GPs should not prescribe OTC medicines for minor ailments, NHS England says

GPs should no longer prescribe OTC medicines for 35 minor ailments and short-term self-limiting illnesses, NHS England has said.

Guidance from NHS bosses sets out how CCGs should curb prescriptions of OTC medicines for eight self-limiting conditions and 27 minor ailments (see below for the full list), which NHS England says are suitable for self care. The guidance also covers prescribing of probiotics and vitamins and minerals.

The restrictions do not affect prescribing OTC medicines for longer-term or more complex conditions, or where minor illnesses are symptomatic or a side effect of something more serious, NHS England said. OTC medicines can also be prescribed if a patient's ability to self manage a condition is compromised  as a result of medical or mental health issues or ’significant social vulnerability’, the guidance says.

GPs can also continue to prescribe OTC medicines if 'in their clinical judgment, exceptional circumstances exist that warrant deviation from the recommendation to self-care.'

Poorer patients at risk

But experts have warned that poor patients could be hit hard by the guidance - echoing a warning last year from the GPC's prescribing lead.

Andrew McCracken, a spokesman for the coalition of health and care charities National Voices, said: 'Many people are entitled to free prescriptions, and while some of those people may be able to pay, a significant number rely on free prescriptions because of their financially vulnerable situation. This guidance risks leaving people unable to afford medicines they rely on.'

He called for GPs to 'use their own medical judgment and work in partnership with their patients'. Mr McCracken added: 'They should continue to prescribe treatments to people who cannot afford to buy them over-the-counter.'

Exceptions to the prescribing restrictions are also covered by the guidance. For example, immunocompromised patients can be prescribed treatments for cold sores.

The guidance says that GPs should no longer routinely prescribe probiotics or vitamins and minerals, with the exception of prescription-only vitamin D analogues. However, patients with a medically-diagnosed deficiency or malnutrition can continue to receive vitamins and minerals on prescription. Calcium and vitamin D can also be prescribed for patients with osteoporosis.

Prescribing restrictions

NHS England said that the move would free up almost £100m a year in funding that could be spent on frontline care. It said that each year the NHS spends £22.8m on treating constipation and £7.5m treating indigestion and heartburn.

GPs have previously warned that banning prescribing of drugs available OTC could put GPs in breach of the GMS contract and leave them vulnerable to complaints. However, a poll carried out by GPonline last year found that most GPs are in favour of the ban coming into effect

Towards the end of last year NHS England issued guidance to CCGs on 18 ‘low value treatments’, including fish oil, herbal remedies and homeopathy, that should no longer be prescribed in primary care.

NHS England chief executive Simon Stevens said: 'The NHS is probably the most efficient health service in the world, but we’re determined to keep pushing further. Every pound we save from cutting waste is another pound we can then invest in better A&E care, new cancer treatments and much better mental health services.'

Dr Graham Jackson, co-chair of NHS Clinical Commissioners and clinical chair of Aylesbury Vale CCG, who was involved with drawing up the guidance said: ‘We recognise that it may be difficult for some patients who have previously been prescribed these products, but it is right that we prioritise our spending on those that provide the best outcomes for patients. This new guidance provides clear direction to CCGs on where those priorities should lie.’

Conditions covered by the guidance
  • Acute sore throat
  • Infequent cold sores of the lip
  • Conjunctivitis
  • Coughs, colds and nasal congestion
  • Cradle cap (seborrhoeic dermatitis – infants)
  • Haemorrhoids
  • Infant colic
  • Mild cystitis
  • Mild irritant dermatitis
  • Dandruff
  • Diarrhoea in adults
  • Dry eyes/sore tired eyes
  • Earwax
  • Excessive sweating (hyperhidrosis)
  • Head lice
  • Indigestion and heartburn
  • Infrequent constipation
  • Infrequent migraine
  • Insect bites and stings
  • Mild acne
  • Mild dry skin
  • Sunburn due to excessive sun exposure
  • Sun protection
  • Mild to moderate hayfever/seasonal rhinitis
  • Minor burns and scalds
  • Minor conditions associated with pain, discomfort and fever
  • Mouth ulcers
  • Nappy rash
  • Oral thrush
  • Prevention of dental caries
  • Ringworm/athlete's foot
  • Teething/mild toothache
  • Threadworms
  • Travel sickness
  • Warts and verrucae

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