Conditions for which over the counter items should not routinely be prescribed in primary care: A consultation on guidance for CCGs

NHS England has launched a public consultation on reducing prescribing of over-the-counter (OTC) medicines for minor, short-term health concerns which could save the NHS £136 million a year and encourage more people to self care.

A list of 33 minor health concerns has been identified by a national joint clinical working group which are either self-limiting or suitable for self-care. Vitamins/minerals and probiotics have also been included as items of low clinical effectiveness which are of high cost to the NHS.

Indicative minor illnesses or items for which prescribing could be restricted:

Self-limiting illnesses:

  1. Acute Sore Throat
  2. Cold Sores
  3. Conjunctivitis
  4. Coughs and colds and nasal congestion
  5. Cradle Cap (Seborrhoeic dermatitis – infants)
  6. Haemorrhoids
  7. Infant Colic
  8. Mild Cystitis

Minor illnesses suitable for self care:

  1. Contact Dermatitis
  2. Dandruff
  3. Diarrhoea (Adults)
  4. Dry Eyes/Sore tired Eyes
  5. Earwax
  6. Excessive sweating (Hyperhidrosis)
  7. Head lice
  8. Indigestion and Heartburn
  9. Infrequent constipation
  10. Infrequent Migraine
  11. Insect bites and stings
  12. Mild Acne
  13. Mild Dry Skin/Sunburn
  14. Mild to Moderate Hay fever/Allergic Rhinitis
  15. Minor burns and scalds
  16. Minor conditions associated with pain, discomfort and/fever. (e.g. aches and sprains, headache, period pain, back pain)
  17. Mouth ulcers
  18. Nappy Rash
  19. Oral Thrush
  20. Prevention of dental caries
  21. Ringworm/Athletes foot
  22. Teething/Mild toothache
  23. Threadworms
  24. Travel Sickness
  25. Warts and Verrucae

Items of low clinical effectiveness:

  • Probiotics
  • Vitamins and minerals.

The consultation will not affect prescribing of items for longer term or more complex conditions or where minor illnesses are symptomatic or a side effect of something more serious.

The consultation recommends that for each condition NHS England would make one of the following recommendations to CCGs:

  • Advise CCGs to support prescribers that a prescription for treatment of [condition] should not routinely be offered in primary care, as the condition is self-limiting and will clear up on its own without the need for treatment.
  • Advise CCGs to support prescribers and patients that a prescription for treatment of [condition] should not routinely be offered in primary care, as the condition is appropriate for self-care.

In the case of vitamins/minerals and probiotics the following recommendation is proposed for consultation:

  • Advise CCGs to support prescribers that [item] should not be routinely prescribed in primary care due to limited evidence of clinical effectiveness.

A condition that is suitable for self-care does not require medical advice and can be treated with items that can easily be purchased over the counter from a pharmacy.

To manage increasing demand, the NHS promotes self-care where possible for minor health concerns and is highlighting:

  • The normal length of time that it takes for a self-limiting condition, such as a cough or cold, or a virus, to clear up of its own accord (usually 1-2 weeks).
  • That it’s more cost-effective to the NHS and often quicker to seek advice from local pharmacists than GPs.
  • That buying over the counter products for minor, acute conditions saves the NHS a great deal of money.

If a person needs advice to be able to self-care – for instance, if they’re not sure if their condition is minor, or one that goes away of its own accord, or they need clinical advice on how to relieve symptoms – the NHS advises they visit a local pharmacy.

NHS England will initially consider that the cases below are examples of exceptions which may apply to the proposed restrictions:

  • 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 ailment.
  • Circumstances where the prescriber believes that in their clinical judgement exceptional circumstances exist that warrant deviation from the recommendation to self-care.
  • Patients where the clinician considers that their ability to self-manage is compromised as a consequence of social, medical or mental health vulnerability to the extent that their health and/or wellbeing could be adversely affected if left to self-care.

For more information see: