How a ban on prescribing drugs available OTC could affect GPs

GPs could be barred from providing tens of millions of prescriptions a year that they currently believe patients need if proposals to ban prescribing of OTC drugs go ahead, analysis suggests.

The latest official NHS Digital data on CCG prescribing shines light on the scale of OTC drug prescriptions, suggesting GPs prescribe tens of millions of the treatments per year.

NHS England is currently consulting on plans to ban treatments considered to have ‘limited clinical value’ and drugs that are also available OTC.

A total of 17.8m items in categories likely to be heavily affected by a ban on prescribing drugs available OTC were prescribed by GPs over the three months from April to June this year - meaning around 71m could be prescribed across a full year.

These prescriptions include treatments for acute diarrhoea, antihistamines, antiperspirants, cough preparations, deodorants, foods, laxatives, minerals, shampoos, sunscreens and vitamins.

OTC prescribing

The 71m items prescribed came at a cost of £346m to the NHS. While  a proportion of drugs in these categories will be unavailable OTC, treatments in other categories are also likely to be affected - and NHS England has said it expects to save up to £645m a year from an OTC prescribing ban on primary care.

The NHS England savings estimate suggests either that the prescribing data is an underestimate, or that the ban will extend into many more categories of treatments.

Even if just a fraction of the 71m items identified by GPonline were otherwise available OTC, the data suggest that GPs will no longer be able to prescribe tens of millions of items they currently offer to patients if the ban goes ahead, and could face several difficult conversations a day telling patients they cannot prescribe the treatments they need.

Leading GPs have previously warned that implementing a ban will fundamentally change the relationship patients have with the NHS and their GPs, creating a situation where doctors decline to provide patients with treatments they recommend.

But a poll carried out by GPonline has suggested most GPs are in favour of the ban coming into effect.

GPC clinical and prescribing policy lead Dr Andrew Green said it was hard to generalise from the chosen list how many of the prescriptions were for OTC drugs.

Prescribing ban

But he warned that many of those that are can only be prescribed to patients with specific conditions that need them.

It would be ‘shocking’ if patients were denied treatments they need because of misunderstandings, he said.

‘Many of these are in the ACBS category so are already only available for restricted conditions, and it is ACBS [the Advisory Committee on Borderline Substances] who should decide these matters, not NHS England or CCGs.

‘It is a mistake to assume that, because treatment is available without prescription, the underlying disease is not serious or deserving of treatment.

‘Sunscreens, for example, are not used for Mediterranean holidays but for people such as those with albinism who should use sunscreens on faces and hands throughout the year in this country, and who risk malignancy if they don’t.

‘Deodorants can be vital for people with faecal continence problems, and hyperhidrosis can be devastating and life-destroying if untreated especially for young people.

‘I fear that many responders to the consultation may not understand the current restrictions and it would be shocking were patients with serious problems denied NHS care on the basis of a misunderstanding.’

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