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NHS England issues ‘letter of comfort’ on OTC prescribing for GPs

GPs who refuse to prescribe over-the-counter (OTC) medicines will not be ‘at risk of breaching their contract’, NHS England has said.

The body issued a ‘letter of comfort’ to GPs to reassure them that if they follow the OTC prescribing guidance they will not be penalised, as long as they use their ‘clinical judgement’.

However, the BMA said the letter ‘does not remove GPs’ professional responsibility to prescribe medications where they are deemed necessary’.

The guidance – which followed a consultation in 2017 – said putting a halt to the routine prescribing of OTC medicines would save almost £100m, which could be reinvested into front-line services.

At the time, the BMA warned that GPs following this guidance would be in breach of their contract, as they would be refusing to issue a prescription for a treatment they had recommended.

In response to the ongoing concerns, NHS England has issued a ‘letter of comfort’ for GPs on the matter, as part of the new five-year GP contract – agreed by the BMA and NHS England.

The letter said: ‘The OTC guidance includes specific reference to prescribers, and requires prescribers to reflect local policies in prescribing practice. In NHS England’s view, this guidance is “relevant guidance” under Regulation 94 and other relevant regulatory references.’

‘Contractors are therefore required to have regard to this guidance and are able to follow the guidance and exercise judgement about when it is (and is not) appropriate to prescribe OTC items, without any risk that they will be in breach of their contract,’ it added. 

But despite this, the BMA said the letter ‘does not remove GPs’ professional responsibility’.

It said: ‘NHS England will provide a “letter of comfort” to all practices and CCGs, stating that where a prescriber decides, in line with local and/or national guidance, not to provide a prescription for an over-the-counter medicine, practices will not be deemed to be in breach of their contract.

‘This does not remove GPs professional responsibility to prescribe medications where they are deemed necessary.’

Clarifying this, a BMA spokesperson said: ‘Necessary would be defined as it being in the patient’s best interest, particularly if there are concerns that the patient would not access the recommended treatment. This would be determined by the individual GP, who would use their professional and clinical judgment.’

The push to cut OTC prescriptions has been controversial, with GPs receiving an increasing number of patient complaints as they try to follow the guidance.

In 2017, the BMA’s GP Committee warned the Government needed to draw up a blacklist in order to reduce OTC prescribing, to avoid GPs risking a breach of contract.

Many CCGs moved to ban OTC prescriptions before the NHS England guidance was published, including NHS East Lancashire CCG, NHS Dudley CCG, NHS Barking and Dagenham CCG, NHS Bedfordshire CCG and NHS Croydon CCG.


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