NHSCC and NHS England launch consultation on commissioning guidance for over the counter items that should not routinely be prescribed in primary care

Today sees the launch of the next stage of our work with NHS England to identify areas of current NHS spend that could be better utilised for higher priority areas, such as primary care and mental health.  Following on from the commissioning guidance that was produced on items which should not routinely be prescribed in primary care a joint consultation on commissioning guidance for conditions for which over the counter items should not routinely be prescribed in primary care is now open.

Dr Graham Jackson, NHSCC co-chair, and co-chair of the clinical working group that developed the list of conditions said: “This consultation is an important part of the ongoing work we are doing on behalf of local clinical commissioning groups alongside NHS England to ensure the NHS budget is spent effectively to deliver the best possible patient care and to encourage more people to self-care.”

The work aims to save up to £136 million on prescriptions for medicines to treat ‘minor conditions’ which could otherwise be purchased over the counter from a pharmacy and/or other outlets such as petrol stations or supermarkets. These prescriptions include items for a condition:

  • That is considered to be self-limiting and so does not need treatment as it will heal or be cured of its own accord;
  • Which lends itself to self-care, i.e. that the person suffering does not normally need to seek medical advice and can manage the condition by purchasing OTC items.

Or items:

  • That can be purchased over the counter, sometimes at a lower cost than that which would be incurred by the NHS;
  • For which there is little evidence of clinical effectiveness.

Graham went on to say:

“It is important that we have an honest conversation with the public, patients and clinicians about what the NHS should and can provide with the constrained funds it has available. As a part of that, it is right that we review what is currently offered on NHS prescription that is also available over-the-counter so that we can prioritise our spending on those products that are the most clinically effective and provide the best outcomes for patients.

NHS England chief executive Simon Stevens, said: “To do the best for our patients and for taxpayers it’s vital the NHS uses its funding well. This consultation gives the public the opportunity to help family doctors decide how best to deploy precious NHS resources, freeing-up money from the drugs bill to reinvest in modern treatments for major conditions such as cancer, mental health and emergency care.”

The list and approach have been developed based on responses that we received to the previous consultation on items which should not be routinely prescribed in primary care, refined by the joint NHS England-NHSCC clinical working group and reviewed following initial feedback received from patient representative organisations.The consultation document sets out proposals for commissioning guidance for CCGs on over the counter (OTC) products for 35 minor and/or self-limiting conditions. The guidance is intended to encourage people to self-care for minor and self-treatable conditions only, rather than for items prescribed to treat long-term conditions and associated symptoms. The guidance also includes some exceptions where ongoing prescribing may be appropriate.

We know that a number of CCGs have already acted to limit prescribing of medicines that can be purchased over the counter. This guidance aims to reduce variation across the country through the introduction of a consistent approach, thereby releasing considerable savings for CCGs to reinvest locally.

Full list of of items and conditions:

  1. Probiotics
  2. Vitamins and minerals
  3. Acute Sore Throat
  4. Cold Sores
  5. Conjunctivitis
  6. Coughs and colds and nasal congestion
  7. Cradle Cap (Seborrhoeic dermatitis – infants)
  8. Haemorrhoids
  9. Infant Colic
  10. Mild Cystitis
  11. Contact Dermatitis
  12. Dandruff
  13. Diarrhoea (Adults)
  14. Dry Eyes/Sore (tired) Eyes
  15. Earwax
  16. Excessive sweating (Hyperhidrosis)
  17. Head Lice
  18. Indigestion and Heartburn
  19. Infrequent Constipation
  20. Infrequent Migraine
  21. Insect bites and stings
  22. Mild Acne
  23. Mild Dry Skin/Sunburn
  24. Mild to Moderate Hay fever/Seasonal Rhinitis
  25. Minor burns and scalds
  26. Minor conditions associated with pain, discomfort and/fever. (e.g. aches and sprains, headache, period pain, back pain)
  27. Mouth ulcers
  28. Nappy Rash
  29. Oral Thrush
  30. Prevention of dental caries
  31. Ringworm/Athletes foot
  32. Teething/Mild toothache
  33. Threadworms
  34. Travel Sickness
  35. Warts and Verrucae

Respond to the consultation

You can see the full consultation document and details of how to respond on NHS England’s website. The closing date to respond is 14 March 2018.