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Independents' Day

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)

  • let people buy as much paracetamol as they want once its confirmed by their doc that they have chronic pain and are not suicidal. job done
    can buy as much as you like in Canada no probs. These limits and the UK attitude to ban everything that can be rarely harmful is a throw the baby out with the bathwater approach and applied too often.
    Also if you don't recommend analgesia for cough cold etc then no need to prescribe. People take these things if they want them but wont help them get better so I don't recommend them and therefore no need to prescribe them unless they get shitty. Would be better if as per Australia they were just not funded by the NHS.

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  • Russell Thorpe

    All that will happen is people on paracetamol will swap to co codamol higher cost and more SE, false economy.

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  • I work in Warrington (ccg mentioned above) and seen the rationale behind this.

    OTC meds prescribed costs 5-20 times more, compared to buying it OTC. In Warrington, estimated saving is 1.5m/year and excludes patients with long term condition, pregnancy and too deprived to afford medication (though I struggle to understand how people claim they can't buy 99p pack of paracetamol whilst they can smoke 5 a day). This is about 7% of the total ordinary care budget.

    Some here may continue to stick their heads in the sand and claim health economy is not their individual concern. But just as we twist our patients they need to start considering their duty to use health care appropriately, we as professionals also need to do the same. As we are funded by the tax payers money, we too have duty to use public fund effectively.

    But yes, NHSE and GMC need to get off their ass and start supporting the clinicians if they want a viable future.

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  • Another article explaining to the next generation of medical students why they should avoid GP. Paracetamol prescribing.....a subject that will get any young heart beating.
    This should have nothing to do with me. If you don't want me to prescribe paracetamol simply remove from the list of drugs I can prescribe. If you want me to use my 'judgement', them my judgement will be different from the next person. Which means the rate of prescribing will never be zero or even close to it. Applying pressure...I don't need any more.

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  • Co-proxamol was a thoroughly dangerous drug - I had two patients inadvertently kill themselves taking someone else's tablets so am pleased to see the back of it. A difficult problem as none of us like seeing patients in pain. Guidance from above is always helpful though.

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  • GP regulations always used to say that the doctor SHALL [not can, may or if the mood takes him/her] any medicines required for the patient on the form provided by the Secretary of State . Unless these have changed, this suggests that the doctor is obliged to prescribe and would be in breach of ToS if he/she did not. The CCG or even NHS England or even the Minister himself could not alter this requirement without a change of the Terms of Service.

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  • The issue is two-fold - GPs have spent years convincing patients that the GP is the only person who can help them get better. And it is (mostly) free on the NHS. As a result, patients now trot off to their GP with every sniffle and mild fungal infection which can be easily treated via the pharmacy, increasing your workload and conditioning patients into not being able to deal with minor ailments themselves

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  • Send the author of this suggestion to the FO.
    Dismantle community pharmacy as their advice is based on finance.
    H2 receptor antagonists and PPI's should never ever appear on OTC lists.if one looks st other meds they should be POM only. Who are the a hole politicians who know better than regulated prescribers.
    Even at that they still cannot legislate for Shipman practice which to my mind makes them unfit for purpose.

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  • I have had complaints for not prescribing drugs like eflornithine for hirsutism , E45 , paracetamol on repeat scripts for a patient who recently bought prepayment card ,but no indication for these to be on repeat ,A patient threatening to complain for not prescribing prednisolone soluble tablets off license for use a mouth wash advised by specialist & medicines management team telling me ,I am not obliged to do so . These are some eg that makes the profession dissatisfactory & I would not recommend my children to become doctors .

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