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GPs vote to stop prescribing OTC medicines

GPs should stop prescribing all over-the-counter medications, according to a poll of delegates at the Pulse Live conference in London today.

GPs attending the Great GP Debate heard arguments for and against the motion that OTC medicines should not be prescribed at primary care level but should instead be bought by patients from pharmacies and other vendors.

A show of hands vote showed that more than 65% of the delegates agreed with that GPs should stop prescribing all OTC medicines, with around 15% saying that they believed GPs should retain the power to prescribe these medicines. A number of delegates remained undecided.

Arguing for GPs to stop prescribing medicines like paracetamol and cough medicine, Dr Shaba Nabi, a Bristol GP and Pulse columnist, said not only could NHS no longer sustain the cost of prescribing these items, it could also harm patients' ability to self care,

She said: ‘Free prescriptions shackle patients and prevent them taking responsibility for their own health, by infantilising by dishing out free medicines to the public in this way we are actually harming them.

'We all know that minor ailments get better by themselves, you don’t necessarily need any treatment but if a patient wants to buy cough medicine or sudafed then it is up to them to pay for it.’

Arguing against a suggestion poorer patients might not be able to afford OTC medication, Dr Nabi said: 'We are not living in a war zone in a third world country. I am a little tired of this patronising attitude towards the poor because it has left us with a society of very entitled patients who have got learned helplessness.

'We don’t provide free nappies, free toothpaste or free shampoo. All of these items are necessary but somehow we are expected to provide free paracetamol and it’s a lot cheaper than some of the other items i have mentioned.

'It should be a stock in your bathroom cabinet. If we stop prescribing these items it would increase competition with the retail outlets and drive down costs.’

Dr Martin Duerden, a GP in Wales and RCGP clinical prescribing adviser argued that restricting the prescriptions of OTC medicines was not the way forward.

He said: ‘There are some conditions where actually buying things to treat your condition are more expensive than getting a prescription from the GP. I would find it very difficult if i was seeing a patient with that particular condition and say ‘oh you can go and buy this stuff’ when I know I can issue a prescription for free.

'OTC medicines are made on the basis of a drug company seeing an opportunity to make some profit, as well as helping patients. The whole designation system based on a notion of safety.

'Whether you can purchase a product from a pharmacist or a general sales list of a supermarket or somewhere like that is actually based on an assessment of whether it is safe to enable provision of that medicine in that way. It’s not based on whether it is a good thing that the patient can manage themselves for this particular condition.’

He added that the argument for patient autonomy and self care could be pushed too far, but it was good practice to keep minor conditions away from the surgery.

He said: ‘I see the role of the pharmacist as being really fundamental to helping support that process but I don’t think that restricting the use of OTC medicines within an individual practice is the way forward.’

Dr Nabi concluded that whatever moves were made regarding GPs prescribing OTC medicines, it should be rolled out on a national level.

She said: ‘There is no doubt in my mind that this should be national legislation. Until the Government legislates on this GPs are running scared of being in breach of contract.’

Readers' comments (8)

  • Azeem Majeed

    Should GPs stop prescribing all OTC medications? This issue was also covered by the BMJ today in a news report.
    http://www.bmj.com/content/356/bmj.j1442

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  • If you stop prescribing paracetamol patients will ask for co-codamol 8/500. If we stop prescribing that they will want 15 or 30/500. I'm afraid it's difficult to stop this.

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  • I think patients should pay the cost of all their medications with an annual maximum cost of maybe £1000. it would incentivise people to waste less and eat better especially if they are diabetic. But then , i am a foreign doctor working in the NHS .

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  • As already suggested, this would be troublesome, especially if GP's are expected to choose who to issue scripts for and who to deny.

    The only way forward is to charge everyone for a script without any exception.

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  • Its a difficult line to draw for longer term regular medications - paracetamol for example - where it is unrealistic for someone with severe OA to restock every four days from the pharmacy. But I completely agree with the sentiment. I think there would have to be a clear set of terms. This, however, would not be a challenge to draw up. I often refuse OTC meds and with a little explanation - "if we save money on this we have more money to spend on more complicated things like treating cancer" - even the most hardened free prescription user often shrug and accept the outcome.

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  • It drives me mad when mother bring 3 children for minor viral infection and demands not only paracetamol but also ibuprofen. i do locum and they are used to this service. i would be glad when we stop rx otc medicine.
    stop free script for hypothyroid patients, it is just madness
    percentage of cost of drug should be paid by all patients. this will stop there demand. percentage of cost of drug to be charged from most people.
    it is not necessary to give free script to all pregnant ladies or all over 60 years age. coeliac patients should buy food themselves.

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  • I can hardly believe some of the comments above. GP s begrudging writing a script for paracetamol and other OTC items. The same lot have already got rid of OOH care , personal lists, small practices and left most patients no longer able to name their GP. What's left ?....and we blame Hunt !

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  • Did they let you keep your cardie?

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