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NHS England reiterates call for GPs to curb OTC prescribing

NHS England reiterates call for GPs to curb OTC prescribing

NHS England has reiterated guidance asking GPs to limit prescribing of over the counter (OTC) medicines, in a bid to improve ‘value for money’. 

The policy, which was first introduced in 2018, recommends that GPs do not prescribe OTC items for which there is ‘limited’ evidence of clinical effectiveness, or where the condition is self-limiting or would be appropriate for ‘self-care’. 

This includes items such as probiotics and vitamins, and conditions that clear up on their own such as sore throats, conjunctivitis and mild cystitis. 

While a review of the 2018 guidance found that no conditions or items should be removed or added, this updated version now includes a focus on health inequalities and resources to support GPs in implementing the recommendations.

ICBs are required to consider how to prevent health inequalities when implementing this guidance, as some patients may struggle to self-care due to ‘significant medical, mental health or social vulnerability’. 

Community pharmacists can also play an ‘important role’ in reducing prescribing of OTC medicines for minor conditions, the guidance said. 

The recently launched Pharmacy First scheme allows pharmacists to consult and prescribe for seven common conditions, in a bid to relieve pressure on GP practices.  

These new prescribing guidelines, published this week, aim to ‘reduce unwarranted variation, improve patient outcomes and provide value for money for the NHS’.

However, NHSE said: ‘The recommendations do not override the individual responsibility of healthcare professionals to support their patients in agreeing the most appropriate treatment options for them, through taking a shared decision-making approach.’

The recommendation not to prescribe for minor conditions which are suitable for self-care does not apply in cases where the GP is managing a long-term condition or treating ‘more complex’ forms of minor illnesses.

GPs may also judge that the patient’s situation is ‘exceptional’ and requires ‘deviation’ from NHS England’s recommendation to use self-care.

In 2018, the national commissioner called on CCGs to curb prescriptions for OTC medicines for these same conditions, following a consultation the year before. 

At the time, the estimated annual cost saving of implementing this guidance was £100m.

But the BMA warned that GPs could be in breach of their contract if they refused to issue a prescription for treatment that they had recommended. 

Pulse later reported that GPs across the UK were experiencing an increasing volume of patient complaints as they had been forced to ration OTC prescriptions. 

And in 2020, data revealed that the ban on prescribing OTC items had saved £32m in the two years since implementation, which was just 16% of NHS England’s projection.

Last year, Healthwatch England said GPs should be encouraged to offer OTC medicines on prescription to patients struggling with the cost of living

GPs around the country had told Pulse that they were seeing more and more patients coming to ask for these prescriptions for minor conditions because they simply have no money to buy them.

Guidance on prescribing OTC medicines

Items with limited evidence of clinical effectiveness

Do not prescribe:

  • probiotics 
  • vitamins and minerals, except:
    • when the patient has a medically diagnosed deficiency
    • calcium and vitamin D for osteoporosis
    • prescription-only vitamin D analogues such as alfacalcidol
    • malnutrition from alcoholism
    • patients suitable to receive Healthy Start vitamins.

Self-limiting conditions 

Do not prescribe OTC items for the following conditions (unless the patient has symptoms suggesting it is not minor or ‘red flag’ symptoms):

  • acute sore throat
  • infrequent cold sores of the lip – the recommendation does not apply to immunocompromised patients
  • conjunctivitis
  • coughs, colds and nasal congestion
  • cradle cap – the recommendation does not apply if the condition is not improving and is causing the infant distress
  • haemorrhoids
  • infant colic
  • mild cystitis.

Minor conditions suitable for self-care

  • mild irritant dermatitis
  • dandruff
  • diarrhoea (does not apply to children)
  • dry eyes or sore tired eyes
  • earwax
  • excessive sweating
  • head lice
  • indigestion and heartburn
  • infrequent constipation
  • infrequent migraine
  • insect bites and stings
  • mild acne
  • mild dry skin
  • mild to moderate hay fever or seasonal rhinitis
  • minor burns and scalds
  • minor conditions associated with pain, discomfort or fever
  • mouth ulcers
  • nappy rash
  • oral thrush
  • prevention of dental caries
  • ringworm or athlete’s foot (does not apply in cases of lymphoedema or history of lower limb cellulitis)
  • sunburn due to excessive sun exposure
  • sun protection 
  • teething or mild toothache
  • threadworms
  • travel sickness
  • warts and verrucae

Source: NHS England


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Please note, only GPs are permitted to add comments to articles

Scottish GP 14 March, 2024 3:44 pm

Cheers chaps, just when we were looking for possible IA. Strategies. Double Yakults all round!

So the bird flew away 14 March, 2024 5:39 pm

Curb prescribing?
Increasing the prescribing of OTC meds is, de facto, industrial action strategy!

David Church 14 March, 2024 8:44 pm

Are they saying that products available OTC are not good value for money, because they are over-priced? Patients will want them on prescription instead, which, if they ask, we CANNOT REFUSE, we can only say that NHSE would ‘prefer they bought it’.

On the other hand, I may have a little something specially just for you, er, ‘under the counter’, you know, where the everyday customers cannot see it, specially for gentlemen on the weekend…….

Darren Tymens 15 March, 2024 10:14 am

Don’t they have bigger problems to be worrying about?

Turn out The Lights 15 March, 2024 10:15 am

Black list them then NHSE.Ban them on a script easy.She how that will effect the government relationship with the punters.Tories Out!

David Jarvis 15 March, 2024 12:29 pm

More work and more complaints for no fiscal benefit to individual GPs. Frankly do your own dirty work. Ban them on prescription and then the patients know who is responsible. Advised us to stop when they remain on the formulary and asking us to take the flack. Yeah right. In your dreams. If those in the centre feel 2% is sufficient they will find it will cost them a whole lot more.

George Forrest 15 March, 2024 12:48 pm

I needed a laugh
Really hilarious p**s take. Nice one NSHE

George Forrest 15 March, 2024 12:49 pm

NHSE even 🙂

Michael Green 15 March, 2024 6:53 pm

Or what? What’re they gonna do? Sanatogen for all

Samir Shah 15 March, 2024 9:59 pm

As if NHSE gives a monkey about general practice 🤣

Anony Mouse 15 March, 2024 10:52 pm

The easiest solution in the world – just blacklist them. Job done

q b 16 March, 2024 9:44 am

I would go further..
I’d move all patients from apixaban (now off patent, 5-6quid a month) to edoxaban as it’s once daily (and costs 60/mth), and jump back onto branded prescribing.

Tbh I think any industrial action won’t work as GPland is still ruled a bunch of cardies who keep thinking ‘but what of the patient ‘.

Honestly, say we are doing a 4 day strike either side of a bank holiday…shut up shop completely.
It’ll bugger up a+e and then maybe they’ll realise how much work we do.

I don’t see things better under labour as they are also of the mindset that the partnership model must go as we earn too much…the dicks just gave themselves 5.5pc and they get expenses?

Liquorice Root- Bitter and Twisted. 16 March, 2024 8:03 pm

I will not enter into combat with a patient over paracetamol on behalf of NHSE.

Dave Haddock 17 March, 2024 12:33 pm

Just don’t.
Not worth the stress.
Patients are fed up enough with access, no continuity, fob-off by phone etc etc.
It’s mad this stuff is available on prescription, but If the nhse don’t want it prescribed, then nhse can take it off prescription.

Imogen Bloor 17 March, 2024 6:41 pm

I agree with prior comments by those who say they would prescribe OTCs in some cases. Quite right. From the outset I thought this policy shift was unfair & perpetuates inequalities. Medication that relieves symptoms of self-limiting illness may improve well-being and functioning; also, the duration, severity or even transmission of several of the conditions on the list may be helped by meds that can be bought over the counter. Take the case of buying headlice treatments for several children as an adjunct to conditioner combing. Restricting prescribing of OTC meds is discriminates against those on low incomes & who are entitled to free prescriptions, as buying OTCs s is a significantly larger percentage of their weekly income than those of us who are more comfortably off. Also, community pharmacists are running

commercial enterprises and patients are not necessarily offered the cheapest option; I’ve witnessed this happen to others and personally experienced being offered more costly non-generic medications. I needed a proprietary steroid nasal spray recently and was offered a branded one when I knew I could get a generic at half the price (which of course I knew I could challenge, but others may just walk away as unaffordable).
Yes, encourage OTCs to those that can afford to & may find it more convenient, but it’s absolutely not fair for all.

Truth Finder 18 March, 2024 12:44 pm

When the complaint comes, NHSE will say it is your clinical decision and will not back you up. Not worth the battle. Prescribe because the rules allow it.

Centreground Centreground 18 March, 2024 1:05 pm

There are currently numerous patients not obtaining essential medications such as anti -hypertensives , inhalers etc. due to cost and cannot afford the outlay for a pre paid certificate. NHS England is a faceless, detached continually failing organisation that has worsened health inequality, failed both patients and staff and hence is least positioned to advise us.

David Banner 18 March, 2024 1:43 pm

Dear NHSE……..either grow a pair and blacklist OTC items (then toughing out the inevitable flak), or pipe down and crawl away..
If anything makes me want to freely prescribe paracetamol to everyone, it’s this article.

Alexis Alexis 18 March, 2024 7:25 pm

Under the contract we are required to prescribe treatment for illnesses and so we wouldn’t have a leg to stand on if we declined to prescribe salicylic acid for a wart and recommended they buy it OTC. Would NHSE defend us? I think not. Either blacklist these drugs as not allowable on an
FP10, change our contract, or accept it.

Mark Howson 20 March, 2024 9:52 am

Prescribing treatment under GMS does not imply an FP10. Any more than prescribing exercise needs a FP10. You can write the instruction on a piece of white paper. Your obligation to prescribe under GMS does not imply an FP10. This was confirmed by NHSE.