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Plans for minor illness prescribing ban would 'breach GP contract', BMA warns

NHS England plans for new over-the-counter medicines restrictions for minor illness could place GPs 'in breach of contract', the BMA has warned.

NHS England proposed in a consultation launched in December that GPs should stop prescribing over-the-counter medicines for over 30 minor, short-term health concerns.

But in its official response, the BMA argues that if a GP were ‘to refuse to issue an FP10 for treatment that they had recommended they would clearly be in breach’ of the GMS contract and ‘open to complaint and possible financial redress’.

The BMA points in particular to paragraph 14.2.2 of the contract which states that ‘a prescriber shall order any drugs, medicines or appliances which are needed for the treatment of any patient who is receiving treatment under the contract’.

It adds that under the new proposals GPs will be forced into ‘the unacceptable position of having to make value-judgements about the likelihood of patients being able to access the required medication’ if a prescription isn’t given.

The 33 conditions listed in the final version of NHS England's proposals 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.

The BMA's submission further disagrees with the classification of several of the illnesses in NHS England's consultation, including indigestion and dry eyes, which it argues ae long-term issues.

The BMA adds that the proposals are ‘particularly problematic’ for patients with long-term conditions living in rural areas or with mobility issues, as ‘the pack sizes of NSAIDs and paracetamol available without prescription are too small to allow for long term use’.

The BMA also warns that older patients and those with disabilities will be ‘disproportionately affected’ by the proposals, in violation of the Equality Act 2010.

It concludes that the changes proposed are ‘too important’ to be managed at a CCG level ‘after local consultation, even if that consultation is nationally co-ordinated’.

The response said: ‘The right of patients to receive treatment free at the point of delivery (but subject to specific charges as defined in regulation) is a fundamental principle of the NHS, and if this is to be changed it should be done so by legislation on a national basis by those elected to represent the population and answerable to them for their actions.

‘This is too important a change from established practice to happen on a local basis after local consultation, even if that consultation is nationally co-ordinated.’

BMA submitted a similar warning to NHS England’s consultation on restricting the prescribing of 18 over-the-counter and ‘low value’ items last year, arguing that plans were ‘unworkable’ and ‘totally unacceptable’.

Readers' comments (14)

  • Is the solution not to direct prescribers to use private prescriptions for OTC items? The only issue there is who pays, not a GP refusing to give a prescription. Seems a simple tweak to me.

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  • Alternatively, and as I have said before, just make otc items non FP10-able and then GPs can be excused from any blame. This requires a politician who is prepared to take the flak though.

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  • Cobblers

    Simple. Total non compliance with any OTC drug ban until and unless they are "Black Listed".

    No discussion. Simple statement BMA. Issue it.

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  • BMA deluded if they believe anyone cares what the BMA think. A pointless toothless irrelevance.

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  • Re Cobblers & Premolars

    Bingo ! As usual the GP is left between a rock and a hard place because weasel politicians haven’t the bottle to ban otc on scrip. Expect League Tables to name n shame the highest prescribers in your local rag soon.

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  • It has been repeatedly pointed out that section 14.2 does not require you to provide an FP10. It only requires you to use an FP 10 if you give a prescription. If you are going to advise the patient to use over-the-counter medicines you do not have to provide a prescription at all of any kind. I wrote to NHS employers, who are responsible for the contract, as our CCG has a long list of otc for which we should not provide FP10s, and they clarified and confirmed this point.

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  • doctordog.

    Maybe NHSE need to discuss this with the GMC?

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  • Like most GP's I always try and avoid prescribing anything that can be bought OTC. This new advice changes nothing. But if a patient insists they cant afford something I will continue to prescribe it until I have the governments backing against any complaints I might receive. And the guidelines are either stupidly obvious (no homeopathy) or stupidly vague (no emollients for dry skin- when does dry skin become eczema?!)

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  • Prescribe non otc drugs or amts

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  • Vinci Ho

    Must not let the government and politicians get away with this easily . NHSE wants to pass buck ostensibly. Absolutely no way . The health secretary must make a statement and our contract changes accordingly.
    I dare you to speak , Agent Hunt on the 70th anniversary year of NHS

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