Viewpoint: Why GPs are right to question prescribing of OTC drugs

GPC member Dr Beth McCarron-Nash reacts to a GP magazine story on prescribing of drugs available OTC, and explains why writing prescriptions for these medicines is an opportunity going to waste.

Dr Beth McCarron-Nash: empower patients to self care
Dr Beth McCarron-Nash: empower patients to self care

I welcome the article in GP magazine debating the prescribing of OTC medicines following a survey of GPs.

In total 68% agreed with the question: 'Should the NHS stop providing prescriptions for medicines available over the counter?' My long-held belief is that the job of a GP is not to just ‘fix’ my patients but also to inform, engage and educate them into knowing more about their own health and to devolve some of the control to them.

Opportunity wasted

So simply writing a prescription for an OTC medicine seems to me to be an opportunity going to waste on several levels.

It’s a topic thrown into sharp relief in an era of funding restraints and an ever increasing workload. The rules regarding POMs and blacklisted drugs are complicated and overdue review. The cost of OTCs is certainly a consideration, both for the NHS and for our patients. Several poll respondents raised the concern that OTC medicines can be more expensive than a prescription and that those on low income cannot afford these prices.

Well, I share those concerns but it depends on the medicine and how any change was managed. I can buy 16 paracetamol for 16p in my local supermarket, or 16 branded paracetamol for £1.55. Others are more expensive, so we would have to look at alternative solutions to ensure patients receive the drugs they need, especially children.

But the average price for an OTC medicine is £3.50, considerably less than the prescription charge and without any of the attendant costs to the NHS of GP resource and pharmacy dispensing fees which are significant and need to be taken into consideration. Certainly with spiralling costs, an ageing population and increasing co-morbidity it’s something we can no longer afford just to ignore.

Many patients receive free prescriptions, but there are minor ailments schemes available in some parts of the country that allow OTC medicines to be available free from pharmacies. This could be a service that we commission in April 2013, but we need to bear in mind that such schemes have not been proven to save the NHS money. Nor do they help patients learn to manage their own health; it simply moves the burden of managing minor ailments to the pharmacy and another health professional.

Empower patients

If our role is, as I believe, to help empower patients to self care appropriately then we have to stop and think. In simply handing over a prescription for an OTC medicine, we are not changing behaviour. We are not equipping patients with the knowledge and resource to understand how to take care of themselves and to recognise when the GP needs to become involved.

If we are to grasp the nettle of early detection for cancers and other life-threatening or long-term diseases, then communication from all healthcare professionals and the NHS should be focused on encouraging patients to be aware and responsible for their health and know the red flag signs and symptoms that signal the need for an essential GP consultation.

If patients are enabled to self care appropriately they will be more confident of 'normal' and when they need to see their GP.  This would free up GP appointment times for their other health needs. To do this also requires us as health professionals to change our behaviour. It is not about saying no to a prescription for paracetamol, it is about us having a grown-up conversation in partnership with our patients about how they feel about taking responsibility for their own health.

Clinician behaviour

When it comes to the behaviour of clinicians, we have to be honest and admit that we have perhaps not done enough to equip ourselves in conducting such a conversation that moves from a ‘do as I say’ consultation to one that focuses on the advice, support and empowerment aspects that go beyond simply writing a prescription. We are faced with a situation where behaviour needs to change among healthcare professionals, patients and the NHS.

The annual Self Care Week comes round in November – why don’t we as a profession spend that week talking about self care rather than simply handing over a prescription? So for one week, let’s start to make it happen. Stop writing scripts and start talking patient empowerment and informed self care.

Dr Beth McCarron-Nash is a member of the GPC, deputy chairwoman of the BMA Education Workforce and Training committee, and a former GPC negotiator

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