OTC Medicines – local prescribing guidance

OTC Medicines – local prescribing guidance

August 14, 2018

Information for Community Pharmacy Teams about new NHS and CCG Guidance on OTC prescribing

The Staffordshire Health Economy Over-The-Counter (OTC) medicines policy recommends that medication for self-limiting conditions, that can be bought OTC, should not normally be prescribed.

The NHS is encouraging patients to seek advice from a Community Pharmacist and/or buy OTC products and should lead to savings in both GP time and prescribing costs while making better use of the skills of our Community Pharmacists.

There is no requirement for GPs to prescribe medicines that are available to buy OTC unless the GP considers there is a necessity to do so for the patient’s condition (as specified in the GMS contract). Many OTC medicines can be purchased more cheaply than the current cost of the prescription charge. Exemption from prescription charges should not normally be a reason to prescribe medication available over the counter.

The policy also supports promotion of self-care and better utilisation of Community Pharmacists as a source of health advice instead of seeking a GP consultation.

Under the OTC policy, the CCGs advise that GPs and other prescribers follow the recommendations for each condition or item (Appendix 2) with due regard to general exceptions (Appendix 3).

General exceptions do not apply to vitamins, minerals, probiotics and those self-limiting conditions where there is limited evidence of clinical effectiveness for the treatments used (e.g. OTC items for cough, sore throat and infant colic).

There may be cases, where the clinician feels that the condition/item falls outside general or specific exceptions and they still wish to prescribe.

It should be noted that the CCG policy is guidance for primary care prescribers. The final decision to prescribe will remain with the prescriber. However, due regard needs to be given to professional guidance around resource management.  Practices will be supplied with a letter that can be shared with Patients advising them that this is a CCG policy and support through the complaints procedures.

General Medical Council (GMC) guidance requires doctors to take into account available resources and give due regard to agreed policy and guidance when making decisions to access to treatment.   See https://www.gmc-uk.org/guidance/ethical_guidance/11837.asp

GMC guidance also states activities such as ‘advising patients on the purchase of over the counter medicines and other remedies’ and ‘providing written information to patients or advice given’ fall under the definition of ‘prescribing’.  See https://www.gmc-uk.org/-/media/documents/prescribing_guidance.pdf_59055247.pdf

Community Pharmacists should not advise patients to request their GP to prescribe medicines available for minor health problems where these are available to purchase.

Conversely, prescribers should be aware that the recommended OTC medicine is licensed for the desired indication as requests for purchasing OTC medicines for unlicensed indications will be refused by Community Pharmacists.

It has been decided that Schools, Care Homes and other residential establishments will be exempt from this policy for now, as we look into the administration issues that arise when a medicine is required but not prescribed.

This policy will be reviewed in the light of new evidence or new national guidance, e.g., from NICE

Please check you are using the most recent version of this policy.

Further information on prescribing policies and the local formulary for South Staffordshire is available via http://www.southstaffordshirejointformulary.nhs.uk/default.asp.

As ever we recognise this is a difficult balancing act for prescribers and healthcare professionals to take into consideration the patient’s expectations, available NHS resources and to give due regard to agreed policies and guidance.   We have therefore worked with the PALS team to ensure you are able to refer these patients directly to them and they will assist the patient. All queries that cannot be resolved by PALS will be escalated to our team.

PALS Contact details for patients are:

Freephone: 0800 030 4563 Mon to Fri 9am to 4pm excl. Bank Holidays (answerphone available)

Email: mlcsu.patientservices@nhs.net

Contact details for queries from healthcare professionals to our team:

Southstaffs.medsoptimisation@nhs.net

Many thanks

Samantha Buckingham

Head of Medicines Optimisation – South Staffordshire

Appendix 1 – Specific Info for Community Pharmacies

Appendix 2 – OTC Prescribing Restricted conditions & items

Appendix 3 – OTC Prescribing General Exceptions




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