On April 9th 2015, the Daily Mail published an article stating that £13 million of NHS prescriptions were for suncreams, implying that patients were abusing the system by obtaining prescriptions for household items and that these prescriptions were an unnecessary drain on the NHS.
The Daily Mail goes on to state elaborate that in 2014, 404,500 prescriptions for suncream were made in the NHS. This is based on the 2014 Prescription Cost Analysis, an annual document published by the Health and Social Care Information Centre, the national provider of information, data and IT systems for health and social care. It can provide details of the number of items and the net ingredient cost of all prescriptions dispensed in the community in England. All drugs dispensed are listed by British National Formulary (BNF) therapeutic class.
In the Prescription Cost Analysis, there are 43 medicines under the term ‘Sunscreen’. 4 of these 43 medicines are treatments for actinic keratosis (pre-cancerous lesions) and these 4 medicines are prescription only. The total cost of these 4 medicines amounts to almost £12 million.
2 other medicines in the category (Sunsense and Uvistat) can only be prescribed within guidelines from the Advisory Committee on Borderline Substances (ACBS). These medicines can only be ‘regarded as drugs when prescribed for skin protection against ultraviolet radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including vitiligo and those resulting from radiotherapy; chronic or recurrent herpes simplex labialis. Anything outside of this is not permissable’.
The cost of these is in the order of £1.2million and there is no indication that they were inappropriately prescribed.
The British Association of Dermatologists (BAD) issued a response on Twitter on 10th April to the article in the Daily Mail of the day before.
In its response the BAD clarify that skin cancer is the most common form of cancer in the UK with over 100,000 people diagnosed with a skin cancer per year. If you have had one skin cancer, your risk of developing further skin cancer is greater, together with people who have certain genetic disorders or those that are on medications or have diseases that suppress the immune system. Whether a prescription for suncream is made or not is decided on a case-by-case basis and is ultimately up to the patient’s doctor.
They also point out that the cost of inpatient treatment of skin cancer patients in England on the NHS in 2011 is over £95 million. This does not include the cost of managing skin cancers in outpatient units or by GPs. Therefore prevention is vastly better than cure, not only for the patient but also for the NHS and sunscreens play a large role in skin cancer prevention.
The BAD also go on to point out that there are a range of conditions in which sun sensitivity plays a role and sunscreen prescriptions in those patients is entirely justified and warranted. These conditions include but are not limited to discoid lupus erythematosus, chronic actinic dermatitis, actinic prurigo, congenital erythropoietic porphyria, dermatomyositis, solar urticaria and vitiligo.
It was therefore worrying that the article in the Daily Mail seemed to be blaming patients for this cost to the NHS. Further perusal of the data shows that out of the £13 million attributed to ‘Sunscreens’, actually only £1.2 million were for prescription sunscreens. Given that there is little information as to why the prescriptions were given and little acknowledgement of the multitude of reasons why certain patients are justified in having a prescription for sunscreen, the article seems to have been somewhat hasty in its conclusions.
Dr Sandy Flann, Consultant Dermatologist.