Emollients on prescription

Many people with eczema are finding it difficult to get their preferred emollient – or, in some cases, any emollient – on prescription.

Why is this?

This is likely to be due to a misinterpretation of NHS England guidance, cost saving measures or a combination of both.

NHS England guidance on the conditions for which over the counter items should not routinely be prescribed in primary care, which was published in 2018, stipulates that emollients should no longer be prescribed for ‘mild dry skin’. Some Clinical Commissioning Groups (CCGs) and GPs have misinterpreted this guidance to mean that people with eczema should no longer be prescribed emollients. The guidance actually states that people with long-term conditions (which include eczema) should still have emollients prescribed for them (see page 12).

GPs are advised, where possible, to prescribe the emollient with the ‘lowest acquisition’ cost from the range of emollients listed in their local formulary. A ‘formulary’ is the list of medicines and other treatments that are available on NHS prescription in a particular area. Formularies vary widely.

Sometimes a patient’s prescription is automatically switched to another treatment, usually to a cheaper alternative. This cheaper alternative should be comparable with or better than the original, but sometimes it’s not. This is known as ‘script switching’.

What about bath and shower emollients?

Unfortunately, it has become very difficult to get bath and shower emollient products on prescription since the BATHE study results came out in 2018. The BATHE study found that emollient bath oils didn’t have any additional benefit for children who were using leave-on emollients to wash with, and it was used as a reason to stop prescribing emollient wash products altogether. National Eczema Society expressed concern about the methodology of the BATHE study to NHS England when the results came out, and made a case for emollient wash products to remain on prescription.

In 2019, the CCG guidance on items which should not routinely be prescribed in primary care was updated to include bath and shower emollient preparations (p. 16), meaning that these items would no longer be prescribed on a routine or regular basis.

Bath and shower emollient products can still be prescribed, but at a GP’s discretion only.

What can I do about it?

You should still be able to get sufficient quantities of leave-on emollient on prescription to treat your eczema effectively, even if it’s not your preferred brand. If you’ve been refused emollient on prescription altogether, or the alternative you’ve been prescribed isn’t working well for you, or you haven’t been prescribed enough, please download and print out our information sheet, and show it to your GP or pharmacist. You could also present the evidence below to your GP or pharmacist.

The NHS England Clinical Working Group that was responsible for the development of the CCG prescribing guidance on OTC medicines has confirmed that:

• It did not intend for this guidance to be a blanket ban on the prescribing of emollients.
• People should still be able to receive emollients on prescription for long-term skin conditions like eczema.
• The prescribing guidance applies only to people with mild dry skin.
• The guidance does not prevent GPs from prescribing emollients based on clinical need, in accordance with their professional duties.

The Dermatology Council for England (DCE) has the content of a letter on their website written by the Deputy Chief Pharmaceutical Officer at NHS England & NHS Improvement, in response to a letter from the DCE. The letter from NHS England states, among other things:

‘The clinical working group did not intend for this guidance to be used as a mechanism to initiate a blanket ban on emollients. If CCGs have implemented the guidance as intended, patients with chronic and severe skin conditions should still be able to receive their emollients on prescription as it is a chronic condition. The recommendation in this guidance only applies to those with mild dry skin.’

Dr Bruce Warner
Deputy Chief Pharmaceutical Officer
NHS England & NHS Improvement

In December 2020, NHS England sent a letter to the British Association of Dermatologists and the DCE. This letter confirms that ‘patients who have been formally diagnosed with a long-term, chronic condition such as eczema, dermatitis or psoriasis’ should continue to have emollients prescribed, if clinically appropriate. The letter also states: ‘Emollients should be prescribed in sufficient quantities as outlined in the NICE clinical guidance for eczema treatments, which take account of patient preference.’

If you’re no longer able to get an emollient bath or shower product prescribed, and leave-on emollients don’t suit you for washing purposes, please download and print out our information sheet on wash products, and show it to your GP or pharmacist. You could also draw your healthcare professional’s attention to the letter mentioned above, which makes it clear that prescribers can prescribe emollient wash products under ‘genuine clinical circumstances when it is appropriate to prescribe [them].’

You can also write to your MP

To find your MP and send them an email, please visit this website, where you can type in your postcode, click on the MP and fill out all the details. For suggestions as to what to include in the message, please download our template letter to an MP.

MPs can not only attempt locally and confidentially to address your individual issue by writing or speaking to the local health agencies and commissioners, but they can also seek to influence national policy by raising the broader issue within Parliament. This includes asking parliamentary questions, writing to the Department of Health and Social Care, leading a debate or meeting Ministers.