Travel vaccinations, gluten-free foods and some painkillers may no longer be available on the NHS under major cost-cutting plans.

NHS England is working on new guidelines to discourage GPs from prescribing medicines, some of which are cheaper to buy over the counter than the £8.40 prescription charge.

All are thought to cost the NHS £12m per year.

Although not included in the current proposed list, suncream, cough treatments and indigestion tablets could be included in future reviews, saving up to £400m more.

Here’s what is being considered as part of the consultation:

  • Gluten-free foods: Around one in 100 people have coeliac disease, caused by a reaction to gluten, that can be treated by cutting the substance from a patient’s diet.

  • Travel vaccines: Vaccines for typhoid, hepatitis A and cholera and a combined jab for diptheria, polio and tetanus are usually available free on the NHS because they protect against diseases deemed to present a risk to public health if brought into the country by travellers. Some countries require visitors to be vaccinated against yellow fever or meningitis, tuberculosis and hepatitis B. These are not available on the NHS and cost around £50.

  • Co-proxamol: Used for mild to moderate pain relief, it is a combination of two active ingredients, dextropropoxyphene and paracetamol, which is typically included as a lower 350mg dose compared with the standard 500mg dose of paracetamol when taken alone.

  • Omega-3 and fish oils: Naturally-occurring oils from certain breeds of fish such as salmon and mackerel have typically been prescribed to promote a healthy heart for patients at risk of heart disease.

Poorly performing practices will be put into a new failure regime
Poorly performing practices will be put into a new failure regime

  • Lidocaine plasters: Large sticking plasters that contain a local anaesthetic, which is absorbed into the skin when the affected area is covered. They tend to be used when pain only affects a certain patch of skin, but can costs less to buy over the counter.

  • Rubefacients: A series of muscle rubs used to relieve skeletal-muscular pain are under review for their effectiveness compared with other forms of muscular pain relief.

  • Liothyronine: A thyroid hormone used to treat certain thyroid conditions including hypothyroidism.

  • Tadalafil (not all uses): Certain uses of the drug tadalafil, which is variously used to help alleviate erectile dysfunction and lower urinary tract infections, may also be phased out under the plans.

  • Doxazosin MR: A series of drugs used to treat hypertension which costs the NHS £7 million last year.

  • Fentanyl: Used in palliative care, it comes as patches and in many cases morphine is considered easier and cheaper to prescribe, and is just as effective for end-of life care.