On 28th March 2017 it was reported that the NHSCC and NHS England are to review NHS funding for ‘low priority’ prescription items, including sunscreen.
We understand that dermatology medicines and products, including sunscreen, are not included in the first set of 10 medicines to be reviewed. However, on the NHS England website they state, “further work In light of the financial challenges faced by the NHS, will consider other medicines which are of relatively low clinical value or priority or are readily available ‘over the counter’”. They go on to mention ‘suncream’ specifically.
LUPUS UK strongly argue that sunscreens do not constitute a ‘low priority prescription item’ and therefore it is not appropriate for inclusion in the review process.
A guideline for the management of systemic lupus erythematosus in adults was published by the British Society for Rheumatology (BSR) in October 2017. This guideline recommends the provision of high-factor sunscreen. The evidence sources included state; “Sunscreens were shown to prevent discoid and sub-acute cutaneous lupus rashes in a case series and to reduce systemic features such as renal disease, thrombocytopenia and hospitalisation in a cohort study. Three open controlled trials, a retrospective case series, and a double blind, controlled trial have shown that sunscreens that block UV-A and UV-B can reduce UV radiation-induced lesions of cutaneous lupus.”
Without sun protection, people with lupus may develop extensive skin disease potentially resulting in hospitalisation, may require expensive drug treatment, and may suffer permanent, disfiguring facial scarring.
Sunscreen should be applied to areas not usually protected by clothing (i.e. the hands, wrists, neck, ears and face) which requires six applications of 5ml (i.e. 30ml/day, 210 ml/week). For 500ml Sunsense Ultra SPF 50, this equates to an annual cost of £450 per year. The Dundee reflectant sunscreen, required for the most severe photosensitive diseases, costs £4,500 per year.
It should also be noted that many people with lupus are already facing financial pressures. 63% of people with lupus in a recent survey stated that they were unable, or find it difficult, to work. A 2009 survey of LUPUS UK members found approximately 25% had to retire early on medical grounds and 42% were receiving disability benefits.
We urge NHS England to consider the views of patient groups, clinicians, commissioners and providers across the NHS during this review.
The British Association of Dermatologists (BAD) have sent an open letter to Mr Simon Stevens (Chief Executive, NHS England) which urges consultation with the appropriate groups and outlines the important clinical need for sunscreens. It specifically mentions lupus as one of the conditions where prescriptions for sunscreen are essential.
A document has been produced by the government called, “Items Which Should not be Routinely Prescribed in Primary Care: A Consultation on Guidance for CCG,’s”. The relevant part concerning the prescription of sunscreen is section 5, page 25.
An online survey is available, where you will be able to leave your views on this matter. If you do wish to leave your views the last date to do so is the 21st October 2017.
You may view LUPUS UK’s response HERE.
We will keep you updated regarding any further developments in this story.
Last updated 10/10/2017