Over the counter medication

NHS England published new prescribing guidance (29 March 2018) which covers 35 minor, short-term health conditions, which are either ‘self-limiting’ or suitable for ‘self-care’.

Self-care can be described as:

  • a self-limiting condition does not require any medical advice or treatment as it will clear up on its own, such as sore throats, coughs, colds and viruses
  • a minor illness that is suitable for self-care can be treated with items that can be purchased over the counter from a pharmacy. These conditions include, for example, indigestion, mouth ulcers and warts and verrucae.

The publication of the guidance followed a three-month national public consultation.

Both CCGs in Devon also conducted a local engagement exercise with clinicians and patient groups and fed this in to the national consultation.

The new guidance recommends that medicines that are available over the counter should no longer be routinely prescribed for 35 minor, short-term conditions.  Vitamins, minerals and probiotics are also included in the restrictions as items of limited clinical effectiveness.

Both Clinical Commissioning Groups in Devon made a decision to implement the guidance in full.

These changes will benefit patients by freeing up valuable GP time and promoting self-care for patients through community pharmacy services.

Why community pharmacy?

  • Pharmacists have the knowledge and skills to help with many healthcare conditions.
  • You don’t need an appointment.
  • Visiting a pharmacist first helps to make more GP appointments available for people with more complex healthcare needs.
  • If your condition is more serious, the pharmacist is trained to signpost you quickly to the right medical care.

Who does the guidance apply to?

  • The new guidance will apply to everyone who is not covered by the general or condition-specific exceptions listed in the guidance.
  • The guidance does not apply to people with long-term or more complex conditions who will continue to get their usual prescriptions.
  • People who receive free prescriptions will not automatically be exempt from the guidance.
  • For patients where the clinician considers that their ability to self-manage is compromised as a consequence of medical, mental health or significant social vulnerability; these patients will continue to receive prescriptions for over the counter items subject to the item being clinically effective.
  • For the self-limiting conditions, where symptom relief may be required, the general exceptions will only apply where the prescription is for an over the counter item that is clinically effective
  • For vitamins, minerals and probiotics, only the condition-specific exceptions will apply.

Minor illnesses or items for which prescribing is restricted

Self-limiting illnesses:

  • 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

Minor illnesses suitable for self-care:

  • Mild irritant dermatitis
  • Dandruff
  • Diarrhoea (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
  • Sunburn protection
  • Mild to moderate hay fever/seasonal rhinitis
  • Minor burns and scalds
  • Minor conditions associated with pain, discomfort and/fever (e.g. aches and sprains, headache, period pain, back pain)
  • Mouth ulcers  
  • Nappy rash
  • Oral thrush    
  • Prevention of tooth decay or cavities
  • Ringworm/athletes foot
  • Teething/mild toothache
  • Threadworms
  • Travel sickness
  • Warts and verrucae  

Items of limited clinical effectiveness:

  • Probiotics
  • Vitamins and minerals.

Exceptions to the guidance

There are certain scenarios where patients should continue to have their treatment with over the counter (OTC) medicines prescribed and these are outlined below:

  • Patients prescribed an OTC treatment for a long term condition or more complex forms of minor illnesses
  • For those patients that have symptoms that suggest the condition is not minor
  • Treatment for complex patients (e.g. those with weakened immune systems).
  • Patients on ‘prescription only medications’.
  • Patients prescribed OTC products to treat an adverse effect or symptoms of a more complex illness and/or ‘prescription only medications’ should continue to have these products prescribed on the NHS.
  • Circumstances where the product license doesn’t allow it to be sold over the counter to certain groups of patients. This may vary by medicine, but could include babies, children and/or women who are pregnant or breast-feeding. Community pharmacists will be aware of what these are and can advise accordingly.
  • Patients with a minor condition suitable for self-care that has not responded sufficiently to treatment with an OTC product.
  • Patients where the clinician considers that the presenting symptom is due to a condition that would not be considered a minor condition.
  • Circumstances where the prescriber believes that in their clinical judgement, exceptional circumstances exist that warrant deviation from the recommendation to self-care.
  • Individual patients where the clinician considers that their ability to self-manage is compromised as a consequence of medical, mental health or significant social vulnerability to the extent that their health and/or wellbeing could be adversely affected, if reliant on self-care. Being exempt from paying a prescription charge does not automatically warrant an exception to the guidance. Consideration should also be given to safeguarding issues.
Over the counter medicines - patient information leaflet Over the counter medicines - easy read leaflet More information about self-care can be found here.

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