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NHS England issues guidance to curb over-the-counter prescribing

NHS England has called on CCGs to curb prescriptions for over-the-counter medicines for conditions such as constipation, diarrhoea and athlete’s foot.

The new guidance - which follows the consultation launched last year - says putting a halt to the routine prescribing of these medicines will save almost £100m to be reinvested in front-line services.

In response to initial proposals of a blanket ban, the BMA had warned GPs would be in breach of their contract if they refused to issue a prescription for treatment that they had recommended.

The final recommendations cover 35 minor, short-term conditions, including dandruff, indigestion, mouth ulcers, travel sickness and coughs and colds.

But there are exemptions including for patients where the clinician believes they will struggle to self-manage because of medical, mental health problems or ‘significant social vulnerability’.

The guidance also does not apply to long-term or more complex conditions who will continue to get their usual prescriptions.

It does point out that people who receive free prescriptions will not automatically be excluded from the new guidance.

NHS England pointed out that annually the NHS spends £4.5m on dandruff shampoos, £7.5m on indigestion and heartburn, and £5.5m on mouth ulcers

Chief executive Simon Stevens said: ‘The NHS is probably the most efficient health service in the world, but we’re determined to keep pushing further.

‘Every pound we save from cutting waste is another pound we can then invest in better A&E care, new cancer treatments and much better mental health services.’

Some CCGs had already cracked down on prescribing of over-the-counter medicines.

Dr Andrew Green, BMA GP committee clinical and prescribing lead, said: 'It is already a basic part of a GP’s job to help patients care for their own minor illnesses, and to explain the availability and proper use of over-the-counter preparations. This is useful guidance regarding those situations where advice about self-care may be all that a patient needs.

'However as there has been no change to the regulations that govern GP prescribing, this guidance cannot be used by CCGs to ban all such treatments. GPs must continue to treat patients according to their individual circumstances and needs, and that includes issuing prescriptions where there are reasons why self-care is inappropriate. This guidance does make it clear that such requirements continue to apply in individual situations.'

NHS England's consultation response said: 'A definitive list of medications that are not authorised would be imperative to support GPs in implementing what is being proposed. A "blacklist" of medications would support GPs in respect of their contractual obligations and avoid challenges to their decisions from patients.

'NHS England and NHS Clinical Commissioners should consult with the Advisory Committee for Borderline Substances in determining exactly how the prescribing restrictions might apply in practice.'

Pulse has asked NHS England whether such a consultation will go ahead.

But RCGP chair Professor Helen Stokes-Lampard welcomed the guidance as it stands.

She said that although the college had 'always been supportive of plans to take safe, sensible measures' to reduce prescribing costs, it had 'concerns about blanket bans being imposed, and GPs losing their freedom to make decisions in the best interests of individual patients'.

She said: 'We are very pleased that NHS England have listened to our concerns and that GPs will retain the ability to use our expert medical judgement and clinical skills to prescribe medicines that are also available to buy over the counter in certain circumstances. It is also welcome that limitations will not affect patients living with longer-term and more complex conditions.'

Dr Graham Jackson, co-chair of NHS Clinical Commissioners and the joint clinical working group, said: ‘On a daily basis, CCGs are forced to make difficult decisions that balance the needs of the individual against those of their entire local population.

‘We recognise that it may be difficult for some patients who have previously been prescribed these products, but it is right that we prioritise our spending on those that provide the best outcomes for patients.’

Conditions for which prescribing should be restricted

1. Probiotics

2. Vitamins and minerals

3. Acute Sore Throat

4. Infrequent Cold Sores of the lip.

5. Conjunctivitis

6. Coughs and colds and nasal congestion

7. Cradle Cap (Seborrhoeic dermatitis – infants)

8. Haemorrhoids

9. Infant Colic

10.Mild Cystitis

11.Mild Irritant Dermatitis

12.Dandruff

13.Diarrhoea (Adults)

14.Dry Eyes/Sore (tired) Eyes

15.Earwax

16.Excessive sweating (Hyperhidrosis)

17.Head Lice

18.Indigestion and Heartburn

19.Infrequent Constipation

20.Infrequent Migraine

21.Insect bites and stings

22.Mild Acne

23.Mild Dry Skin

24.Sunburn

25.Sun Protection

26.Mild to Moderate Hay fever/Seasonal Rhinitis

27.Minor burns and scalds

28.Minor conditions associated with pain, discomfort and/fever. (e.g. aches and

sprains, headache, period pain, back pain)

29.Mouth ulcers

30.Nappy Rash

31.Oral Thrush

32.Prevention of dental caries

33.Ringworm/Athletes foot

34.Teething/Mild toothache

35.Threadworms

36.Travel Sickness

37.Warts and Verrucae

Source: NHS England board papers

Readers' comments (23)

  • The DOH and NHSE have the power to blacklist OTC drugs, but lack the courage to front up to the public. So they take the cowardly route of bullying GPs into taking the flack, followed presumably by league tables then naming & shaming the worst offenders. Well that just won’t wash any more, so if you are serious on OTC prescribing either have the courage of your convictions and ban it, or shut up and crawl away.

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  • Well said David. If we do not prescribe when indicated the complaints will come and we could end up with the GMC or NHS England investigations. The BMA is right. Unless the legislation changes and they are prepared to back us up, we shall continue to prescribe.

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  • 'The NHS is probably the most efficient health service in the world, but we’re determined to keep pushing further.'

    Cheap is not the same as efficient.

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  • If gov are serious about this they would allow us to write an 'OTC prescription' so that we know what complex medications patients are taking (and otc meds are important to know about); we can prescribe decent amounts (not 32 paracetamol at a time); yet the patient pays for those meds at the pharmacy.

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  • Black list and allow GPs to dispense private prescriptions.Unitl a drug is blacklisted carry on prescribing what the patient needs.NHSE and the Government need to lead and not bully.

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  • As usual Stokes-Lampard does the bidding of Jeremy Hunt, she wants us to make the decisions on rationing rather than him.
    Go girl, soon be Gong time

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  • RCGP..... cock off and grow a pair! Until then pretend you know what GPs actually do rather than acting as some DoH lackey.
    Can be sorted in 5 mins. Ban them and there is no issue at all, leave it as it is and we will prescribe, can do without a GMC case against me, because no one will be fighting my corner for me.

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  • A hopeless fudge. I’ll keep dishing out paracetamol where needed.

    If the DoH can’t grow a pair, why should I?

    Besides, the hit to my dispensing fees is a powerful disincentive.

    2 fingers rampant.

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  • £100m to be reinvested in front-line services.
    Fat chance!

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  • Question is why should we make those decision and then invite complaints.
    We may make 99 correct decision but one wrong decision and then aftermath of that ( answering patient /NHS / GMC) is not worth it.
    Either government bans them outright so everybody is treated in same way & we can actually tell patients that prescribing these items is NOT allowed by GOVERNMENT ( not GP) IF government is so bothered about vulnerable patients then they can set up another mechanism at pharmacy where those patients can their OTC drugs free or at reduced cost.
    Enough of bullying and taking flak for government's policies and underfunding the system. My job is to treat patients . Let those politicians make fianacial decision and take praise or flak for their decisions..

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