In response to the national guidance on conditions which OTC items should not routinely be prescribed in primary care, the NW London CCGs have agreed to adopt this guidance. The NW London Prescribing Wisely OTC programme will now be aligned to the national guidance with the:
- Adoption of the guidance’s list of medical conditions for which OTC medicines should not be routinely prescribed- note no requirement to ask patients if they are willing to purchase
- Adoption of the national list of exceptions where the treatment should be prescribed.
There is significant overlap in the products covered in the NW London Prescribing Wisely programme and the conditions covered in the national guidance, with some very minor differences. The national guidance applies to all patients, including those who would be exempt from paying prescription charges, unless they fall under the exceptions.
The NHS England general exceptions apply to all the listed conditions. These are:
- Patients prescribed an OTC treatment for a long term condition (e.g. regular pain relief for chronic arthritis or treatments for inflammatory bowel disease).
- For the treatment of more complex forms of minor illnesses (e.g. severe migraines that are unresponsive to over the counter medicines).
- For those patients that have symptoms that suggest the condition is not minor (i.e. those with red flag symptoms for example indigestion with very bad pain.)
- Treatment for complex patients (e.g. immunosuppressed patients).
- Patients on prescription only treatments ( receiving a POM for one of the conditions eg. prophylactic migraine treatment).
- Patients prescribed OTC products to treat an adverse effect or symptom of a more complex illness and/or prescription only medications should continue to have these products prescribed on the NHS.
- Circumstances where the product licence doesn’t allow the product to be sold over the counter to certain groups of patients. This may vary by medicine, but could include babies, children and/or women who are pregnant or breastfeeding. Community Pharmacists will be aware of what these are and can advise accordingly.
- Patients with a minor condition suitable for self-care that has not responded sufficiently to treatment with an OTC product.
- Patients where the clinician considers that the presenting symptom is due to a condition that would not be considered a minor condition.
- Circumstances where the prescriber believes that in their clinical judgement, exceptional circumstances exist that warrant deviation from the recommendation to self-care.
- Individual patients where the clinician considers that their ability to self manage is compromised as a consequence of medical, mental health or significant social vulnerability to the extent that their health and/or wellbeing could be adversely affected, if reliant on self-care. To note that being exempt from paying a prescription charge does not automatically warrant an exception to the guidance. Consideration should also be given to safeguarding issues.
The guidance also lists probiotics, vitamins and minerals as items of limited clinical effectiveness. It is important to note that for the items of limited clinical effectiveness, the general exceptions do not apply to these items although please note the specific exceptions eg. probiotics for ACBS approved indications.
NHS England have produced a FAQ for GP practices and a quick reference guide for healthcare professionals which can be found on the links below:
The full national guidance is available on the following link:
NHS England will be providing further implementation resources in coming months including a patient information toolkit.
Brent CCG spent around £3.3 million on over the counter items last year and believes prescribing in line with the national guidance will release savings that could be put to better use to support vital healthcare in the borough. The change should also help to ease some of the pressure on GP surgeries, so doctors and other healthcare professionals can concentrate on patients with more serious or long term conditions. Pharmacies will continue to play a key role in advising people on self-care of minor ailments, medicines and signposting to other services if needed