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Let’s not go OTT on OTC



The idea that GPs should stop prescribing for minor illness sounds like a really good one. Probably because it is. So well done NHS Somerset CCG for recommending that local GPs cease prescriptions for minor ailments suitable for self-care. After all, it’s not just about cutting back on profligate prescribing, though it will do that by giving the less assertive among us permission to say ‘can’t’ rather than ’won’t’. It’s also a fightback against the culture of medicalisation and dependence, transferring responsibility back to the punters and freeing up appointments.

Somerset GPs are in effect being corralled, sacrificial-lamb-like, into a pilot study

Yay! So what’s not to like? Well, actually, the fact that the whole concept is more nuanced than you might imagine. I’ve spent most of my last 28 years being very careful to say to anxious parents of febrile juniors that they can give paracetamol to their precious progeny for those burning-up moments ‘if you like’, but I also point out that it’s not really necessary, given that fever is a normal reaction to viral infections etc. That way I can resist the inevitable request for a prescription – and so avoid countless future consultations like this – because I’ve made explicit that their ‘need’ is actually a ‘want’, and one that can be fulfilled by OTC purchase. 

And, of course, that protects me from a complaint that I’ve breached my terms of service, which states, for those who don’t know this off-by-heart, that ‘…a prescriber shall order any drugs, medicines or appliances which are needed for the treatment of any patient… by issuing the patient… a prescription.’ Note: ‘needed’.

And this works fine for most of Somerset’s list, particularly for items that should never get anywhere near hallowed FP10 paper, such as tonics, health supplements, homeopathy and other such bilge. Where things get murkier is the large grey area – I reckon about 2/5 of those listed – which involves effective and reasonable treatments which, yes, are for minor ills and which, yes, are available OTC, but which, yes, I do often prescribe.

Because when you get into a debate about whether a patient really ‘needs’ (vs ‘wants’) to treat, say, his athlete’s foot, hayfever or ‘occasional indigestion’, it all gets a bit existential, even if the patient thinks it’s simply about him wanting to save some dosh because he gets his scripts for free.

Hmm, where do I stand contractually then? Not sure. And nor does the GMC help, with its advice that I must ‘…provide effective treatment based on the best available evidence’ followed a few short paras later by a reminder that I must, ‘…make good use of the resources available to us’.

So some clear national guidance, trumpeted widely through the media to a prescription-hungry public, and leading to the necessary contractual and GMC tweaks, would be the sensible way ahead. Which means it’ll never happen. In the meantime, Somerset GPs are in effect being corralled, sacrificial-lamb-like, into a pilot study for the CCG to see if they can get away with it. And if it does all go shit-shaped, presumably it’s just hard cheese. Which I believe is plentiful in Somerset.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield