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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)

  • 8.16pm... well said. Why are parents encouraged to give paracetamol or brufen for fever? As you said, anti pyretics potentially prolong symptoms, presumably because fever is an infection defence mechanism. Medication should only be used t
    As analgesic, if needed, not anti pyretic.
    I see no reason whatsoever to prescribe anyone, including children, calpol etc, although for those who take 8 paracetamol per day for chronic pain, I think it's a different issue entirely, as otherwise they could only buy 3 days at a time off the shelf. Perhaps the ridiculous rule of only buying small quantities should be scrapped? After all, if you're determined to overdose, you will just visit a couple of shops!
    About time the GMC backed us and told the public to start looking after their minor ailments

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  • I agree with 1st. Post. This CCG advice is unbelievable. Lose your job by following their advice? NO WAY. The only charge that the CCG can bring against a GP regarding this matter is that of "overprescribing". To avoid this, prescribe in smaller quantities. If ever charged by anybody, remember the diagnosis and recommended treatment. If you are brave, the sly foxes will only bark at your feet.
    Retired and experienced GP.

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  • Careful for what you wish for.
    Banning OTC like paracetamol for chronic pain will lead to an increase in POM replacements like NSAIDs and Coco30/500.
    Paracetamol for children costs peanuts and there are better therapeutic areas to save money.

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  • Its a great idea but it needs to be national NHS policy.

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  • the cost of paracetamol may be low but the dispensing fee probably triples the overall cost to the NHS.

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  • We are keen to stop prescribing OTC medication but this must be a central policy and not down to the whim of individual Drs / surgeries

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  • Prescribe when you have a patient who you feel won't be able to afford it. CCGs have their problems, patients theirs and we have to have a clear conscience and do our duty as well as we can.

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  • Don't hear much about the rural, elderly and patients with no transport trying to buy boxes of 16 & 32s tabs. Think the patient should be treated as an individual case..... :-))

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  • Pharmacies will only sell in packets of 16Visiting pharmacies every 3 or 4 days for Paracetamol or Ibuprofen is a great waste of time.

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  • This really is going too far ! First they take away the only REALLY effective analgesic available - coproxamol, & tell us to replace it with one which is, we are told, equally as effective (???) paracetamol !! NOW, the demand rockets so high that they can't even fund that. So, paracetamol, a drug known to be potentially bad for one's liver & & good for suicide will only be available unmonitored & unsupervised to all the chronic pain sufferers who already have inadequate pain relief !!
    Do you REALLY call this good medical practice ?

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