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Should GPs stop prescribing all OTC medications?

Dr Matt Piccaver argues that GPs are not needed for these treatments, while Dr Grant Ingrams says this approach will put GPs at risk

Dr Matthew Piccaver

Dr Matthew Piccaver

YES

 I’m probably not alone in groaning internally when someone asks for a bottle of paracetamol suspension to ‘stock up’. Increasingly I point them to the local convenience store. 

The NHS was originally completely free at the point of delivery. Then came charges for prescriptions, and items such as spectacles and dental treatment. Prescribing, one of the larger sources of NHS expenditure, is often under scrutiny as a source of savings.

Simple painkillers, antihistamines, assorted lotions and potions can be purchased for relatively little cost from a plethora of sources.

I’ve seen paracetamol on sale for 16p, a box of 28 cetirizine for £1, hydrocortisone cream on special offer and three for two on nappy rash cream. These are inexpensive, effective treatments that don’t need the cost of a prescribing clinician, or the time spent to get an appointment or stand in line at a dispensary hatch. This is not a case of refusing treatment, as some may argue, but redirecting people to a more appropriate place of care, particularly for simple conditions where OTC medications are identical. I think we all want to see good value for money from our tax pound, particularly when it comes to the NHS.

For the most part, patients accept that the NHS needs to find ‘efficiency savings’. Increasingly I meet people who will happily purchase something if it is available OTC and CCGs are increasingly looking to restrict their prescription, with the NHS now looking to review prescription of certain OTC items.

Might this approach lead to more complaints? Perhaps. But if carried out in an open, transparent fashion and for the right reasons, I don’t see this as a problem.

It might be feasible to provide inexpensive or even free selected OTC medications off prescription on presentation of proof of entitlement, although this might prove a slippery slope to having to prove entitlement to other NHS care.

There’s a real drive towards self-care from the NHS hierarchy. If the virtues of self-care are to be extolled, then people need to be directed to sources of it. This means paying for the odds and ends of minor ailment treatment. 

The NHS is part of the UK’s national identity. But perhaps it’s time we all did our bit to save a few quid here and there.

Dr Matt Piccaver is a GP in Glemsford, Suffolk

Dr Grant Ingrams

Dr Grant Ingrams

NO

This policy is fraught with risk to GPs and public health. A cornerstone of the NHS is that healthcare is free at the point of delivery. While there are some exceptions, this has resulted in the UK having the lowest number of patients not accessing healthcare due to cost – 4% in the UK compared with 37% in the US where healthcare costs are now the commonest cause of bankruptcy.

Not prescribing OTC medications causes hardship for some patients who are forced to choose between buying medication or food. Such a policy would particularly affect patients from deprived households and is more complex in the case of children: could a parent be considered to be neglecting their child if they are not buying GP-recommended OTC medication they cannot afford? Would the relative of an impoverished elderly patient be expected to pay for all their OTC medications? Buying occasional paracetamol would not bankrupt anyone, but if you have several children, or it is needed over a long period, the costs could be prohibitive.

NHS regulations state that GPs must prescribe any drug they feel is needed for the care of the patient. If a GP refused to prescribe a medication on the sole grounds that it was available OTC, they would be at risk of GMC action for failing to treat patients properly. 

There are many more appropriate ways to make savings on prescribing. For example, by prescribing sunscreen only when there is abnormal photosensitivity, or Colief only for infants with lactose or sucrose intolerance.

Current NHS austerity is a political choice, with the Government choosing to invest less in the NHS than other civilised countries, while introducing costly ideological changes not related to patient need. Why should GPs put themselves in the firing line of angry patients? 

Patients should be encouraged to self-care for minor and self-limiting conditions via a national campaign, but a blanket ban on prescribing OTC drugs will only harm vulnerable patients, increase health inequalities and put GPs at risk.

Dr Grant Ingrams is a GP in Glenfield, Leicestershire

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Readers' comments (10)

  • working in a very rural patch with a dispensary - local shop not up to much and the nearest supermarket is 9 miles. I agree that we should encourage people to buy their own OTC meds but as it stands we are not allowed to sell them! Woulsd be happy to if we could

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  • My opinion is probably halfway between Matt's and Grant's. I think their should be a campaign to make patient's aware of all the important points raised in this discussion, and then leaving it to the patient to self assess and decide if they are able to buy a medication OTC or ask for it on prescription depending on their socio-economic circumstances.

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  • If paracetamol becomes non-prescribable we would need to end the "no more than 32 tablets at a time" rule for OTC sales.

    Otherwise patients face a choice between visiting the chemist potentially every 4 days or asking their GP for something stronger which may be unnecessary.

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  • Vinci Ho

    Typically , this has become a left versus right ideology debate which has come down to the ground level, Our Level ,as we are facing our patients directly everyday. While political leaders are evading the responsibility of conducting a open , transparent and honest discussion with the public reaching a generally acceptable decision, we are left with a task of 'damned you do , damned you don't'.
    As I always argue , general practice should be driven by central ground politics in this country, given the history and telos of NHS. It certainly appears that some kind of redirecting our patients to pharmacies to buy over- the-counter medicines, is inevitable under this suffocating atmosphere created(and left behind) by the government in NHS.Somebody has to do the dirty job with potential backlash of complaints . For that , I can only say the skin(with my interest in dermatology!)on my face has grown thicker and thicker last few years(not as successful as our 'beloved' health secretary).
    At the level of breaking the news to our patients(in a tone of encouragement), it cannot get away from our fundamental teaching in consultation: it is a shared understanding and decision. Perhaps, it can be even put as sharing the burden and diminishing resources in general practice. We need help on resources defined as money ,manpower, expertise and time(one for all , all for one) . I would argue the help from our patients is more 'useful' than from the government?One journey to pharmacy, if affordable, can already do so helping our resources and workload.........

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  • Vinci - you are a legend!

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  • So anyone who gets a TIA and can't afford to buy aspirin will instead just have to cross their fingers that they don't get a stroke... while they're still capable of crossing their fingers!

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  • I think any medicine which costs less than £5 per month or course of treatment should not be provided free by the state unless their are exceptional reasons why not. A local CCG now longer funds IVF - for anyone. In a publicly funded health service there is always rationing - there has been since the outset (Bevan had to decide - monocles vs spectacles). The NHS is bloated - just go and look in any patients home how many meds are stacked up -unused and wasted. My idea would save £1bn per year - in GP and Pharmacist time. If this isn't the way forward then we should give these meds for free - give every person 10 tickets such that they can get them as with the metro or evening standard for nothing - maybe in a vending machine. Its silly to assume that people can't pay for anything - we pay for =toothpaste , nappies, shampoo, hair cream, moisturisers , cereal etc. Also - we are encouraging self care - how can we do this on the one hand and then ask them to come in for OTC meds on the other


    PS cheapest I have seen a month supply of Antihistamines is 17p on line

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  • Mac, 75mg of Aspirin is less than 10p per week. Please let me who can't afford that?

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  • PS - 75 mg Aspirin at 10p per week will cost the state £5 per week. Please don't tell me thats OK

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  • Our CCG has obtained legal advice which essentially stated that the CCG could not "ban" the prescribing of these items but that the GP would have to use their clinical judgement as to whether to issue a prescription. The reality of this advice is that the GP would become a financial arbiter.
    This may well expose the GP to complaints and litigation for malpractice and/or discrimination. How will the GP explain why some patients are given free medication whilst others are not, unless they make a financial assessment against agreed criteria, which, of course, really isn't our job is it?
    In response to Clare Gerada's comment about the cost of aspirin: It is not just about cost. How will a bedbound patient in a nursing home obtain their aspirin? Will the GP record be updated to indicate that the patient is receiving it otc. I know that otc meds are often unrecorded in the clinical record. This has implications for QOF and automated drug interaction warnings. I guess we could issue private scripts but I can imagine how messy this could become.

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