Exclusive: CCG prescribing restrictions could put GPs in breach of GMC rules

'Hard-line' CCG advice to restrict prescribing of medicines available over-the-counter could put practices at risk of breaching GMC advice, the GPC has warned.

GPs are under increasing pressure to limit prescribing costs (Photo: iStock)
GPs are under increasing pressure to limit prescribing costs (Photo: iStock)

Bristol CCG has released guidance calling for practices in the area to restrict prescribing of medicines available over-the-counter (OTC) to crack down on avoidable costs.

The move comes as GPs across England face rising pressure to cut the cost of prescribing, with growing numbers of CCGs under severe financial pressure. GPonline reported last week that three quarters of GPs saw pressure on prescribing budgets increase over the past year.

GPC prescribing subcommittee chairman Dr Andrew Green told GPonline that the Bristol measures were 'probably the most hard-line' he had seen. He warned that the restrictions – which call for GPs not to prescribe any drug available OTC – go too far, and could put GPs in breach of regulations.

GP workload

He warned that CCGs – many of which are facing ‘significant deficits’ – were becoming ‘increasingly restrictive’ on GP budgets.

Bristol CCG, however, said the move would help cut down GP workloads as well as costs, and that practices had asked for guidance to help ease pressure on them to prescribe OTC medicines.

In a letter to practices in May, Bristol CCG said research had shown that wasted medicines cost it around £5.7m per year, with much of the waste down to analgesics, laxatives and creams – ‘most of which can be bought by patients quite cheaply at pharmacies and supermarkets’.

It added: ‘We also need to consider that by prescribing medicines that are readily and cheaply available from pharmacies and supermarkets we are not promoting the self-care message as well as we could be.

‘Prescribing OTC medicines costs the NHS a lot more than it would if the patient bought them themselves, so it would be wise to reduce patient reliance on these medicines.’

GP prescribing budgets

It enclosed a poster for GPs to display in their practices, which informs patients the surgery has ‘taken the decision NOT to prescribe these medicines except in exceptional circumstances’, because they are freely available to buy OTC.

Among others, the list of affected drugs includes painkillers, anti-diarrhoeals, laxatives, colic treatments, hay fever preparations, threadworm tablets, indigestion remedies, emollients/shampoos, sun creams, analgesic creams, treatment for bites/stings, uncomplicated conjunctivitis and decongestant nasal sprays.

Dr Green advised against practices displaying the poster. Although there is no problem not prescribing some of the drugs on the list, GPs could be in breach of their contractual duty if they refuse to provide those available to selected groups of patients under ACBS regulations, such as sun creams, and other effective drugs that happen to not be prescription-only, he said.

He said: ‘We must remember that drug companies have got many previously prescription-only medicines re-categorised over recent years, and it was never intended that these drugs would then cease to be available with a prescription on that basis.

GMC action

‘Any GP refusing to prescribe on an FP10 a drug that they had decided was clinically indicated would be in breach of their contractual duties, and might even face action from the GMC for failing to treat properly. I would not advise any practice to display such a poster, all patients need individual consideration and prescribing if appropriate.’

He added that GPs should promote self-care among patients. ‘I think it is to all our benefits if patients make good use of alternatives to attending a GP where possible, and so we should encourage self-care and proper use of community pharmacy.

‘A quite acceptable work-around is for GPs to explain that treatment can be purchased but then, if the patient asks for an FP10, to provide one. A GP refusing to do so would in my view be in breach of the regulations.'

A spokeswoman for Bristol CCG said: ‘Bristol CCG issued this guidance in response to a large number of requests from our GP members, who tell us prescribing OTC medicines takes up a significant amount of their time and resources. Many other CCGs across the country have already offered similar advice, in some cases for quite some time.

‘The guidance is in the spirit of the BMA’s own advice stating "a patient is entitled to drugs that the GP believes are necessary, not those which the patient feels should be prescribed".

‘We have made it clear that patients are absolutely entitled to the medication they need. But we are asking people to be responsible in terms of what they are asking their doctor for.’

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