Dr Matthew Piccaver
I’m probably not alone in groaning internally when someone asks for a bottle of paracetamol suspension to ‘stock up’. Increasingly I point them to the local convenience store.
The NHS was originally completely free at the point of delivery. Then came charges for prescriptions, and items such as spectacles and dental treatment. Prescribing, one of the larger sources of NHS expenditure, is often under scrutiny as a source of savings.
Simple painkillers, antihistamines, assorted lotions and potions can be purchased for relatively little cost from a plethora of sources.
I’ve seen paracetamol on sale for 16p, a box of 28 cetirizine for £1, hydrocortisone cream on special offer and three for two on nappy rash cream. These are inexpensive, effective treatments that don’t need the cost of a prescribing clinician, or the time spent to get an appointment or stand in line at a dispensary hatch. This is not a case of refusing treatment, as some may argue, but redirecting people to a more appropriate place of care, particularly for simple conditions where OTC medications are identical. I think we all want to see good value for money from our tax pound, particularly when it comes to the NHS.
For the most part, patients accept that the NHS needs to find ‘efficiency savings’. Increasingly I meet people who will happily purchase something if it is available OTC and CCGs are increasingly looking to restrict their prescription, with the NHS now looking to review prescription of certain OTC items.
Might this approach lead to more complaints? Perhaps. But if carried out in an open, transparent fashion and for the right reasons, I don’t see this as a problem.
It might be feasible to provide inexpensive or even free selected OTC medications off prescription on presentation of proof of entitlement, although this might prove a slippery slope to having to prove entitlement to other NHS care.
There’s a real drive towards self-care from the NHS hierarchy. If the virtues of self-care are to be extolled, then people need to be directed to sources of it. This means paying for the odds and ends of minor ailment treatment.
The NHS is part of the UK’s national identity. But perhaps it’s time we all did our bit to save a few quid here and there.
Dr Matt Piccaver is a GP in Glemsford, Suffolk
Dr Grant Ingrams
This policy is fraught with risk to GPs and public health. A cornerstone of the NHS is that healthcare is free at the point of delivery. While there are some exceptions, this has resulted in the UK having the lowest number of patients not accessing healthcare due to cost – 4% in the UK compared with 37% in the US where healthcare costs are now the commonest cause of bankruptcy.
Not prescribing OTC medications causes hardship for some patients who are forced to choose between buying medication or food. Such a policy would particularly affect patients from deprived households and is more complex in the case of children: could a parent be considered to be neglecting their child if they are not buying GP-recommended OTC medication they cannot afford? Would the relative of an impoverished elderly patient be expected to pay for all their OTC medications? Buying occasional paracetamol would not bankrupt anyone, but if you have several children, or it is needed over a long period, the costs could be prohibitive.
NHS regulations state that GPs must prescribe any drug they feel is needed for the care of the patient. If a GP refused to prescribe a medication on the sole grounds that it was available OTC, they would be at risk of GMC action for failing to treat patients properly.
There are many more appropriate ways to make savings on prescribing. For example, by prescribing sunscreen only when there is abnormal photosensitivity, or Colief only for infants with lactose or sucrose intolerance.
Current NHS austerity is a political choice, with the Government choosing to invest less in the NHS than other civilised countries, while introducing costly ideological changes not related to patient need. Why should GPs put themselves in the firing line of angry patients?
Patients should be encouraged to self-care for minor and self-limiting conditions via a national campaign, but a blanket ban on prescribing OTC drugs will only harm vulnerable patients, increase health inequalities and put GPs at risk.
Dr Grant Ingrams is a GP in Glenfield, Leicestershire