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Over the Counter Medicine

Position statement on the prescribing of medicines available to purchase over the counter for self-limiting and minor health conditions

In line with NHS England’s guidance on conditions for which over-the-counter items should not be routinely prescribed, SW London CCGs* do not support routine prescribing of medicines available to purchase over the counter as treatments for self-limiting and minor health conditions where:

Self-care is the most appropriate route

AND

  Medicines and treatments are available to buy over the counter

Routine prescribing of treatments for the conditions shown below is no longer supported. Acute sore throat

Infant colic

Mouth ulcers

Conjunctivitis

Infrequent cold sores of the lip

Nappy rash

Coughs and colds and nasal congestion

Infrequent constipation

Oral thrush

Cradle cap (Seborrhoeic dermatitis – infants)

Infrequent migraine

Prevention of dental caries

Dandruff

Insect bites and stings

Ringworm/ Athletes foot

Diarrhoea (adults)

Mild acne

Sun protection

Dry eyes/ sore tired eyes

Mild cystitis

Sunburn due to excessive sun exposure

Earwax

Mild dry skin

Teething/ mild toothache

Excessive sweating (hyperhidrosis)

Mild irritant dermatitis

Threadworms

Haemorrhoids

Mild to moderate hay fever/ seasonal rhinitis

Travel sickness

Head lice

Minor burns and scalds

Warts and verrucae

Indigestion and heartburn

Minor conditions associated with pain, discomfort and/ or fever (e.g. aches and sprains, headache, period pain, back pain)

Rationale

  • These self-limiting and minor health conditions can be treated effectively and safely using over the counter medicines available from pharmacies and other retail outlets.
  • Treatments for these conditions can be purchased over the counter, often at a lower cost than that which would be incurred by the NHS or at a cost less than the prescription charge.
  • There is little evidence of clinical effectiveness for some of these products.
  • By reducing spend on these products, resources can be used for other higher priority areas that will have greater impact for patients, support improvements in services and /or deliver transformation that will ensure the long term sustainability of the NHS.

Clinical judgment should be used when considering whether it is acceptable or appropriate to ask patients to purchase their medication. For details of exclusions to this guidance, please see Appendix 1 for general exemptions and https://www.england.nhs.uk/publication/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed-in-primary-care-guidance-for-ccgs/ for condition specific exclusions.

Reference: NHS England ‘Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs’ (March 2018) https://www.england.nhs.uk/publication/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed-in-primary-care-guidance-for-ccgs/ Final 27 August 2018 v1

Guidance and recommendations for clinicians

  • These self-limiting and minor health conditions can be treated effectively and safely using over the counter medicines available from pharmacies and other retail outlets.
  • This applies to all prescribers within SW London, including non-medical prescribers, GPs, community services, hospitals, extended hours, urgent care and A&E departments.
  • Community pharmacists should support this approach and not routinely advise patients to request their GP to prescribe over the counter medicines available for self-limiting conditions and minor health conditions where these are available to purchase.
  • Community pharmacists should be aware of ‘red flag’ symptoms for patients presenting with symptoms related to the conditions above.
  • Local self-care briefings to support clinicians can be found here
  • Clinicians should advise patients of availability of over the counter products noting OTC licensing (included in self–care briefings) but use their clinical judgement to decide whether it is acceptable or appropriate to ask patients to purchase their medication.
  • GPs must continue to treat patients according to their individual circumstances and needs, and that includes issuing prescriptions where there are reasons why self-care is inappropriate. See British Medical Association advice : https://www.bma.org.uk/advice/employment/gp-practices/service-provision/prescribing/over-the-counter-medicines-guidance
  • For details of exclusions to this guidance please see Appendix 1 for general exemptions to the guidance and NHS England ‘Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs’ (March 2018) https://www.england.nhs.uk/publication/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed-in-primary-care-guidance-for-ccgs/ for condition specific exemptions.
  •  Non-prescription medicines (over the counter medicines) do not require any written consent from a GP or other healthcare professional to allow school and nursery staff to administer them. For guidance on medicines in schools and nurseries see Appendix 2

Patient Leaflets and support materials

NHS England has published patient materials to support implementation of this guidance and includes:

  • Patient leaflet.
  • Easy read version of the leaflet.
  • A black and white handout for prescribers to hand directly to patients during a consultation

Print ready and design files of the leaflet are available from NHS Comms Link. https://nhsi.kahootz.com/connect.ti. You will need to create an account if you don't already have one.

Guidance for patients, carers and guardians

  • Patient information leaflets explaining the guidance can be found here.
  •  Some of these conditions are considered to be self-limiting i.e. they will get better themselves and so do not need treatment.
  • Most of these conditions lend themselves to self-care i.e. the person does not normally need to seek medical advice and can manage the condition by purchasing over the counter items.
  • By keeping a selection of essential medications at home you can treat the symptoms of these conditions in a timely manner.
  • Community pharmacists can offer advice on how to manage the symptoms of these conditions, when to seek medical advice, and what to take if you are on other medication. You do not need to make an appointment to see the pharmacist and many pharmacies are open late nights and at the weekend when the doctor’s surgery is closed.
  • Helpful advice in managing these conditions can also be found at :
  •  
  • See your GP if the condition does not resolve after using over the counter products for the recommended period of time by your pharmacist.
  • There are exceptions to this position which includes patients with complex illness or long term conditions. Please see

https://www.england.nhs.uk/publication/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed-in-primary-care-guidance-for-ccgs/

Guidance for Schools and Nurseries

  • Non-prescription medicines (over the counter medicines) do not require any written consent from a GP or other healthcare professional to allow school and nursery staff to administer them.

Medicines for Schools and Nurseries

Schools and childcare providers sometimes ask parents/carers to obtain prescriptions or written permission from a GP for over the counter medication such as paracetamol before they will administer to the children in their care. To support implementation of this, the CCGs would like to clarify the interpretation around the current guidance around use of medicines in nurseries and schools.

  • Schools and nurseries can only administer prescription medicines to a child when they have been prescribed by a doctor, dentist, nurse or pharmacist.
  • Non-prescription medicines (over the counter medicines) do not require any written consent from a GP or other healthcare professional to allow school and nursery staff to administer them.
  • All medication must only be administered to a child under the age of 16 where written permission for that particular medicine has been obtained from the child’s parent or carer.

Further Information:

Nurseries:

The Department for Education revised their ‘Statutory Framework for the Early Years Foundation Stage’ guidance in April 2017 EYFS Statutory Framework 2017, which refers to the handling of medicines by EYFS providers. – http://bit.ly/2mRqffO

Schools:

The 2015 Department for Education issued statutory guidance ‘Supporting pupils at school with medical conditions.’ – http://bit.ly/2wGLwtb

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