Prescribing over-the-counter medicines

NHS England published revised commissioning guidance on reducing prescribing of over-the-counter medicines. Read what conditions are included, what prescribers need to do and if you are in breach of the contract.

Location: England
Audience: GPs Practice managers
Updated: Monday 7 September 2020
GP practice article illustration

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.

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.