NHS England introduces new OTC prescribing restrictions for minor ailments

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

In the year prior to June 2017, the NHS spent approximately £569m on prescriptions for medicines which could otherwise be purchased over the counter. | iStock
In the year prior to June 2017, the NHS spent approximately £569m on prescriptions for medicines which could otherwise be purchased over the counter. | iStock

New guidance from NHS England, following the consultation launched in December 2017, sets out how CCGs should curb prescriptions of OTC medicines for conditions considered to be either self-limiting or suitable for self-care. The guidance also covers prescribing of probiotics and vitamins and minerals.

Once CCGs have adopted the guidance locally, it will apply to everyone who is not covered by the general or condition-specific exceptions specified. 

Exceptions

The restrictions do not affect prescribing of OTC medicines for long-term or more complex conditions, or where minor illnesses are symptomatic or a side-effect of something more serious.

OTC medicines can also be prescribed if the prescriber believes there are exceptional circumstances where in their clinical judgment deviation from the recommendation to self-care is warranted. In addition, an exception can be made if the prescriber believes a patient's ability to self-manage a condition is compromised as a consequence of medical, mental health or significant social vulnerability and their health would be adversely affected if reliant on self-care.

However, being exempt from prescription charges does not automatically warrant an exception to the guidance.

Vitamins and minerals, and probiotics have been included as standalone categories in the guidance since they have been identified as high cost in terms of OTC spend. GPs should no longer routinely prescribe these products, with the exception of prescription-only vitamin D analogues such as alfacalcidol.

However, patients with medically diagnosed deficiency or malnutrition can continue to receive vitamins and minerals on prescription and patients with osteoporosis can still be prescribed calcium and vitamin D supplements.

Improving funding

NHS England has said that the new prescribing guidance will free up almost £100m annually in funding that could be spent on frontline care. It said that the NHS spends £22.8m on treating constipation, £7.5m on treating heartburn and indigestion and £4.5m on dandruff shampoos every year.

'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', said Simon Stevens, NHS England's chief executive. 

Dr Graham Jackson, co-chair of NHS Clinical Commissioners and clinical chair of Aylesbury Vale CCG, who was involved in producing 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
  • Infrequent 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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