Some protections for vulnerable patients as NHS England rules out routine prescribing of common OTC products

The NHS England Board has approved guidance that will restrict routine prescribing of over-the-counter (OTC) medicines for 35 minor, self-limiting or short-term health conditions.

But in response to concerns expressed during the guidance’s consultation phase, the final guidance includes a number of exemptions for patients whose ability to manage self-care is compromised because of “medical, mental health, or significant social vulnerability”. This includes patients with financial difficulties, although being exempt from paying prescription charges will not mean an automatic exemption from restrictions introduced by the new guidance.

Treatments restricted by the guidance include products for indigestion, cradle cap, haemorrhoids, head lice, mild acne, and “minor conditions associated with pain”. Vitamins and minerals should also no longer be routinely prescribed, the guidance says.

In some cases exceptions to the restrictions on prescribing apply, for instance if cradle cap is causing a child distress, but in other cases, such as diarrhoea, no exceptions were identified.

Clinical commissioning groups (CCGs) will now decide whether to adopt the proposals in their areas.

The decision to approve the guidance was made following a consultation that ran between 20 December 2017 and 14 March 2018, which heard that some patients were unaware that they could visit a pharmacy rather than a GP for advice on how to manage minor conditions. The NHS England guidance states that CCGs must be prepared to supply patients with better information on signposting.

Concerns were also raised during the consultation about the impact of the guidance on patients in rural communities, with limited access to a community pharmacy. In response, the guidance has been updated to emphasise that CCGs must take into account their latest local Pharmaceutical Needs Assessment, and “consider the impact of this guidance on rural areas and access to a pharmacy and pharmacy medicines”.

Sandra Gidley, chair of the Royal Pharmaceutical Society’s English Pharmacy Board, said: “All pharmacists understand the importance of encouraging people to self-care and buy over the counter treatments when they are able to do so. Restricting access to over the counter medicines would have increased health inequalities. We are pleased that NHS England has recognised our concerns and have made positive changes.

“However we remain concerned that the implementation might disadvantage patients on low incomes and people may be denied treatment because of their inability to pay. We will continue to work closely with pharmacists to ensure effective implementation and make sure that access to medicines is based on clinical needs.”

NHS England said the guidance would save almost £100m each year, and NHS England chief executive, Simon Stevens, said: “Across the NHS our aim is to: ‘Think like a patient, act like a taxpayer’.”