Prescribing over-the-counter medicines

From 1 April 2019, Tower Hamlets is making changes to the prescribing of medicines that can be bought over the counter for 35 minor, short-term health conditions in line with guidelines published by NHS England. These changes will benefit patients by freeing up valuable GP time and promoting self-care through community pharmacy. 

NHS England (NHSE) published new prescribing guidance (29 March 2018) which covers 35 minor, short-term health conditions, which are either ‘self-limiting’ or suitable for ‘self-care’.

Self-care can be described as: 

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

The publication of the guidance followed a three-month national consultation. Tower Hamlets CCG also conducted a local engagement exercise with clinicians and patients groups and the resulting comments and recommendations were included in the CCG’s response to NHSE.

The new guidance recommends that:

  • Medicines which are available over the counter should no longer routinely prescribed for 35 minor, short-term conditions.
  • Vitamins, minerals and probiotics are also included in the restrictions as items of limited clinical effectiveness.

Who does the policy apply to?

The new guidance will apply to everyone who is not covered by the general or condition-specific exceptions listed in the guidance. In relation to the exceptions, it is important to highlight that:

  • 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.
  • For the self-limiting conditions, where symptom relief may be required, the general exceptions will only apply where the prescription is for an over the counter item that is clinically effective​
  • For vitamins, minerals and probiotics, only the condition-specific exceptions will apply.

General Exceptions

There are however, certain scenarios where patients should continue to have their treatment OTC medicines prescribed and these are outlined below:

  • 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 OTC 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.
  • Patients prescribed OTC products to treat an adverse effect or symptoms 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 breast- feeding. 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.

List of minor illness or items for which prescribing is restricted:

Self-limiting illnesses:
  • Acute Sore Throat
  • Infrequent Cold Sores of the lip 
  • Conjunctivitis  
  • Coughs and colds and nasal congestion
  • Cradle Cap (Seborrhoeic dermatitis – infants)
  • Haemorrhoids
  • Infant Colic
  • Mild Cystitis
Minor illnesses suitable for self-care:
  • Mild Irritant Dermatitis
  • Dandruff
  • Diarrhoea (Adults)
  • Dry Eyes/Sore (tired) Eyes
  • Earwax
  • Excessive sweating (Hyperhidrosis)
  • Head lice
  • Indigestion and Heartburn
  • Infrequent constipation
  • Infrequent Migraine
  • Insect bites and stings
  • Mild Acne
  • Mild Dry Skin
  • Sunburn
  • Sunburn Protection
  • Mild to Moderate Hay fever/Seasonal Rhinitis
  • Minor burns and scalds
  • Minor conditions associated with pain, discomfort and/fever. (e.g. aches and sprains, headache, period pain, back pain)
  • Mouth ulcers  
  • Nappy Rash
  • Oral Thrush    
  • Prevention of tooth decay or cavities
  • Ringworm/Athletes foot
  • Teething/Mild toothache
  • Threadworms
  • Travel Sickness
  • Warts and Verrucae  
Items of limited clinical effectiveness:
  • Probiotics
  • Vitamins and minerals.