As part of its efforts to save the NHS money, NHS England published revised commissioning guidance on reducing prescribing of over-the-counter medicines.
This is a summary of the guidance for GPs, developed by the BMA GPs committee.
What prescribers should do
- Continue to make the care of the patient their first concern.
- Advise patients if treatment for their condition is available over the counter.
- Provide an FP10 if, in the opinion of the GP, not doing so may put the patient at risk of not having necessary treatment.
Conditions affected
NHS England recommends that over-the-counter medication for 35 minor conditions should not be routinely prescribed in primary care.
| Conditions | |||
|---|---|---|---|
| Acute sore throat | Infrequent cold sores of the lip | Conjunctivitis | Infant colic |
| Coughs/colds/nasal congestion | Cradle cap (infants) | Haemorrhoids | Mild cystitis |
| Mild irritant dermatitis | Dandruff | Diarrhoea (adults) | Dry/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 | Sun protection | Mild to moderate hayfever |
| Minor burns and scalds | Minor conditions associated with pain, discomfort and/or fever | Mouth ulcers | Nappy rash |
| Oral thrush | Prevention of dental caries | Ringworm/athletes foot | Teething/mild toothache |
| Threadworms | Travel sickness | Warts and verrucae | Probiotics, vitamins and minerals |
Exceptions are listed in our full guidance.
The BMA position
We believe it is a vital part of a GP’s job to help patients care for their own minor illnesses, and to explain the availability and proper use of over-the-counter medicines.
NHS England’s advice for CCGs (clinical commissioning groups) is useful for situations where advice about self-care may be what a patient needs.
There has been no change to the regulations for GPs prescribing, however, so it cannot be used by CCGs to ban all such treatments. GPs must continue to treat patients according to their individual needs. This includes issuing prescriptions when self-care is inappropriate.
The contractual position
Concerns have been raised that GPs refusing to prescribe medication when it has been judged as needed may be in breach of their contract because of the below clause.
A prescriber shall order any drugs, medicines or appliances which are needed for the treatment of any patient who is receiving treatment under the contract.GMS contract
NHS England has addressed this in a letter of comfort to GPs assuring that they would not be in breach of their contract.