Over the counter prescribing

Position Statement for prescribing preparations available to buy over the counter (OTC) for self-care 

Position Statement for prescribing preparations available to buy over the counter (OTC) for self-care
NHS Bromley CCG is committed to delivering best value by ensuring that we use our resources well. Therefore to help us to support the cost effective, evidence based use of medicines, NHS Bromley CCG no longer supports the routine prescribing of health supplements and medications that can be bought over the counter for self-limiting, short-term illnesses and minor conditions.

Why are we doing this?

• We want to help people lead longer, healthier lives and support them to take better care of their health.  Self-care is about avoiding becoming ill and seeking help when needed.  By managing minor health needs through self-care, it will help to ease the pressure on the NHS.
• Bromley has a set amount of money to pay for the health services that are needed and  has a duty to spend that money wisely. 

What treatments and preparations are included?

• Pharmacy Only (P) and General Sales Lists (GSL) treatments that can be purchased over the counter from a pharmacy with or without advice
• GSL treatments (including a patient information leaflet) that can be purchased from other retail outlets such as supermarkets, petrol stations, convenience and discount stores
• Treatments that are used to treat a condition that is considered to be self-limiting and so does not need treatment as it will heal/resolve by itself; and/or
• Treatments that are used to treat a condition which lends itself to self-care, i.e. that the person suffering does not normally need to seek medical care and/or treatment for the condition.

Examples of treatments available OTC which should no longer be routinely prescribed on the NHS in Bromley : (This list is not exhaustive)
 
Our list: 

• Acne treatment
• Analgesic/pain relief treatment (short term pain, fever, headache, muscle/joint injury, infrequent migraine)
• Anti-fungal treatment (athlete’s foot, oral and vaginal thrush, ring worm, dandruff)
• Antiperspirant treatment (excessive sweating)
• Antiseptic creams and treatment for minor burns and scalds
• Camouflage creams
• Cold sore treatment
• Colic treatment
• Constipation treatment
• Cough, cold and sore throat treatment
• Cradle cap treatment
• Diarrhoea treatment
• Ear wax remover
• Emollients and bath oils for mild dry skin 
• Eye treatments/lubricating products (Conjunctivitis/ dry eyes)
• Fluoride containing products for prevention of dental caries
• Haemorrhoid (piles) treatment
• Hayfever treatment
• Head lice treatment
• Herbal and complementary treatments
• Homeopathic preparations
• Indigestion and heartburn (dyspepsia) treatment
• Mild cystitis treatment
• Mouth ulcer treatment and treatment for teething
• Nappy rash treatment
• Scabies treatment
• Sunburn treatment
• Suncream
• Threadworm treatment
• Topical steroid treatment (insect bites/stings, contact dermatitis, nappy rash)
• Travel sickness treatment
• Vitamins and minerals
• Wart and verruca treatment
    

What general exclusions apply?

• Medicines that can only be obtained with an NHS prescription - Prescription Only Medicines (POM)
• Where an OTC medicine is outside of its marketing authorisation, also known as “off-label use” or “unlicensed use”. For example when it is not licensed for use during pregnancy or where age or existing medical condition restrictions apply
• Where an OTC medicine is being prescribed for a long-term (chronic) condition e.g. regular analgesia in osteoarthritis
• Frail or housebound patients
• Where there are possible safeguarding concerns including, but not limited to, children, where there might be concerns that treatment might otherwise not be provided.
   

Guidance for prescribers

General Medical Council (May 2013) guidance 'Good practice in prescribing and managing medicines and devices' states the following:

• “‘Prescribing’ is used to describe many related activities, including supply of prescription only medicines, prescribing medicines, devices and dressings on the NHS and advising patients on the purchase of over the counter medicines and other remedies”
• Clinical judgment should be used when considering whether it is acceptable or appropriate to ask patients to purchase their medication.
• The Self Care Forum has produced numerous resources that can be used by healthcare professionals to help support people to self-care

 
Patients should be advised that:

• The NHS recommends everyone keeps a well-stocked medicine cabinet with self- care medicines. Find out more here
• Community pharmacists can offer advice on how to manage short term illnesses and minor conditions, when to seek medical advice, and what to take if they take other medications. Patients do not need to make an appointment to see the pharmacist, and many pharmacies are open late nights and at the weekend
• If their problem is more serious and needs the attention of another healthcare professional such as their GP, the pharmacist will advise them on this.
   

Advice is also available from:

• NHS Choices
• Bromley CCG 'self-care for life!' section
• Self care forum
• NHS 111