Proposals to limit prescriptions for some ‘over the counter’ products

Medway residents are being asked for their views on national proposals to limit prescriptions for some ‘over the counter’ products such as dandruff shampoo, freeing up funds to expand other treatments for major conditions such as cancer and mental health problems.

In Medway in the last six months, almost £400,000 has been spent on drugs that could have been purchased over the counter. This is a 16% reduction on the same period last year, which is thanks to Medway Clinical Commissioning Group’s (CCG) published advice to healthcare professionals.

Medway CCG is now planning to update its guidance on prescribing over-the-counter medicines for 33 minor, short-term health concerns. This is part of a national consultation designed to create a consistent approach across the country.

The guidance includes items for a condition that does not last long or that does not need treatment as it will heal of its own accord; or that people can treat themselves as the person suffering does not normally need to see a doctor but may decide to seek help with symptom relief from a local pharmacy and use an over-the-counter medicine.

The consultation also includes items that can be purchased over the counter, sometimes at a lower cost than that which would be incurred by the NHS and those for which there is little evidence of clinical effectiveness. The proposals do not affect prescribing of items for long term or more complex conditions or where minor illnesses are symptomatic or a side effect of something more serious.

Sarah Vaux, Chief Nurse at Medway Clinical Commissioning Group, said: “In many cases self-care is actually more efficient as patients do not have to wait for a GP appointment and then a prescription – they can simply talk to their pharmacist and purchase the most appropriate treatment over-the-counter.

“To do the best for our patients and for taxpayers it’s vital the NHS uses its funding well. We want to know what people in Medway think about the national plans to help us 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.”

By reducing spend on treating conditions that are self-limiting or which lend themselves to self-care, these resources can be used for other higher priority areas that have a greater impact for patients, support improvements in services and deliver transformation that will ensure the long-term sustainability of the NHS.

In the year prior to June 2017, the NHS spent approximately £569 million on prescriptions for medicines which can be purchased over the counter from a pharmacy and other outlets such as supermarkets.

Over-the-counter products currently prescribed include remedies for dandruff, indigestion, mouth ulcers and travel sickness. Nationally the NHS each year spends:

  • £4.5 million on dandruff shampoos – enough to fund a further 4,700 cataract operations or 1,200 hip replacements every year.
  • £7.5 million on indigestion and heartburn – enough to fund nearly 300 community nurses.
  • £5.5 million on mouth ulcers – enough to fund around 1,500 hip replacements.

If patients were to self-care for these three conditions alone, it would save the NHS £17.5 million allowing funds to be diverted to other areas.

Some of the products currently can be purchased over the counter at a lower cost than that which would be incurred by the NHS – for example, a pack of 12 anti-sickness tablets can be purchased for £2.18 from a pharmacy whereas the cost to the NHS is over £3 after including dispensing fees, and over £35 when you include GP consultation and other administration costs. Similarly some common tablets are on average four times more expensive when provided on prescription by the NHS.

NHS England and NHS Clinical Commissioners have worked closely with GPs, pharmacists and patient groups to develop and refine the list of conditions for which prescribing could be restricted, as well as where exceptions may apply.

Some over the counter products currently prescribed are quickly and easily available in community pharmacies where the public can also ask for an NHS consultation with a pharmacist if they are unsure about what treatment they need for minor illnesses and need clinical advice.

Local pharmacies provide NHS services in the same way as GP practices – and pharmacists train for five years in the use of medicines before they qualify as clinical professionals.

A pharmacist will assess symptoms and consider any long-term conditions, and the medicines that the person is taking, before providing a recommendation. They will either:

  • Support/advise in the decision to self-care
  • Sell an over the counter medicine (which doesn’t need a prescription or visit to a GP) that will help relieve symptoms and make the person more comfortable
  • Or signpost to the right medical care if the pharmacist considers the condition is serious enough to warrant further medical help

These savings form a key building block of the NHS’s 10 point efficiency plan contained in the Next Steps on the NHS Five Year Forward View, published in March 2017, and support the ambition to ensure greater value from the NHS’s £17.4 billion medicines bill, through improving health outcomes; reducing waste, over-prescribing and over-treatment; and addressing excessive price inflation by drug companies.

The national consultation and guidance document is available at

To complete the Medway survey and to find out more, visit