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GPs to face ban on OTC prescribing for self-limiting illnesses

NHS England will ban GPs from prescribing over-the-counter medicines for 34 self-limiting conditions under proposals to be released in the new year.

Under the new proposals, GPs will be unable to prescribe over-the-counter medicines, including paracetamol, for self-limiting conditions.

NHS England today said it will release a full consultation on restricting OTC prescribing in the new year in a bid to save money, specifically targeting treatments that are cheaper for patients to buy than the NHS.

The 34 conditions include cough and colds, infant colic, mild migraine, malaria prevention and haemorrhoids.

The consultation will also look at the prescribing of probiotics and vitamins and minerals.

At the same time, NHS England released guidance for CCGs on restricting prescribing of 18 medicines that it had previously identified in a consultation earlier this year, which its board approved with few changes.

As a result, NHS England has given CCGs guidance on implementing the changes.

The new consultation is focused on OTC medications that can be purchased by the patient at a lower cost than the NHS pays, treats conditions that are self-limited and could be managed by self care.

As an example, NHS England said: ‘Paracetamol is an average of four times as expensive when provided on prescription by the NHS, compared to when it is purchased in pharmacies or supermarkets. It can costs around £34 for 32 on prescription including dispensing and GP consultation fees.’

It says that it will consider each of the conditions (see box), and decide which treatments should not be routinely offered in primary care.

The NHS England statement says: ‘GPs issued 1.1 billion prescription items at a cost of £9.2 billion in 2015/16. The vast majority were appropriate but many were for medicines, products or treatments that do not require a prescription and can be purchased over the counter from pharmacies, supermarkets, petrol stations, corner shops or other retailers in some cases at a much lower cost than the price paid by the NHS.

‘The NHS could save around £190m a year by cutting such prescriptions for minor, short-term conditions, many of which will cure themselves or cause no long term effect on health.’

The BMA GP Committee’s prescribing lead Dr Andrew Green said: ’The BMA believes it is important for patients to be encouraged to self-care wherever possible, as this is in their own interests as well as those of the wider population. Most GPs already encourage patients to purchase items over-the-counter where appropriate and this will continue. However, where a GP has judged the patient to have a need for a drug, there remains a contractual obligation to offer a prescription which must be honoured.

’We have already expressed our concerns about the impact of these proposals on vulnerable people, and the recognition that there are circumstances where prescribing is appropriate is welcomed, although without legislative change there remains the potential for GPs to be placed in difficult situations. Where this happens GPs must make the care of their patient their first concern.’

Indicative conditions or items for which prescribing could be restricted

1. Probiotics

2. Vitamins and minerals

3. Acute Sore Throat

4. Cold Sores

5. Conjunctivitis

6. Coughs and colds and nasal congestion

7. Cradle Cap (Seborrhoeic dermatitis – infants)

8. Haemorrhoids

9. Infant Colic

10.Contact Dermatitis

11.Dandruff

12.Diarrhoea

13.Dry Eyes/Sore (tired) Eyes

14.Earwax

15.Excessive sweating (Hyperhidrosis)

16.Indigestion and Heartburn

17.Insect bites and stings

18.Malaria prevention

19.Mild Acne

20.Mild Dry Skin/Sunburn

21.Mild to Moderate Hay fever/Allergic Rhinitis

22.Mild Migraine

23.Minor burns and scalds

24.Minor conditions associated with pain, discomfort and/fever. (eg aches and sprains, headache, period pain, back pain)

25.Mouth ulcers

26.Nappy Rash

27.Oral Thrush

28.Prevention of dental caries

29.Ringworm/Athletes foot

30.Scabies/ Head Lice

31.Simple Constipation

32.Teething/Mild toothache

33.Threadworms

34.Travel Sickness

35.Vaginal Thrush

36.Warts and Verrucae

Source: NHS England board paper

Readers' comments (29)

  • ... and if a punter complains? I hope they will also advise the general public of the ban and not put weasel get out clause for themselves!!

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  • All illness is eventually self limiting......

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  • @Atul,

    Our CCG have implemented this type of scheme and saved a lot of money. One of the things they did really well was to provide a route to handle all the complaints - and they certainly backed GPs who tried to stop prescribing etc medications.

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  • Obi - you are missing the point.
    GPs have no wish to become involved with complaints over this - that the complaints will be processed with support for the individual GP is comforting but does not resolve the issue. If HMG or one of its agencies makes such a decision, they should have the common decency to broadcast it to everyone (also much fairer to inform patients what is available).

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  • If they black list them then fine

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  • haha!!! How much does severe malaria cost to treat?
    A strep throat is never acute, is it????
    Oral thrush is never a bother to someone with terminal cancer, is it?
    Head lice never spreads through a school, does it??
    Scabies is such a pleasant condition, isn't it... as is threadworms
    travel sickness... also a very nice way to travel...
    ***Hlth bureaucrats in UK are uncaring disgusting people.

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  • One of the difficulties relates to the use of paracetamol in low-grade but prolonged arthritis. Being able to buy only 32 tablets at any one time, and therefore having to go every few days to the chemist may be possible in the big cities, but in the country it's a nightmare, especially if the nearest chemist is four miles away and you need the medication for three months.

    The other problem is severity. How do you ascertain the severity of pain? At the beginning of my career as a GP I felt that most arthritic pain was minor. Then I had a frozen shoulder/ rotator cuff injury and was on at least one occasion left nearly in tears by the continuous nature of the pain over months. That's quite a different scenario from a short time of the same intensity of pain: it's the unremitting, unrelenting nature of it that makes it a whole new ballgame (especially when you can only buy the tablets in small quantities), so the cost in petrol and time of getting adequate supplies is a considerable overhead.

    The bottom line is that prescribing of paracetamol for chronic or long-time pain needs to be treated separately from acute pain.

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  • NHS ENGLAND WILL "BOTTLE IT" AS USUAL AND SAY IT IS DOWN TO "GP DISCRETION".
    THEN IF WE DON'T PRESCRIBE, WE WILL THEN RECEIVE A LETTER FROM THE GMC SAYING WE ARE "SUBJECT TO INVESTIGATION" FOR REFUSING TO PRESCRIBE VERRUCA OINTMENT ETC-THE USUAL INTIMIDATORY AND MENACING GUFF.

    LOOK, THE JOB IS BAD...NO WORSE...REALLY BAD.
    DON'T LET IT RUIN YOUR LIFE LIKE IT HAS MANY OTHERS....GET OUT, LEAVE, ANYTHING.

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  • When oh when will we start rationing unnecessary investigations in hospital carried out "just in case"? How much does an unnecessary MRI scan cost compared to removal of ear wax? One shows exactly what we already expected clinically, the other allows that deaf old man to hear his family again...

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  • National Hopeless Service

    Most CCGs are trying to stop the prescribing of such meds altogether not just for self limiting illness. 'Self limiting' is just too open ended. Patients are great at learning to game the system and I suspect everyones arthritis will flare up every time they get a snotty nose.

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  • Need to blacklist the drugs or we will just keep prescribing as long as we have other bullying and harassing quangos baying for our blood,why dont you go and have another meeting.

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  • About time too.
    A lot of comments missing the point - it says for mild self-limiting conditions not chronic long-term ones.
    This will save money and time, both desperately needed.
    As for complaints how about standard letters? Straightforward enough.

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  • I can see this being quite helpful. There is a sizable chunk of patients who always want a prescription for their child for paracetamol or for cream for the tiniest bit of almost invisible dry skin on the baby.

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  • If at the end of this public (!) consultation some patients whose primary purpose for attending is to get a free script eventually decide to stop coming to us for these conditions, that is good news.

    Surely that's the big picture message here.

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  • The savings quoted include cost of the consultation, will we gate a refund when we send them away with nothing? Because they will still come. Some alternative math going on.

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  • sorry you are still in breach of terms of service if refuse so unless terms of service altered I wont be doing it

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  • Fine by me, but needs to be drug specific not condition specific.
    Needs to be a very clear permanent ban on prescribing drugs that can be bought O.T.C.
    Also THEY need to take responsibility for this change and not pretend it is just GPs being mean and unwilling to prescribe.

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  • You are only in breach of contract if you recommend and then don't prescribe. I simply tell patients they MAY like to try some paracetamol to help with their symptoms, it is an option they can consider. Or give them a PIL of lifestyle changes for reflux/Gord and say they MAY find antacids helpful and MAY like to try them. For headlice I advise wet combing and that they MAY like a special comb to do this as it is easier than picking the nits/lice out. Very few of these conditions need treatment or severe harm will come to a patient, so if you do not recommend, you are not in breach of terms. I advise that if they are unsure what else may help, a Pharmacist is a specialist in this area and they should definitely speak to them about it

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  • No no no.
    Remove them from FP10 then we can talk.
    Do not ask me to provide cover for your political decisions.
    You may find my discretion is distinctly lop sided.

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  • Knowledge is Porridge

    I'm ok with this. It's the closest thing to leadership we have seen. The issue has always been about a fair policy across different GPs, practices and regions and therefore someone at the top needs to put their name to this. Politicians are shot down for any rationing, so it's time the NHS leadership did some leading. Keep going, there is plenty more to address.

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  • healthcare free at the point of delivery........
    thin end of the wedge

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  • Not blacklisted by DoH will not do the bullies need to "pay a penance."

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  • Define 'mild' migraine!

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  • I fully support this, but our contract needs to change so we are not obliged to prescribe a medication for a problem. They also need to charge for appointments- both GP and specialist( even if this is subsidised) One lady told me if I didn't prescribe for her dandruff shampoo she. 'always goes on to get a severe dermatitis of the scalp requiring hospital treatment' costing the NHS more and that she couldn't afford to buy it , another diabetic complained he needs the expensive test strips for his monitoring machine, and if I didn't do this he wouldn't put himself to the slightly more inconvenient monitoring via the alternative machine etc. The CCG always replied it was at the 'doctors discretion' so leaving all potential blame for me.

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  • just read the document,
    47.CCGs will be expected to take this guidance into account in formulating local
    polices, and prescribers should reflect these local policies in their prescribing
    practice. This guidance does not remove the clinical discretion of the prescriber in
    accordance with their professional duties.

    so all the blame is on us, no thanks

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  • Strangely enough most self-limiting illnesses are known retrospectively and many significant conditions may occur with a lot of the symptoms displayed in the long list of symptoms etc. I wonder who’s responsible if I speculate what is or isn’t a self-limiting illness. Will the DOH issue me with a retrospectoscope? Oh yes, who will fund the cost of this instrument?

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  • Seems sensible, but as others have noted, it would be good to have specific medicines and preparations added to the blacklist in the Tariff, target than just a list of specific conditions.

    Also worth reminding patients (and quite a few doctors, maybe) that the 32 tablet limit on paracetamol sales applies to shopkeepers, not to pharmacists. The latter are regulated professionals who can quite sensibly say, for example,

    "yes I see you're using 8 paracetamol a day for your pain, and that knee is going to hurt for a while, so if i sell you 100 tablets that will last you just over 2 weeks, or I could do 200 to last you the month, which suits you?".

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  • I thought malaria prophylaxis was a private prescription? if you can afford to travel to a malaria area can afford the prophylaxis.

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  • Pharmacists will be rubbing their hands together. This represents a massive opportunity to sell patients expensive "remedies" which are of no or limited effectiveness. Patients do not just turn up and collect a prescription. We diagnose, exclude more serious conditions, advise on self care and sometimes issue a script. What qualifies pharmacists to do the first two of these activities? Sooner or later, people will die when the diagnosis that the sharp eyed GP would have made is missed by the fiscally focused pharmacist. Then it will be like 111 and Grenfell - hand wringing an lessons learned blah, blah, blah.

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