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Large number of CCGs crack down on OTC prescribing ahead of national consultation



Local GP leaders have hit out at a growing number of CCGs stopping or putting restrictions in place to prevent GPs from prescribing over-the-counter medicines before the conclusion to an ongoing national review.

NHS Dudley CCG is the latest to announce that, starting from next week, GPs in the area will no longer prescribe treatments for minor ailments, including medicines like paracetamol, ibuprofen, head lice lotion and indigestion tablets.

They will also not prescribe treatments where there is little evidence that they have a real clinical benefit, including cough syrups, nasal congestion sprays, sore throat products and vitamin supplements.

NHS England is currently in the process of consulting on restricting a range of over-the-counter and low-value items, whilst the Department of Health is consulting on banning the prescribing of gluten free foods.

In all, Pulse is aware of at least 19 CCGs which have either introduced, or are consulting on, proposals to curb over-the-counter prescribing.

Londonwide LMCs highlighted a large number of similar plans to restrict prescribing in several parts of the capital.

The London schemes include:

  • NHS Barking and Dagenham CCG, NHS Havering CCG and NHS Redbridge CCG, which all have ‘Spending NHS money wisely’ plans;
  • NHS Brent CCG, which has a ongoing consultation titled ‘Choosing Wisely: changing the way we prescribe’;
  • NHS Merton CCG, which is also consulting on proposals; and
  • NHS Croydon CCG, which is working with other South London CCGs on updating ‘Choosing Wisely Policies’ (formerly known as ‘Effective Commissioning Initiatives).

And last week Pulse unveiled proposals by North West London CCGs to instruct GPs to ask patients if they are willing to pay for items that are available over the counter.

Meanwhile, areas which have already cracked down on over-the-counter prescribing include four CCGs in Lincolnshire as well as Somerset, Bristol, Warrington, East Riding of Yorkshire, Luton, Bedfordshire and two CCGs in Cheshire.

Londonwide LMCs said they disagree with the proposals on the basis that they undermine the principles on which the NHS is based; that they are unworkable; and that they are likely to compromise GPs under their GMC requirements as stated in Good Medical Practice.

Dr Michelle Drage, chief executive of Londonwide LMCs said: ‘If the Government feels that GPs shouldn’t be prescribing certain over-the-counter treatments, then it is the Government that need to take responsibility in deciding what is and is not open to GPs to prescribe rather than passing the buck to CCGs and already hard-pressed GPs.’

But NHS Dudley CCG chair Dr David Hegarty said: ‘In Dudley there is an increasing demand for prescriptions for medication that can be bought over the counter at relatively low cost, often for self-limiting or minor conditions.

‘These changes will benefit patients by making it more convenient to get treatment for minor ailments from a local pharmacy or shop, and will also free up valuable GP time. Together this will save the local NHS around £2m per year, which could be used to protect other treatments.’

Where a treatment is needed for a long-term chronic condition or there are legal restrictions on the amount of medicine that can be purchased over the counter from community pharmacies, Dudley GPs will still be able to prescribe the items.

Which items could GPs be banned from prescribing?

Co-proxamol

Dosulepin

Prolonged-release Doxazosin

Immediate- release Fentanyl

Glucosamine and Chondroitin

Herbal treatments

Homeopathy

Lidocaine plasters

Liothyronine

Lutein and antioxidants

Omega-3 Fatty Acid Compounds

Oxycodone and Naloxone combination product

Paracetamol and Tramadol combination product

Perindopril Arginine

Rubefacients

Once-daily Tadalafil

Travel vaccines

Trimipramine

Source: NHS England consultation