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GPs come under pressure to stop prescribing over-the-counter drugs

GPs are coming under increasing pressure from CCGs to stop providing prescriptions for paracetamol and other over-the-counter medications, despite warnings from GP leaders this could put GPs in breach of their prescribing responsibilities under GMC regulations.

Pulse has learned of four CCGs across England that are writing to GPs urging them to refrain from prescribing OTC medications for minor ailments in moves aimed at cutting their prescribing spends.

At least another seven are trying to push similar schemes through – with one even proposing to limit long-term prescriptions of paracetamol for arthritis.

However, the GPC has warned that GPs could risk being in breach of GMC rules and regulations on prescribing if they don't prescribe a treatment they have recommended.

Commissioners have said they have the backing of GPs, but local GP leaders are urging caution and in one area GPs have forced CCGs to back down on the move.

NHS East Riding of Yorkshire, NHS Luton, NHS Warrington and NHS Bristol CCGs all recently advised GPs they should no longer prescribe over-the-counter medicines for self-limiting illnesses.

Pulse has learnt that:

  • NHS Warrington CCG sent GPs information on medicines for self-care, advising that for self-limiting conditions ‘unless there are exceptional circumstances, these medicines will no longer routinely be prescribed and patients will be expected to buy these themselves’. They advised GPs should no longer prescribe pain killers for minor aches and pains and should recommend a few drops of olive oil instead of ear wax removers.
  • NHS Bristol CCG informed GPs they should 'aim to restrict the prescribing of medicines of limited clinical value and those that could be bought cheaply over the counter’;
  • NHS East Riding of Yorkshire CCG sent GPs a letter saying the local LMC ‘supported an approach that encourages people including adults and children to buy their own over-the-counter medicines where appropriate such as paracetamol, ibuprofen and other medications for minor ailments’;
  • In Luton, patient leaflets explained: ‘Luton CCG has asked health care teams not to prescribe some medicines any more'. Medicines listed included painkillers for minor aches and pains, soluble pain relief, creams and tubular support bandages for sprains/sports injuries;
  • Bedfordshire, Eastern Cheshire and Western Cheshire and Heywood, Middleton and Rochdale CCGs are in the process of consulting on proposals that would see campaigns to cut down on OTC prescribing.

And CCGs in the East Midlands have launched a consultation that could see GP prescribing restricted even further, calling for suggestions on how they can cut paracetamol prescriptions to patients with long-term chronic pain from arthritis. 

In a joint press release, Leicester City, West Leicestershire and East Leicestershire and Rutland CCGs said they were surveying patients to ‘investigat(e) ways they can reduce the amount they spend on prescribing items which are also freely available to buy in supermarkets and community pharmacies’, which they would consult on.

The CCGs singled out the £1.5m cost of prescribing paracetamol for arthritis in particular.

Dr Anu Rao, medical officer at Leicester, Leicestershire and Rutland LMC, said that 'providing small quantities of over-the-counter medications such as common painkillers like paracetamol on prescription is not an effective use of resources.’

But she added that this did not include patients with long-term conditions.

The GPC also warned that GPs may risk breaching GMC prescribing regulations.

Dr Andrew Green, chair of the GPC clinical and prescribing said: ‘There is the world of difference between GPs properly encouraging patients to self-care and denying them drugs that they have recommended.

‘Commissioners and GPs need to remember that they are required by regulation to offer their patients an FP10 if they believe the treatment is appropriate.’

Dr John Ashcroft, executive officer at Derbyshire LMC, told Pulse GPs in his area recently resisted the same approach from CCGs in his area.

Dr Ashcroft said: ‘The CCGs did bring this idea that we should stop prescribing analgesia and tell people to go and buy it over the counter. However, we pointed out it’s actually against our regulations to do that.'

However, Dr Shaba Nabi, a GP in Bristol who supported the initiative in her area, said: 'Self-care for minor illness was encouraged by many GP practices, well before the CCG guidance was released. This was in order to reduce access demands for these minor ailments in areas where patients would attend a GP appointment for a prescription for many over the counter preparations as they were entitled to free prescriptions.

'No policy (practice or CCG) has ever prohibited the prescribing of these items as prescribing decisions lie very much with the prescriber.'

GMC chief executive Niall Dickson said: 'Of course a doctors’ first duty is to their patients, and they should ensure that patients have good access to care and treatments. But healthcare does not exist in a financial vacuum and the health systems of the UK like all other systems have finite resources; doctors should use NHS funds efficiently and follow reasonable guidance from commissioners.

'While of course doctors must always exercise their professional judgement in every case, our guidance clearly states that they should make good use of resources.'

Readers' comments (39)

  • NO NO NO. This is quite simple. The government can quite easily blacklist these drugs making them impossible to prescribe. But they are too cowardly to do this and make GPs bear the brunt of resentment. We should not be the fall guys for this any longer and GPs on CCGs who recommend this action should be ashamed of themselves. Quislings.

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  • Do these CCGs not have any other more important issues to focus on.

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  • Well said partner at 10:08!
    No one is honest enough to mention to patients all these are the result of poor funding. Just keep hitting the clinicians and if there is a complaint blame the clinicians.

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  • completely agree with the first post. exactly how I view this. We are put between the rock and the hard place here

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  • Vincenzo Pascale

    It's comic. Simply comic

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  • Not comic but very serious .If we are to turn back the tide of ever increasing demand, patients must be told(yes,told) to take responsibility for their minor ailments .The rest of the world must think we are mad to offer free access to a highly qualified clinician simply because patients can't be bothered to pay for a few tablets.
    We can have a coughs and sniffles service,or a highly focussed system to detect and treat serious pathology, and if anyone suggests we should see every short-lived headache in case we miss meningitis .......welcome to Burnout City.

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  • We don't prescribe paracetamol and ibuprofen for minor ailments in our practice.

    It does lead to a reduction in consultation rates

    The government needs to stand up and give the GMC permission to make this law

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  • Although it sounds comic, I feel this is something *some* GPs need to be reminded off. There have been many occasions where I have asked my GP can I buy this medication OTC, to be told 'yes you can, but I'll prescribe it anyway'.

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  • When you are in crisis - it is very easy to blame anyone who you perceive to be the enemy for everything - whether that is the CCG, GPC, RCGP or LMCs. This prevents you from being objective about an issue.

    This is not about putting a gun to anyone's head and telling them they must not prescribe x y or z. Of course this decision always lies with the prescriber. But this is about changing the culture to reduce entitlement and enhance self-care. Surely this is what we want as GPs?

    It is much easier to have a practice policy for something than for an individual GP to act as an island. Similarly, it is easier for practices to embrace a policy if the CCGs facilitate it. Going one step further - it will be better still for the policy to go national then ALL CCGs could embrace it.

    Partners - you run a business. A business which is creaking at the seams. You cannot run this business if the highly skilled and depleted workforce is seeing nothing but coughs and colds because the public can't be bothered to buy a 20p box of paracetamol.

    If enough of us embed this culture, it will soon become national policy.

    And it is not at all helpful for the GPC to accuse those of us who try to empower patients in self-care to be in breach of contract.

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  • 1) as per the first post , i asked our medicines Managment person that instead of us being made the bad guys they should make firm policies so patients can complain to them when they don't get there paracetamol..... No can do was the answer!

    2)I agree@1.44 but you could refuse such a script also! Having done Locum work I know there are some surgeries with deprivation in which the patient demographic ( white / non white , unlike the sweeping generalisation made by a previous post) who expect such simple scripts as there is no surgery or CCG policy. "No" is easy if it is understood and respected.... Otherwise enjoy a painful day with numerous 20min consults on why your not issuing paracetamol and the odd complaint letter thrown in for good measure.

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  • Govt here in Oz has made it impossible to prescribe OTC medications on the national prescription scheme (known at the PBS), so no-one will bother you for paracetamol, anti-fungal creams, anti-histamines etc

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  • NHS Brighton & Hove also.
    Actually seems reasonable to me!

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  • child with pyrexia-- rx paracetamol or ibuprofen is justified. if child well then no need to prescribe. . some patients ask for rx for possible illness when they go abroad. that is misuse.
    let patient pay 10% of cost of drugs , they will have reason not to waste. stop free script for hypothyroid patients.

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  • Don't forget that many of these meds are simply shipped off to their relatives in their native countries with the British taxpayer bearing the cost.

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  • i do not see any thing wrong with asking patients to buy paracetamol or ibuprofen or cough remedies from counter and patients do have to tak responsibility as well . thanks

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  • You have a duty to presrcibe using NHS resources responsibly.. this is a gmc and rcgp equirement and this means no OTC meds for minor ailments. It is the reason most doctros do not give paracetamol for children for a temperature. The GMS contract requires us to give advice on medication but not provide it on an FP10 if it is available otc.

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  • It's not fair to restrict paracetamol for long term conditions. You can only buy 32 tablets at a time OTC - i.e. 4 days worth. Not fair to make people with painful conditions have to go to the chemist every 4 days to get their paracetamol!

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  • I think the whole discussion misses the point. We should stop endorsing that parents give their children Paracetamol "to bring the temperature down" and advise them not to try and 'treat' colds with regular Calpol. This would be in line with NICE guidance, which I feel is largely being ignored. It is not about banning it but about appropriate prescribing. If parents wish to offer their child paracetamol to ease discomfort caused by a high temperature, then that would be in line with guidance, but not necessary. We GPs are partly to blame if we, maybe inadvertently, continue to nurture the false belief that infections and fever require Paracetamol. Research in fact shows that infections take longer to clear if parents give regular paracetamol to 'keep the temperature down'. We are in the process of changing our approach with regards antibiotic prescribing; maybe antipyretics should be next?

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