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GPs should prescribe OTC medicines to poor patients, watchdog suggests

GPs should prescribe OTC medicines to poor patients, watchdog suggests

GPs should be encouraged to offer over-the-counter (OTC) medicines on prescription to patients struggling with the cost of living, a patient watchdog has said.

Healthwatch England said that the cost of living ‘should never be a barrier to healthcare’ and called on NHS England and the Government to put ‘immediate actions’ in place so that people can access the care they need.

In a report published this week, the watchdog said that guidance should encourage GPs to offer people OTC medications on prescription based on socioeconomic grounds.

However, the suggestion goes against NHS England guidance to curb prescriptions for over-the-counter medicines. In 2018, the commissioner issued guidance aiming to put a halt to the routine prescribing of some medicines in a bid to save £100m to be reinvested in front-line services.

GPs around the country have recently told Pulse that they are seeing more and more patients coming to ask for prescriptions for over-the-counter medicines for minor conditions because they simply have no money to buy them.

The Healthwatch report also suggested that NHS England should re-open its review of the Healthcare Travel Cost Scheme and consider reimbursement for patients for the travel costs to see GPs, dentists and pharmacists.

It also recommended that primary care teams make people who need medication aware of pre-payment options.

NHS England should also work with Ofcom and telecommunications companies to ensure that hospital and GP phone numbers are part of the freephone service, so that ‘cost is never a barrier to phoning a health service,’ Healthwatch said.

The report said: ‘The cost of living is having a detrimental impact on people’s decisions about their healthcare. But if you are disabled, on means-tested benefits or aged 18-24, you’re more likely to avoid vital health services due to the fear of extra costs.

‘We set out immediate actions for the Government and the NHS.’

The watchdog released the results of a poll of 2,000 adults in England, conducted four times between October last year and March.

It suggested that people are ‘increasingly avoiding vital health and care services due to the fear of extra costs’ including:   

  • going to a dentist because of the cost of checks ups or treatment 
  • booking an NHS appointment because they couldn’t afford the associated costs, such as accessing the Internet or the cost of a phone call 
  • buying over-the-counter medication they normally rely on 
  • taking up one or more NHS prescriptions because of the cost

The report added: ‘As a patient champion, we are worried that vital health and care services are out of reach for many people. 

‘We know that people living with ill health and disability are already much more likely than others to be pulled into poverty because of spiralling costs. 

‘Making decisions between eating, medications and keeping medical devices running, can further impact their physical and mental health, putting them in danger.’  

Dr Selvaseelan Selvarajah, a GP in Tower Hamlets, said the prescription and dentistry issues highlighted in the report particularly resonated with his experience working in one of London’s most deprived boroughs.

He told Pulse: ‘The issue about prescriptions is something that we see often in Tower Hamlets and we have been campaigning for the restoration of a minor ailment scheme, which was really well used in Tower Hamlets.

‘Making patients aware of pre-payment options is also helpful but that can still be a significant cost for some patients.

‘If the Government can fund the freephone service, we would definitely welcome that but practices should not be asked to fund that themselves.’

RCGP chair Professor Kamila Hawthorne told Pulse: ‘It’s concerning to hear that some patients are being priced out of much-needed care, whether that’s because they can’t afford over-the-counter medication, the cost of a prescription, or travel to an NHS appointment.  

‘GPs are witness to the impact of rising costs on patients, many of whom are struggling to maintain their physical and mental health given the higher prices of day-to-day necessities.

‘Some vulnerable patients already receive free prescriptions, but those who don’t often have to decide which of their medications they are going to get, as they can’t afford everything on prescription. 

‘There are existing measures in place – such as the Prescriptions Prepayment Certificate – to relieve some of the financial burden on a patient’s treatment.

‘However, further solutions are clearly needed to ensure all our patients can access the care they need. Patient care is our number one priority and ensuring that a person has access to the treatment they need is our fundamental goal.’

Professor Azeem Majeed, professor of primary care and public health at Imperial College London, told Pulse: ‘GPs will be fully aware of the financial pressures and poverty that many of their patients are experiencing.

‘GPs will always do their best to help, for example, advising patients to look at over-the-counter options for drugs as this can sometimes be cheaper than paying a prescription charge and using annual prepayment certificates to reduce the prescription charge burden.

‘However, the responsibility for addressing poverty ultimately lies with government and employers rather than the NHS.’

Earlier this year, a snapshot survey of Pulse readers found that a round 22% of GP consultations were mental or physical health problems caused or exacerbated by the cost-of-living crisis.

The survey of 1,000 GPs also revealed that 16% of partners are implementing initiatives in their practices to try and help patients, including providing warm spaces within the surgery.

The report’s recommendations in full


Guidance should encourage GPs to offer people over-the-counter medications on prescription based on socioeconomic grounds. 


NHS England should re-open its review of the HTCS, and introduce reimbursement for journeys to people’s GP, dentist and pharmacy teams. 

NHS freephone 

NHS England should work with Ofcom and telecommunications companies to ensure that hospital and GP phone numbers are part of the freephone service, so cost is never a barrier to phoning a health service. 

Benefits system 

Government should ensure benefits, including Statutory Sick Pay (SSP), keep pace with inflation in real terms. 

Government should also extend the amount of time SSP can be paid to people who can no longer work due to long waits for NHS treatment. One in ten people wait over four months for a GP referral, and 92% of people on waiting lists are currently waiting up to 46 weeks for a hospital appointment. This means that the current 28-week access cannot support those who need it. 


Health leaders and regulators should look at what more can be done to ensure telecommunications providers introduce and raise awareness of social tariffs to eligible households, as the uptake of this support remains low

Recent research by Citizens Advice suggests that up to one million people have cancelled their broadband in the last year because they couldn’t afford it.

As we increasingly move to more remote ways of communicating, tracking, managing and attending NHS appointments, we must ensure that everyone can access the support they need.

Source: Healthwatch England


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

Dylan Summers 2 June, 2023 2:06 pm

I’m unclear how much influence Healthwatch England has. I’d never heard of it, though its website says it’s a statutory body.

Centreground Centreground 2 June, 2023 2:14 pm

Most of the money being wasted within the NHS is via PCNs likely to be hundreds of millions and could be directed to address health inequalities but instead unnecessary huge Clinical Director payments for little to no work, unnecessary administration payments which could be done within practices with less cost and inexperienced and inappropriate PCN staff who have been introduced and now creating a lifeline burden of costs as lower standards become accepted within the NHS as the norm.

Anonymous 2 June, 2023 8:06 pm

If you are claiming benefits, the meds are for free. If you are not on benefits, you can eat less KFC. Sorted.
No to prescribed paracetamol.
Nanny state will collapse.

Chin Whybrew 3 June, 2023 2:00 pm

Why oh why are they suggesting that GP prescriptions are needed?
Why increase the GP workload even more?!
The obvious thing to do is to allow pharmacists to issue scripts for OTC medicines for people who are entitled to free prescriptions. Years ago, there was a voucher scheme to do just this, as part of minor illness scheme for pharmacy.
It would also reduce the number of people we care navigated to pharmacy who come back to us saying they don’t want to or can’t pay for the meds and can we please prescribe the meds the pharmacy recommended.