When I was growing up, we had a medicine cupboard. Among the plasters, pills and potions, there was also a miniature bottle of whisky for medicinal purposes. The irony of this is that we were a strictly Muslim household. My parents obviously had a far more relaxed attitude to the rules than many of my patients who refuse to take gelatine-containing capsules.
As a child, the only medicine I recall us receiving from the GP was banana-flavoured amoxicillin. Anything else like paracetamol, cough mixture, Vicks or cod liver oil were stocked in the medicine cupboard.
But now, the entire population, rich and poor, young and old, has lost the ability to self-care. Common sense has been suspended in favour of a ‘you can’t be too careful, doc’ paranoia. Even when we have reassured a patient that their two-week cough is unlikely to be serious, they will insist on a range of over-the-counter medications because they are entitled to free prescriptions.
GPs are drowning in workload but the Government keeps opening more floodgates. Well here’s one lifejacket – over-the-counter prescriptions.
Just because a patient is not paying a prescription charge, that does not make their medication free. But a bottle of liquid paracetamol can be obtained from the pound shop for – you’ve guessed it – £1. Every time we prescribe a bottle of this, we reinforce GP attendance at a cost of £40 per consultation. If we add to this the cost of the medication and pharmacist involvement, the country is paying about £45 for a £1 bottle of medicine. The NHS is haemorrhaging this sort of money on a daily basis, spending more than £80m a year on paracetamol alone. This figure doesn’t even include the cost of seeing a GP for the script.
Every GP I know thinks is madness but we are unsupported in making a stand. The entitlement and complaints culture has stripped us of independent decision-making. We need to feel empowered to say ‘no’ to these requests, but no one will do this without a narrative supporting it. So patients with self-limiting illnesses will clog up the service because no one in power has the guts to suggest they should self-medicate, regardless of their income. We cannot rely on the RCGP or GPC to campaign for practical suggestions so we need to do it ourselves. We need collectively to refuse to prescribe this sort of nonsense. Maybe then we could provide a decent service for patients in genuine need.
In anticipation of the backlash of comments telling me how poor some patients are, let me share my family’s story of self-care. My parents had nine kids and always kept a supply of Calpol and vitamin drops, in spite of a very low income. They viewed it as no different from providing toothpaste, soap and other toiletries the NHS does not fund.
So you see, to quote from Disney’s Tangled, my mother really did know best. She knew to keep a medicine chest.
Dr Shaba Nabi is a GP trainer in Bristol.
