Some Clinical Commissioning Groups (CCGs) in England are running campaigns encouraging patients to purchase over-the-counter (OTC) medicines and healthcare products from a pharmacy, or to have these supplied through a minor ailments scheme, rather than to have them prescribed. This may mean more people visiting the pharmacy, more frequently, or sometimes for larger quantities of these medicines and healthcare products. This support alert has been written to provide professional guidance.
What has prompted these campaigns?
Some CCGs are looking to reduce the routine prescribing of medicines that have been assessed to be of low clinical value or priority, or that are readily available for OTC purchase in order to save the NHS money.
In July 2017 NHS England issued a public consultation on the items which should not be routinely prescribed in primary care. The output of the consultation will be guidance for CCGs that will influence the approach of CCGs across England.
We have published a briefing on the consultation plans here.
Which medicines are included?
The consultation and some of the existing campaigns affect a range of medicines including
- Prescription only medicines
- OTC pharmacy and general sale medicines, such as
- Analgesics for self-limiting conditions
- Cough and cold remedies
- Indigestion and heartburn remedies
- Suncream products
- Homeopathic remedies
- Herbal remedies
- Vitamins and food supplements
Putting patients first
Healthcare professionals are responsible for the care they provide to their patients and you will have both a professional and regulatory duty to use professional judgement to provide safe and effective patient-centred care. This means acting in the best interests of the patient and making sure that their care is your first concern.
If you believe the medicine or healthcare product should be prescribed rather than sold OTC you should discuss this with the general practice. It could be useful to check if your CCG has published their prescribing policy online. This is normally available and can be reviewed to see how it should apply to your patient.
Some OTC medicines are subject to legal restrictions on the quantity that can be sold without a prescription for public safety or health reasons.
These include paracetamol and aspirin where there is a restriction for no more than 100, non-effervescent tablets or capsules to be sold to a person at any one time. As most OTC pack sizes are for 16 or 32 dose units, in practice this means less than 100 can be sold. There are no legal limits on the quantity of OTC effervescent tablets, powers, granules or liquids that can be sold.
In addition the MHRA have also published best practice guidance which recommends not selling more than two packets of pain relief in any one transaction.
You can use professional judgement to decide the appropriate quantity to supply within the legal framework, taking into account the best practice guidance and the case-by-case circumstances. We have general guidance on exercising professional judgement here.
Minor ailment schemes
You may also able to help patients under a local minor ailment scheme. These schemes are commissioned locally and enable participating pharmacies to supply medicines for certain conditions on the NHS. Further information for patients on minor ailments schemes is avaialble on the NHS Choices website.