Question to the Department of Health and Social Care:

To ask the Secretary of State for Health what steps his Department is taking to ensure that the pain management of cancer and palliative care patients will not be affected by proposals to restrict the prescription of fentanyl.

NHS England held a three month consultation between July and October 2017 on draft guidance for clinical commissioning groups (CCGs) on a range of ‘items that should not routinely be prescribed in primary care’. This included immediate release fentanyl.

At the end of November, the NHS England Board considered the responses received and evidence submitted during the three month public consultation, which closed on 21 October, and the content of final statutory guidance to CCGs. The three recommendations covering immediate release fentanyl which have been agreed are:

- Advise CCGs that prescribers in primary care should not initiate immediate release fentanyl for any new patient;

- Advise CCGs to support prescribers in deprescribing immediate release fentanyl in all patients and, where appropriate, ensure the availability of relevant services to facilitate this change; and

- Advise CCGs that if, in exceptional circumstances, there is a clinical need for immediate release fentanyl to be prescribed in primary care, this should be undertaken in a cooperation arrangement with a multi-disciplinary team and/or other healthcare professional.

However, these recommendations do not apply to patients undergoing palliative care treatment and where the recommendation to use immediate release fentanyl in line with the National Institute for Health and Care Excellence guidance, has been made by a multidisciplinary team and/or other healthcare professional with a recognised specialism in palliative care.

‘Items which should not be routinely prescribed in primary care: Guidance for CCGs’ has now been published and more information can be found here:

https://www.england.nhs.uk/medicines/items-which-should-not-be-routinely-prescribed/