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GPs told to ask patients if they require over-the-counter prescription

GPs across a large area of London have been asked to curb prescribing of a wide range of over-the-counter medicines, listed by commissioners.

Under the plans, published by North West London CCGs, GPs should ask patients if they are willing to pay for iterms includling paracetamol, ibuprofen, antihistamines, skin creams and antacids themselves.

The full list includes over 25 medicines available over the counter, and which the CCGs said were often cheaper without a prescription.

The CCGs also recommend that GPs do ‘not routinely’ precribe a list of over 10 items, including cough and cold medicines, mouthwashes and travel sickness tablets, readily available on the high street.

Further, the CCGs want GP practices to stop accepting repeat prescription requests from pharmacies, as these can lead to medicines being ordered which the patient does not need. Instead, they want patients, or their carers, to order repeat prescriptions from their GP practice in person.

The CCGs, which face a £130m annual saving target, said the plans would help curb ‘wasteful prescribing’ and help its bid to reduce a £15m-a-year prescribing budget.

Dr Ian Goodman, NHS Hillingdon CCG chair and clinical lead for the ‘Choosing Wisely’ campaign, said: ‘The NHS can’t afford to waste money on medicines that people don’t need or don’t intend to take.

‘We are giving patients control over their own repeat prescriptions which will be a more efficient, safer way of working.’

The BMA’s GP committee has previously fought back against such proposals, suggesting guidelines to prevent GPs prescribing certain medicines are ‘unworkable’.

But Dr Goodman said it makes good sense to prescribe fewer medicines that can be bought on the high street, adding that these were only guidelines.

He said: ‘We are reminding GPs to consider clinical need carefully when prescribing any of these items. If the patient is unable to afford the medicine or product, then they will still, of course, be prescribed as usual.’

But Healthwatch Hillingdon questioned whether the proposals were ‘the best way to achieve the desired savings’.

It said its own analysis of the plans ‘shows a maximum saving of £2-3m at best’, recommending instead ‘further enhanced training and support for GPs to improve appropriate clinical prescribing and a reduction in medicine wastage through a North West London public awareness campaign’.

A spokesperson said: ‘We do not think that the current proposal has given sufficient thought to the overall impact on the NHS.

‘Reduced GP access to some of the items proposed in this local list may result in an increase in GP appointments and costly hospital admissions.’

An estimated £300m of prescribed medicines are wasted every year according to NHS England, which is currently reviewing a national scheme for curbing costly prescribing of over-the-counter and ‘low value’ items.

An NHS spokesperson told Pulse that the result of that review is delayed and is now expected in the ‘second quarter’ of the current financial year.

Proposals in full

1. GPs will ask patients if they are willing to buy certain medicines or products that can be bought without a prescription.

2. GPs will not routinely prescribe certain medicines and products which can be bought without a prescription.

3. To reduce waste, patients will be asked to order their own repeat prescriptions.

Source: The North West London ‘Choosing Wisely’ consultation