New commissioning guidance on over the counter items that should not routinely be prescribed in primary care

The NHS England board have today approved new guidance to curb routine prescriptions for over the counter medicines for minor, short-term conditions, many of which will cure themselves or cause no long-term effect on health, such as those for constipation and athletes foot. It is estimated that this new guidance could release as much as £136 million each year for CCGs to reinvest in other services.

The guidance published and distributed to CCGs today is the result of the joint public consultation that NHSCC ran with NHS England, after CCGs asked for a nationally co-ordinated approach to the development of commissioning guidance in this area to ensure consistency and address unwarranted variation. This follows on from commissioning guidance on 18 items which should not be routinely prescribed in primary care, which we worked jointly with NHS England on and was published in November 2017. Together, these have been significant pieces of work for NHSCC over the last year to support our members to release NHS funding locally and fund higher priority areas.

The new over the counter medicines guidance will curb the routine prescribing of products that are for:

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

The guidance will not affect prescribing of over the counter items for longer term or more complex conditions or where minor illnesses are symptomatic or a side effect of something more serious.

Graham Jackson - board meetingResponding to the approval of the new guidance, Dr Graham Jackson, co-chair of NHS Clinical Commissioners and clinical chair of Aylesbury Vale Clinical Commissioning Group, who also co-chaired the joint clinical working group for this work said: “Unfortunately the NHS does not have unlimited resources and ensuring patients get the best possible care against a backdrop of spiralling demands, competing priorities and increasing financial pressures is one of the biggest issues CCGs face. It is not good use of the NHS’s limited resources to issue prescriptions for products which are not clinically effective, or for conditions that will get better without treatment or whose symptoms can be managed with appropriate self-care.

“On a daily basis, CCGs are forced to make difficult decisions that balance the needs of the individual against those of their entire local population. We recognise that it may be difficult for some patients who have previously been prescribed these products, but it is right that we prioritise our spending on those that provide the best outcomes for patients. This new guidance provides clear direction to CCGs on where those priorities should lie.”

Simon StevensNHS England chief executive Simon Stevens said: “Across the NHS our aim is to: ‘Think like a patient, act like a taxpayer’. The NHS is probably the most efficient health service in the world, but we’re determined to keep pushing further. Every pound we save from cutting waste is another pound we can then invest in better A&E care, new cancer treatments and much better mental health services.”

Once CCGs have adopted the new guidance locally, it will apply to everyone who is not covered by the general or condition-specific exceptions listed in the guidance document. In relation to the exceptions, it is important to highlight:

  • 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.

The consultation received over 2,500 responses to the consultation with the majority from patients, members of the public and clinicians, including responses from 140 CCGs. The responses were positive with over 70% agreeing with the overall proposals.

More information is available on the NHS England website.

29 March 2018