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Independents' Day

Large number of CCGs crack down on OTC prescribing ahead of national consultation

Local GP leaders have hit out at a growing number of CCGs stopping or putting restrictions in place to prevent GPs from prescribing over-the-counter medicines before the conclusion to an ongoing national review.

NHS Dudley CCG is the latest to announce that, starting from next week, GPs in the area will no longer prescribe treatments for minor ailments, including medicines like paracetamol, ibuprofen, head lice lotion and indigestion tablets.

They will also not prescribe treatments where there is little evidence that they have a real clinical benefit, including cough syrups, nasal congestion sprays, sore throat products and vitamin supplements.

NHS England is currently in the process of consulting on restricting a range of over-the-counter and low-value items, whilst the Department of Health is consulting on banning the prescribing of gluten free foods.

In all, Pulse is aware of at least 19 CCGs which have either introduced, or are consulting on, proposals to curb over-the-counter prescribing.

Londonwide LMCs highlighted a large number of similar plans to restrict prescribing in several parts of the capital.

The London schemes include:

  • NHS Barking and Dagenham CCG, NHS Havering CCG and NHS Redbridge CCG, which all have ‘Spending NHS money wisely’ plans;
  • NHS Brent CCG, which has a ongoing consultation titled ‘Choosing Wisely: changing the way we prescribe’;
  • NHS Merton CCG, which is also consulting on proposals; and
  • NHS Croydon CCG, which is working with other South London CCGs on updating ‘Choosing Wisely Policies’ (formerly known as ‘Effective Commissioning Initiatives).

And last week Pulse unveiled proposals by North West London CCGs to instruct GPs to ask patients if they are willing to pay for items that are available over the counter.

Meanwhile, areas which have already cracked down on over-the-counter prescribing include four CCGs in Lincolnshire as well as Somerset, Bristol, Warrington, East Riding of Yorkshire, Luton, Bedfordshire and two CCGs in Cheshire.

Londonwide LMCs said they disagree with the proposals on the basis that they undermine the principles on which the NHS is based; that they are unworkable; and that they are likely to compromise GPs under their GMC requirements as stated in Good Medical Practice.

Dr Michelle Drage, chief executive of Londonwide LMCs said: ‘If the Government feels that GPs shouldn’t be prescribing certain over-the-counter treatments, then it is the Government that need to take responsibility in deciding what is and is not open to GPs to prescribe rather than passing the buck to CCGs and already hard-pressed GPs.’

But NHS Dudley CCG chair Dr David Hegarty said: ‘In Dudley there is an increasing demand for prescriptions for medication that can be bought over the counter at relatively low cost, often for self-limiting or minor conditions.

‘These changes will benefit patients by making it more convenient to get treatment for minor ailments from a local pharmacy or shop, and will also free up valuable GP time. Together this will save the local NHS around £2m per year, which could be used to protect other treatments.’

Where a treatment is needed for a long-term chronic condition or there are legal restrictions on the amount of medicine that can be purchased over the counter from community pharmacies, Dudley GPs will still be able to prescribe the items.

Which items could GPs be banned from prescribing?



Prolonged-release Doxazosin

Immediate- release Fentanyl

Glucosamine and Chondroitin

Herbal treatments


Lidocaine plasters


Lutein and antioxidants

Omega-3 Fatty Acid Compounds

Oxycodone and Naloxone combination product

Paracetamol and Tramadol combination product

Perindopril Arginine


Once-daily Tadalafil

Travel vaccines


Source: NHS England consultation

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Readers' comments (17)

  • Just don't put your GMC licence on the line for the CCG's convenience!

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  • Dr Smit you are absolutely right. Let recommendation come from NHSE / Govt. All these talks of telling GP not prescribe OTC medicines are useless if not backed up by NHSE/Government with assurance that GMC will not entertain any complain against us for not prescribing these OTC medicnes

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  • ask patients if they are willing to pay for items that are available over the counter - good luck with that!

    GMS contract says GPs must supply a prescription for any recommended OTC drugs that are available on prescription.

    If a patient wastes an appointment to ask for something cheap, why waste even more time trying to dissuade the entitled demander and risk a time-consuming complaint also. (GPs' time is never costed into these "resource-saving" ideas)

    And who are GPs to decide who "can" and "can't afford" to buy OTC?

    only sensible/workable/acceptable solution is to make it statutory so GPs have force of law behind them. Of course politicians are scared of that so continue to put people who actually see patients in the firing line

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  • not for the CCG to tell GPs what they can prescribe. There membership need to tell the CCG the rules

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  • I do not prescribe most otc medicines as a prescriber who uses NHS resources responsibly, as required by the GMC. It is rare for a patient to object. The majority of my colleagues rarely prescribe paracetamol for children which is an example of an otc medicine...

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  • Apparently, the Government has allowed a staggering 88% of the population NOT to pay prescription charges:

    They now regret their decision and they force us to retrieve the money for them, assisted by our elite colleagues sitting on CCG Governing Bodies.
    Pending guidance from RCGP and BMA "leaders" I totally ignore the ban.

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  • I always prescribe OTC preparations if I am asked. It is not possible to be certain about hardship and even if it was was this sort of discrimination seems so arbitrary and open from an ethical point of view. At exactly what household income does someone become deserving? As has been said so repeatedly this is cowardly behaviour by government and more appallingly by CCGs who should not be putting their fellow GPs into such an impossible position.
    If your CCG is trying to do it name and shame the GPs involved.

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  • Until the Government man up and black list these drugs will continue to prescribe for all the above mentioned reasons.

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  • As long as these medicines are available on FP10, no one can stop these medicines on prescription.

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  • as I have said for 15 years now there needs to be a national formulary. If it is not on it then you pay for it. This needs to be drawn up by DOH.

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