10. Have you given birth in the last 6 months?
Yes No
Prefer not to say
11. What is your sexual orientation?
Bisexual (both sexes)
Gay (same sex)
Heterosexual/straight (opposite sex)
Lesbian (same sex)
Other
Prefer not to say
12. Are you transgender?
Is your gender identity different to the sex you were assumed at birth?
Yes No
Prefer not to say

Thank you for taking the time to complete this survey.

Please return to:

FREEPOST RTEJ-AGSA-UAZL

NHS North Kirklees CCG

4th Floor

Empire House

Wakefield Old Road

Dewsbury

WF12 8DJ

Please return no later than Sunday 27 November 2016. Unfortunately, we cannot accept any responses after this date.

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