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NHS England issues 'letter of comfort' on OTC prescribing for GPs

GPs who refuse to prescribe over-the-counter (OTC) medicines will not be 'at risk of breaching their contract', NHS England has said.

The body issued a 'letter of comfort' to GPs to reassure them that if they follow the OTC prescribing guidance they will not be penalised, as long as they use their 'clinical judgement'.

However, the BMA said the letter 'does not remove GPs' professional responsibility to prescribe medications where they are deemed necessary'.

The guidance - which followed a consultation in 2017 - said putting a halt to the routine prescribing of OTC medicines would save almost £100m, which could be reinvested into front-line services.

At the time, the BMA warned that GPs following this guidance would be in breach of their contract, as they would be refusing to issue a prescription for a treatment they had recommended.

In response to the ongoing concerns, NHS England has issued a 'letter of comfort' for GPs on the matter, as part of the new five-year GP contract - agreed by the BMA and NHS England.

The letter said: 'The OTC guidance includes specific reference to prescribers, and requires prescribers to reflect local policies in prescribing practice. In NHS England’s view, this guidance is “relevant guidance” under Regulation 94 and other relevant regulatory references.'

'Contractors are therefore required to have regard to this guidance and are able to follow the guidance and exercise judgement about when it is (and is not) appropriate to prescribe OTC items, without any risk that they will be in breach of their contract,' it added. 

But despite this, the BMA said the letter 'does not remove GPs' professional responsibility'.

It said: 'NHS England will provide a "letter of comfort" to all practices and CCGs, stating that where a prescriber decides, in line with local and/or national guidance, not to provide a prescription for an over-the-counter medicine, practices will not be deemed to be in breach of their contract.

'This does not remove GPs professional responsibility to prescribe medications where they are deemed necessary.'

Clarifying this, a BMA spokesperson said: 'Necessary would be defined as it being in the patient’s best interest, particularly if there are concerns that the patient would not access the recommended treatment. This would be determined by the individual GP, who would use their professional and clinical judgment.'

The push to cut OTC prescriptions has been controversial, with GPs receiving an increasing number of patient complaints as they try to follow the guidance.

In 2017, the BMA’s GP Committee warned the Government needed to draw up a blacklist in order to reduce OTC prescribing, to avoid GPs risking a breach of contract.

Many CCGs moved to ban OTC prescriptions before the NHS England guidance was published, including NHS East Lancashire CCG, NHS Dudley CCG, NHS Barking and Dagenham CCG, NHS Bedfordshire CCG and NHS Croydon CCG.

Readers' comments (17)

  • "Necessary would be defined as it being in the patient’s best interest, particularly if there are concerns that the patient would not access the recommended treatment"

    Presumably this means continue to prescribe OTC meds for patients who say they can't afford the recommended treatment?

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  • One area of conflict here is the aim to get people to purchase their medications for hay fever and allergic rhinitis OTC. The evidence is very clear that the majority of those who see their GP do so because of failure of OTC medication be effective. There are numerous reasons for this, including the alternative diagnosis of non allergic rhinitis. The Practice which I attend has a notice virtually telling these people to go away. They are thus left to the tender
    ministrations of pharmacists, who we must always remember are not clinicians.A recent study from Australia (where rhinitis is considered a pharmacy only disease) demonstrates poor patient outcomes.
    The patient needs to be seen by a clinician to confirm diagnosis and to get a management plan. Once this has been done, and the medications needed are OTC then direct the patient to the pharmacist, but not the other way round. As a profession, we must not allow the CCGs or other bodies to dictate poor clinical practice which invariably leads to worse outcomes for our patients, delay in them receiving correct advice and prolonged periods of impaired quality of life.

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  • Just keep prescribing until our lily-livered government blacklists otc meds. No complaints and no breach of contract. Simples

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  • Nhsfatcat

    Is it shiny like at school or triple ply soft Andrex?

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  • This is absolutely typical of the woolly thinking and policy making to which we are subject. For goodness sake NHSE grow a backbone and simply blacklist all items that are readily available OTC. I really do not believe it when people say they cannot afford 32p for a pack of Paracetamol. The benefit of this also is that it encourages self-management of problems that all too readily present to primary care.

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  • Peter Swinyard

    What a fudge! Do I need a letter of comfort? I've not been accused of a criminal offence! We either prescribe to all or refuse to all - leaving us to decide if someone can't afford it is really unacceptable. We will always get the "entitled Grauniad reader" patient who insists on a script and has the time to make life miserable as the complaint process (usually direct to NHSE thus involving the PAC) grinds through. Let's just get the clarity of NHS prescribable or not.

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  • BLACK List them if you dare

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  • Tantalus

    Letter of comfort - wasn’t that what they gave to the IRA ?

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  • Who are they kidding?

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  • Black list or we will just continue,take responsibility as you are the executive.

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