The NHS is considering banning some medication to save money.
Bosses have already drawn up a hit list of which GP treatments to withdraw.
And a second list may follow.
NHS England say the items affected could be picked up over the counter at a cheaper cost then the £8.60 prescription charge.
But many elderly patients and those who qualify for free prescriptions would have to pay under the proposed changes.
Other items are only available on prescription but there are thought to be alternatives which cost less to provide.
Items on the initial list include a modified release version of the common blood pressure tablet doxazosin and gluten-free foods.
Paracetamol, suncream, cough treatments and indigestion tablets could be included in future reviews.
And there are even warnings that much more could follow in years to come.
Here are some of the treatments under threat:
Around one in 100 people have coeliac disease, caused by a reaction to gluten, that can be treated by cutting the substance from a patient’s diet.
Once diagnosed as coeliac by a doctor, patients in most parts of the UK can receive gluten-free staple foods from a pharmacy through a prescription from a GP.
Foods approved for prescription include bread or rolls, breakfast cereals, crackers and crispbreads, flour and flour-type mixes, oats, pasta and pizza bases.
The amounts of gluten-free staple foods a sufferer can receive each month are controlled by the National Prescribing Guidelines.
Vaccines for typhoid, hepatitis A and cholera and a combined jab for diptheria, polio and tetanus are usually available free on the NHS.
The health service offers the vaccinations free of charge because they protect against diseases deemed to present the greatest risk to public health if brought into the country by travellers.
Some countries require visitors to be vaccinated against diseases such as yellow fever or meningitis prior to arrival, while travellers to some parts of the world are advised to have inoculations against a range of other diseases, including tuberculosis, hepatitis B, Japanese encephalitis and tick-borne encephalitis.
These are not usually available on the NHS and can cost around £50 for each dose.
Co-proxamol is used for mild to moderate pain relief is a combination of two active ingredients, dextropropoxyphene and paracetamol, which is typically included as a lower 350mg dose compared with the standard 500mg dose of paracetamol when taken alone.
There is limited evidence suggesting co-proxamol is more effective at treating pain than a regular dose of paracetamol, for either acute or chronic use.
There have been previous concerns that the drug has been linked to suicides and poisonings and it was gradually phased out from wide use between 2007 and 2007.
Omega-3 and fish oils
Naturally-occurring oils from certain breeds of fish such as salmon and mackerel have typically been prescribed to promote a healthy heart for patients at risk of heart disease.
The fatty acid omega-3 usually comes in capsule form and has been used to help prevent irregular heartbeats and reduce the risk of clotting by making the blood less sticky.
Historic concerns about prescribing omega-3 stem from limited evidence suggesting the fatty acid is effective in capsule form, and little to categorically suggest what a recommended adult daily intake should be.
Doxazosin are a series of drugs used to treat hypertension, but doxazosin modified release (MR) tablets are only believed to be effective for a very small number of patients.
This form of doxazosin cost the NHS £7 million last year.
It is described as clinically effective but with a cheaper alternative
The potential saving: £7.1m
Even terminally ill patients could see a type of treatment stopped.
Generally used in palliative care, fentanyl is a strong painkiller that comes as patches for terminally ill patients.
In many cases morphine is considered easier and cheaper to prescribe, and is just as effective for end-of life care.
A series of muscle rubs used to relieve skeletal-muscular pain are under review for their effectiveness compared with other forms of muscular pain relief.
Bosses believe they have a low effectiveness.
Estimated savings are £6.4m
Liothyronine is a thyroid hormone used to treat certain thyroid conditions including hypothyroidism.
Only small numbers of patients are found to benefit from the drug, which is generally more expensive than other forms of thyroid medication
Mark Littlewood, director-general of the Institute of Economic Affairs, said: “Given the financial mess the NHS has found itself in for some years now, it is a wonder these low-cost household products were provided for in the first place – particularly when vital cancer drugs are being rationed.
“While this review is a step in the right direction, it does not go far enough.
“There will need to be significantly more radical cutbacks and a complete rethink of the system in order to achieve a financially sustainable and efficient health service.”
Source : Chroniclelive