Norgine is Calling the NHS to Remove Constipation From the List of Restricted Conditions in Proposed CCGS Guidancei - Constipation is a Very Serious Condition

LONDON, March 27, 2018 /PRNewswire/ --

Norgine is extremely concerned about the inclusion of constipation as a "minor" illness in new NHS England proposals to cut GP prescribing for certain health conditions.

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The inclusion of constipation, alongside other conditions such as dandruff, trivialises what can be a very serious condition. The consultation classifies constipation as "infrequent" or "minor". However, these are not medically recognised classifications and we consider that this lack of clarity will only serve to increase the variation that this consultation seeks to address. All chronic and serious constipation begins with what would be here described as "infrequent" or "minor". Similarly, "infrequent" constipation may also be very serious.

Anton Emmanuel, Consultant Neuro Gastroenterologist at University College Hospital and the National Hospital for Neurology and Neurosurgery said:

"Although constipation is a very common condition, it is a very serious one. For those suffering, it can result in serious quality impairments in quality of life and, if inappropriately treated, is associated with significant costs in the form of unplanned admissions to emergency departments. Even in constipation that might be considered "minor" or "infrequent", there are a wide range of symptoms and every patient is different. Encouraging self-help medication requires caution. Serious health issues often start with minor symptoms. It is essential that patients are encouraged to visit their GPs to discuss their symptoms and to receive the most appropriate advice and treatment."

He added: "I am very worried that these proposals will actively discourage patients from speaking to their GPs about what is already considered a taboo subject, which will lead to many more cases of severe illness and trips to A&E."

June Rogers MBE Specialist Continence Adviser, Bladder and Bowel UK said: "We need to be mindful of the fact that constipation is not a 'minor condition' and that it may be a symptom of an underlying co-morbidity. The concern is that individuals may try to self-manage the problem by buying over the counter treatment, without seeing a health care professional and undergoing an appropriate assessment. The elderly are particularly at risk and the following document highlights the issues for those individuals with learning difficulties https://www.ndti.org.uk/uploads/files/Constipation_RA_report_final.pdf.^[ii]"

Dr Penny Dobson MBE, Chair, Paediatric Continence Forum added: "The Paediatric Continence Forum (PCF) has significant concerns that NHS England's proposals to restrict the prescription of laxatives for infrequent constipation could result in children with constipation not receiving appropriate treatment, and the very real and concerning risk of this condition deteriorating into the serious condition of impaction. Constipation and other bladder and bowel issues which begin in childhood can persist into adulthood, particularly if appropriate treatment is not sought or offered, and can result in reductions in school attendance, visits to A&E and emergency admissions for faecal impaction. Restricting the prescription of laxatives because they can be bought over the counter could also result in parents not understanding the importance of treating their child's constipation, or force parents with limited financial resources to make difficult decisions about their child's health. We would urge NHS England to reconsider these proposals and consider the clinical benefits and the substantial savings that can be gained from delivering appropriate care for bladder and bowel issues at the earliest possible stage."

Peter Martin, COO at Norgine said: "While we acknowledge that the revised proposals allow certain patient exemptions - the guidance is vague and requires patients to prove to their GP that 'exceptional' circumstances warrant them receiving free NHS treatment. We believe this is unworkable and unfair."

He added: "We strongly believe that NHS prescribing, for whatever medical condition, should be made based on clinical need - and not the ability to pay. Including constipation in these proposals is the thin end of the wedge - exacerbating health inequalities, reducing patient outcomes, and eroding basic NHS principles."

References:

i. UK consultation: Conditions for which over the counter items should not routinely be prescribed in primary care: a consultation on guidance for CCGs

ii. https://www.ndti.org.uk/uploads/files/Constipation_RA_report_final.pdf