So the NHS in England spent £87million on paracetamol last year (2015) – that is £7m more than the previous year or growth of nearly 9%. Looking behind this figure there were 22million prescriptions. If 20% of these were new then a GP entered paracetamol into their prescription system 4.4million times, printed a prescription and signed it. The remaining 80% were requested by patients, reviewed by the practice, printed out, signed by a doctor and handed to a patient, sent to a pharmacy or handled electronically. That is 22million dispensing fees, 22million prescriptions containing paracetamol bundled up and sent to the NHSBSA, 22million items processed, costed, repaid to community pharmacy and cross charged to the responsible CCG.

I haven’t started yet to include the 2.5million co-dydramol prescriptions and the 15million co-codamol that add another £100m in costs. There is a discussion to be had about the value of some of these combinations in terms of added efficacy, added side effects and flexibility of use. Personally I have tried to avoid them in favour of a paracetamol backbone with additional analgesics used flexibly, although some would argue that the long term use of paracetamol has its drawbacks.

I haven’t even considered some simple NSAIDs like ibuprofen which generates approximately 3.5million prescriptions each year. Or even 75mg aspirin which generates 27million prescriptions a year. Or the £20million we spend on sodium fluoride tablets each year

So a veritable empire built out of the humble basic pain killer – paracetamol. It remains a very effective painkiller – very safe in the right hands – and in the wrong hands very toxic. It is almost ubiquitous in our society and available in small quantities from petrol stations and newsagents – it is probably present in most people’s medicine chest or bathroom cabinet.

It is not just the money – although £80million would buy quite a few front line staff – but you have to consider the time taken to manage the 22million transactions from GP to community pharmacy reimbursement.

I have asked successive Health Ministers to think about Paracetamol and simply moving it to the non-reimbursible list in the drug tariff – in simple terms to stop the NHS paying for it. There would be no pressure on GPs to reduce prescribing and persuade patients to buy it – no unequal access to free medicines and a clear message to the population that self care is essential to keep the NHS running and you should visit your community pharmacy first.

I am reminded that the NHS has to make £22b of efficiency savings – did Mr Stevens tell the Health Committee that he is struggling to realise these savings at the front line, but has made progress with some central initiatives. Well here is one for him!

But they all nod sagely and write it down. And I wait……


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