Self–care using medicines in the home without needing a prescription
NHS Ashford Clinical Commissioning Group, NHS Canterbury and Coastal Clinical Commissioning Group, NHS South Kent Coast Clinical Commissioning Group and NHS Thanet Clinical Commissioning Group
Opens: 4 September 2017
Closes: 2 October 2017
To restrict prescribing of over the counter / minor ailment medicines to those conditions where the clinical need can only be met by a prescription.
To tighten the prescription guidance on 18 items which are ineffective, or need safer guidelines, or where an alternative form would be more cost effective without reducing clinical effectiveness
There is an NHS Clinical Commissioners and NHS England national consultation, looking at how to improve prescribing in primary care (GP practices and local pharmacies), which the Ashford Clinical Commissioning Group (CCG) and other East Kent CCGs will respond to. To help them respond, they want to know what you think of the proposals to reduce prescribing of medicines widely available over the counter or tighten prescribing guidance on some items which are ineffective, or can be prescribed in more cost effective ways.
Have your say
You can give us your views in a number of ways:
- Fill in the onlne survey www.surveymonkey.co.uk/r/EKotcmedicines
- Fill in the paper copy of the survey found at the back of the consultation document and send it to FREEPOST ADDRESS
- Contact the Engagement Team on or Nelcsu.firstname.lastname@example.org
- If you belong to a group or organisation, you can invite us along to one of your meetings by contacting us on the details above
The four East Kent CCGs have a big financial challenge to meet in the short term. While the NHS budget has been protected, costs and demand for healthcare have increased. Currently approximately £10 million more is being spent nationally than the existing budget on medicines. They think the money they spend on items that are readily available over the counter might be better spent on treatments, staff and essential services that patients cannot get in any other way. They
also believe it will be of beneft to patients to promote a positive emphasis on self-care for minor ailments and illnesses, which you can manage effectively at home and in a way that suits you.
Why are we proposing to restrict the prescribing of these medicines for short-term, self-limiting minor illnesses or conditions?
The four east Kent CCGs spend approximately £3.69 million per year on the medicines that are available to buy over the counter. Many of these prescriptions are for the short term relief of minor ailments. A signifcant proportion of this money can be better spent meeting the healthcare needs of those requiring signifcant treatment for much more serious health problems.
From time to time everybody feels ill, perhaps with a cold, cough, upset stomach, fever or aches and pain. At the moment, these common, minor illnesses can be treated with medicines that you can buy over the counter at a pharmacy or supermarket, or have prescribed by a doctor. One in fve GP appointments are currently taken up by people who want advice and treatment for similar minor illnesses, costing the NHS in England about £2 billion a year
There are a wide range of over the counter medicines that don’t need a prescription from your GP, that are just as effective for minor illnesses as prescribed treatments; at a much lower cost to the NHS than if your GP or doctor prescribes the same medicines. Getting a prescription for medicines that you can buy yourself without a prescription is more expensive because of the time it takes health professionals to book appointments, see you, process prescriptions and dispense medicines. For example, a simple painkiller such as paracetamol is widely available in supermarkets and local pharmacies and costs around 25p per packet for you to buy compared to costing the NHS £2.50. The real, total cost of a prescription for paracetamol can be signifcantly more when
staffng and administrative costs are included. In comparison, August 2017 prices for paracetamol available over the counter in east
- £ 54p, supermarket Dover (Asda)
- £ 75p, service station Ashford (Applegreen)
- £ 25p, pharmacy, Margate (Boots)
- £1.00, corner shop, Bean/Chartham (Chartham village stores)
In 2014/15 the CCGs in east Kent spent approximately £820,000 prescribing paracetamol, money that could otherwise have financed lifesaving treatments and equipment.
Where medically appropriate, if you have long term pain and are prescribed daily paracetamol, this will continue to be prescribed to you. The restriction would be aimed only at occasional users, not at people who require packets of, for instance, 100 tablets, which are not available over the counter.
Despite people’s willingness to self-treat, there are still 57 million GP consultations nationally a year for minor conditions at a total cost to the NHS of £2 billion.
These appointments take up an average of one hour a day for every GP. Research shows that people often abandon self-care earlier than they need to, typically seeking the advice of a GP within four to seven days. It is estimated that by limiting the prescribing of widely available medicines suitable for self-care:
- every GP will have up to one hour a day freed up to see patients with more serious conditions
- signifcant reductions in GP prescribing costs will be achieved
- there will be a reduction in medicines waste and costs associated with medicines waste
- patients and carers will be better informed about how to manage minor conditions
What does it include?
These changes apply only to situations and minor conditions where NHS Choices recommends self-care. For some conditions this will be related to the severity of the condition (for instance mild acne is included but severe acne requires prescription only medicines) and/or to the duration of the condition (for example, a cough
that has persisted for more than three weeks requires a GP appointment). Over the counter medicines are the types of medicines that can be bought either from a community pharmacy or, in many cases, a general retailer like a supermarket. Some of these medicines can only be sold under the supervision. of a pharmacist, others are deemed safe enough to be widely available from general retailers.
Examples of some of the medicines included are:
- Cough and cold remedies
- Antihistamines and other treatments for hayfever
- Antacids for heartburn and indigestion
- Diarrhoea – adults and older children
- Creams for vaginal and vulval infections or thrush
- Nicotine Replacement Therapy for smoking cessation
- Malaria prevention
- Creams for fungal infections such as athlete’s foot
What doesn’t it include?
GPs will still prescribe any medicines that are available by prescription only, such as antibiotics, statins, blood pressure treatments and so on. Where a treatment is needed which can only be prescribed, then the patient’s regular doctor will still be able to prescribe this.
To tighten the prescription guidance on 18 items
NHS England is proposing to alter the national NHS guidance on prescribing of some items by:
- limiting the prescription of vitamins or dietary supplements, herbal or homeopathic remedies which have limited clinical evidence, such as glucosamine
- limiting the use of certain medications such as strong pain relief which are considered safer if used only by hospitals for acute care
- recommending the use of more cost effective and clinically appropriate alternatives for some forms of medication, such as combined paracetamol and Tramadol
- limiting travel vaccines to those currently available on the NHS.
Eligibility and exceptionality
These proposed changes apply to:
- All patients registered with or attending a healthcare appointment at a general practice.
- All patients, whether or not they pay for their prescriptions. Exemption from prescription charges does not exempt an individual from self-care for minor conditions.
- All prescribers within the area covered by the four east Kent CCGs, including nonmedical prescribers, GPs, out-of-hours and A&E departments.
What happens next?
The East Kent CCGs will collate and analyse all your feedback, together with the views of our clinical staff and this will inform our submission to the national consultation.
Any decisions nationally about revising prescription guidance will depend on the feedback given and any changes to national NHS guidance will take some time to implement.
After the consultation all the local feedback concerning the restricting of prescriptions of over the counter medication for everyday illnesses will be used to produce a report with recommendations that will be taken back to the CCG Governing Bodies for their final decision on the proposal and whether any action locally can or should be taken.