Lois Rogers

Many patients with severe eczema, psoriasis or other debilitating skin conditions rely on simple, but often highly effective creams and ointments prescribed by their doctors.

But it’s now emerged that the NHS is paying many times over the odds for these products – in some cases up to 17 times more than they should cost – because patients have to get GP prescriptions filled at High Street chemists. And as a result of this high cost to the NHS some of these patients are missing out on treatments.

Toby Butt, now 12, has lived with agonising eczema all this life. The condition is characterised by chronic itching and for children in particular, the itching is impossible to ignore. But as they scratch, they can end up stripping away entire sections of skin, causing cause burning pain, bleeding and infection – over the years Tony has ended up spending weeks in hospital being treated with intravenous antibiotics.

Toby’s condition does not respond to standard treatments such as medicated moisturisers and steroid creams – instead it is being controlled by regular doses of a highly toxic drug called methotrexate which prevents cell growth and is normally used to try to stop a patient’s cancer progressing.

However, the risk of exposing a child to unpredictable and potentially serious side-effects such as liver damage, means the specialists treating him are unwilling for Toby to continue to take the drug for more than two years. That time limit is up in February and it is not clear what will be available as an alternative treatment.

In some respects Toby has been one of the lucky ones because he is getting a cheap and effective treatment.

Countless other patients with debilitating skin conditions are being denied treatment because it is too expensive – and yet the reason it is expensive is because the Government has turned a blind eye to a practice that allows the NHS to be charged more than £300 a pot for products that could cost just £12.

These traditional ointments contain coal tar, sulphur or sometimes dissolved aspirin, in aqueous cream, a base of paraffin oils used for generations for dry skin. They are effective for eczema, psoriasis, rosacea and other skin diseases suffered by an estimated eight million people across Britain.

The creams are normally mixed in NHS pharmacies for hospital use, but a loophole means they are now being sold for more than £300 a pot by private manufacturers servicing GP prescriptions issued through High Street pharmacies.

Private manufacturers have come in as part of the drive to open up the NHS to market forces, but as a result patients and taxpayers are being penalised.

The practice has been exposed by the British Association of Dermatologists (BAD) which says up to £400million a year of taxpayers’ money is being wasted on paying too much for these treatments.

Even 2 per cent salicylic acid cream which can also be effective for these inflammatory skin conditions costs the NHS £75 million a year, says the BAD. By contrast, the more potent methotrexate tablets cost as little as 38p a week.

The Psoriasis Association which represents 1.8 million people, says they are getting a steady stream of complaints from patients because GPs, under increasing pressure to cut drug costs, are refusing to supply the ever more expensive lotions and creams.

The treatments are called ‘specials’ because they are not licensed as medicines but are mixed by specialist pharmacists. The creams contain long-established cheap ingredients such as aspirin and coal tar, which have a well-recognised soothing effect.

In Scotland they are still supplied at NHS prices but in England pricing is governed by market forces, and the creams are made by 14 member companies of the Association of Pharmaceutical Specials Manufacturers (APSM).

David Eedy, president of the BAD is leading a campaign against what he says is profiteering by these companies.

‘Basic coal tar psoriasis treatment cream is now being produced by specialist manufacturers and sold to the NHS via High Street chemists for £333.93 instead of £12.41, while a variety of other skin treatment creams made for about a tenner in pharmacies attached to hospitals, are now costing the NHS, in prescriptions provided outside hospitals, £246-£346 for every pot used,’ he says.

‘We have tried to discuss it with the APSM but it says it doesn’t have to talk to us.’

Because of a commitment to open the NHS to market forces and competition, the Government has now prevented NHS pharmacies that manufacture these creams for hospital use from also offering them through community pharmacies.

David Eedy has complained to Susan Grieve, the Government’s principal pharmacist. ‘She says it would be illegal for her to tell pharmacies such as Boots and Lloyds to get these creams from the NHS or any other particular supplier because she would be interfering with the free market,’ he says.

Ben Howlett, Conservative MP for Bath who has taken up the issue, said the health minister Alistair Burt told him in July he would investigate the reasons for the price difference in Scotland, but no explanation has been provided. ‘These profits cannot be justified and are quite outrageous,’ Howlett told Good Health.

When we approached the APSM for a comment it issued a statement saying: ‘There are inherent costs involved with maintaining a high level of production capacity to fulfil orders, as well as express delivery costs. If APSM members are asked to produce them they are generally bespoke “one-off” preparations, [and] the ingredients are sourced, manufactured, quality checked and sent out the same day.’

Meanwhile Toby is fortunate that his care – and prescriptions – remain under a hospital specialist.

Toby, who lives with his mother Marion, 46, a classroom assistant, his father Mark, 45, a chartered surveyor, and brother Dominic 14, in Burton-on-the-Wolds, Leicestershire, has been repeatedly hospitalised to combat life-threatening infections that have attacked through open wounds that have appeared on his body since the age of nine months.

‘GPs often don’t understand the severity of the condition, the treatments that are needed or the life-altering implications of not giving them,’ says Marion.

‘Until he was five Toby never slept through the night. I spent most of my nights in his room, changing the sheets because of these constantly weeping and bleeding sores, trying to soothe him, putting on cream and trying to cool him down.

‘The eczema first appeared on his feet when he started crawling at eight or nine months and I thought it was carpet burns, but it soon spread to his whole body. He has had a rotten time because he was in constant pain and itching and has spent weeks in hospital on intravenous antibiotics to treat the infections.’

Because Toby is so badly affected his treatment is under the direct supervision of specialist consultants at the Queen’s Medical Centre in Nottingham, and for the moment, Marion is confident his drugs and creams will continue to be provided through the hospital, so he will not be affected by the issue of GP prescriptions.