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Independents' Day

GPs told to ask patients if they require over-the-counter prescription

GPs across a large area of London have been asked to curb prescribing of a wide range of over-the-counter medicines, listed by commissioners.

Under the plans, published by North West London CCGs, GPs should ask patients if they are willing to pay for iterms includling paracetamol, ibuprofen, antihistamines, skin creams and antacids themselves.

The full list includes over 25 medicines available over the counter, and which the CCGs said were often cheaper without a prescription.

The CCGs also recommend that GPs do 'not routinely' precribe a list of over 10 items, including cough and cold medicines, mouthwashes and travel sickness tablets, readily available on the high street.

Further, the CCGs want GP practices to stop accepting repeat prescription requests from pharmacies, as these can lead to medicines being ordered which the patient does not need. Instead, they want patients, or their carers, to order repeat prescriptions from their GP practice in person.

The CCGs, which face a £130m annual saving target, said the plans would help curb 'wasteful prescribing' and help its bid to reduce a £15m-a-year prescribing budget.

Dr Ian Goodman, NHS Hillingdon CCG chair and clinical lead for the 'Choosing Wisely' campaign, said: 'The NHS can’t afford to waste money on medicines that people don’t need or don’t intend to take.

'We are giving patients control over their own repeat prescriptions which will be a more efficient, safer way of working.'

The BMA's GP committee has previously fought back against such proposals, suggesting guidelines to prevent GPs prescribing certain medicines are ‘unworkable’.

But Dr Goodman said it makes good sense to prescribe fewer medicines that can be bought on the high street, adding that these were only guidelines.

He said: 'We are reminding GPs to consider clinical need carefully when prescribing any of these items. If the patient is unable to afford the medicine or product, then they will still, of course, be prescribed as usual.'

But Healthwatch Hillingdon questioned whether the proposals were 'the best way to achieve the desired savings'.

It said its own analysis of the plans 'shows a maximum saving of £2-3m at best', recommending instead 'further enhanced training and support for GPs to improve appropriate clinical prescribing and a reduction in medicine wastage through a North West London public awareness campaign'.

A spokesperson said: 'We do not think that the current proposal has given sufficient thought to the overall impact on the NHS.

'Reduced GP access to some of the items proposed in this local list may result in an increase in GP appointments and costly hospital admissions.'

An estimated £300m of prescribed medicines are wasted every year according to NHS England, which is currently reviewing a national scheme for curbing costly prescribing of over-the-counter and 'low value' items.

An NHS spokesperson told Pulse that the result of that review is delayed and is now expected in the 'second quarter' of the current financial year.

Proposals in full

1. GPs will ask patients if they are willing to buy certain medicines or products that can be bought without a prescription.

2. GPs will not routinely prescribe certain medicines and products which can be bought without a prescription.

3. To reduce waste, patients will be asked to order their own repeat prescriptions.

Source: The North West London 'Choosing Wisely' consultation


Readers' comments (21)

  • Pay? Hey Doc, it's all very well for you in your flash car, I've got five kids to feed...

    Pay? I'll have you know I fought a war for this country....

    Pay? I've paid my stamp for 40 odd years and these young 'uns don't know what work is..

    Pay? Bet you wouldn't ask me if I was ( insert random nationality here)....

    See my issue with this isn't the principle. It's the fact that we are being asked to take the flak for a conversation our political masters are too frit to have.

    If they came out and said to the public "sorry folks, party is over, buy your own Ibuprofen", and then made em all non FP10-able, that'd be one thing.

    But to a man and woman they are yellower than custard. So we get left to beg and plead the population to go along the pharmacy aisle at Tesco and save NHS resources for something vital like employing armies of red braced types to tell us the benefits of working at scale.

    ''Tis a dogs breakfast, from base to apex.

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  • 'just give me 200 tramadol because I can't keep going to the chemist to get 2 packs of paracetamol every 4 days with my arthritis Doc'

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  • Daily Wail 'Why fatcat Doctors wont give your sick child life-saving paracetamol'
    to sound of GMC sharpening knives

    Grinding P 6:17 you are spot on. Make them nonFP10. Any other route and MDU fees ratchet up another notch

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  • Vinci Ho

    Once again , politicians and bureaucrats passed the buck to us to be the 'bad guy' and 'ask' the patients. I have started to ask adding more inches on my face (not even bother with what GMC said) , in a shared decision fashion . Sometimes worked , sometimes didn't . Also use local pharmacy schemes ' Care of the Chemists' in some patient groups which can register and get free paracetamol etc but even they are closing down and shortening the list of medications .
    Truth is the government would never have the honesty and audacity to make them non FP10.

    And by the way , more important to me:
    RIP and thank you Liu Xiaobo
    Will never forget 4/6/1989

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  • Cobblers

    There has been a letter going round here in East Kent. I replied thus:

    We can all agree that if a patient has allergy symptoms then the correct management is to get some antihistamines from Asda or Wilko (cheaper) rather than see the GP.

    However that is a large step away from the letter I read this morning that stated that antihistamines would not be prescribed for hay fever by the GP.

    That act puts the GP in breach of contract in that if there is medical need then a FP10 should be used to prescribe that medication. GMS 2014 14.2.2 a)

    We have had this before in terms of issuing private scripts to patients for drugs manifestly cheaper privately than a prescription charge.

    So my question stands. "If a patient makes a complaint to NHSE that they have been told to buy from Asda rather than get a FP10, will the CCG indemnify the Practice?"

    I suspect the answer will be either a negative or a massive silence.

    I'm willing to take a punt on this and bet at least sixpence. :-)

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  • Cobblers

    Oh and that letter went out about 2 weeks ago.

    Silence came the reply.


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  • I have nothing to add to Grinding Premolars excellent and all too accurate post.

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  • ps - how does the statement "To reduce waste, patients will be asked to order their own repeat prescriptions" square with the push to adopt pharmacy based electronic repeat prescribing?

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  • GMS section 14 says you must use an FP10 if you prescribe. It does not say you must prescribe. You can advise a person to use antihistamine and you do not have to prescribe it.

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  • I keep hearing how great pharmacists are but even with hay fever their advice seems limited to antihistamines, ignoring nasal steroids.

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