Welsh government advisory body considers restrictions on prescribing of OTC medicines

If proposals to limit routine prescribing of over-the-counter (OTC) medicines in Wales are introduced, patients who are told their condition can be treated with OTC medicines should be directed to a pharmacy, Community Pharmacy Wales (CPW) has said.

The recommendation was made in response to a consultation by the All Wales Prescribing Advisory Group (AWPAG), a Welsh government advisory body, on whether to restrict prescribing of OTC medicines for certain minor, self-limiting conditions.

CPW said that while it fully supported the principles of the proposal, it was conscious that “OTC medicines can be purchased from outlets other than community pharmacies, such as corner shops and local garages, where the quality of advice provided will often fall far short of that provided in a community pharmacy”.

The draft guidance put out for consultation by the AWPAG identified 35 conditions for which OTC items should not routinely be prescribed in primary care. The list of conditions is identical to that given in NHS England’s guidance for CCGs issued on 29 March 2018, and includes head lice, indigestion and acute sore throat. The consultation document states that Wales spent £850m on prescriptions in 2015/2016 — 5.7% of the Welsh government’s total expenditure. 

But the document also notes that it may not be possible to save the entire cost of current expenditure on prescriptions for these conditions, partly because “alternative supply mechanisms for some conditions within NHS Wales, for example via the common ailments service (CAS), also levy costs against the overall NHS Wales budget”.

Under the pharmacy-based CAS, patients can receive free OTC medicines for 26 minor ailments, providing they first undergo a private consultation with a pharmacist. Patients who do not wish to have a consultation are advised that they can still buy an OTC medicine.

In its consultation response, CPW recommend that if the prescribing guidance is introduced, it must tally with guidance for the CAS.  

“One of the key principles agreed at the introduction of the CAS was that all prescribers would follow the same prescribing guidelines and that patients would not be able to ‘play one prescriber off against another’,” it said. “CPW would therefore want to ensure that this principle remains in place.”

CPW also proposed that the nine conditions listed in the AWPAG’s consultation that are not currently offered as part of the CAS — including infrequent migraine and insect bites — should be included in the CAS in future.

Health boards would decide whether, and how, to implement the guidance, the consultation document says. The consultation closed on 11 January 2019 and the feedback received will be considered at a meeting of the All Wales Therapeutics and Toxicology Centre, which supports the AWPAG, on 20 March 2019.