The real cost of over the counter prescriptions


NHS England recently published its guidance for CCGs on the over the counter (OTC) items which should not be routinely prescribed in primary care writes Deborah Evans. Whilst items have not been ‘blacklisted’, many patients will not have access to these medicines because they are unable to afford them.

The impact

There are strong arguments from NHS England for restricting prescribing.

In the year prior to June 2017, the NHS spent approximately £569 million on prescriptions for medicines, which could otherwise be purchased OTC from a pharmacy or other outlets. The medicines chosen include items for conditions that are considered self-limiting or where self-care can happen without needing to see a doctor. The items identified in the list can frequently be purchased at a lower cost than the price paid by the NHS and in some cases, there is little evidence of clinical effectiveness.

There are however, certain scenarios where patients should continue to have their treatments prescribed, outlined within the guidance.

The implications

Implementing this guidance will require CCGs to make difficult decisions about how to spend the NHS budget and further prioritisation when it comes to patient treatment. Healthcare professionals, including doctors and pharmacists, will have potentially challenging discussions with patients who have been receiving these items without restriction. All healthcare professionals will need to provide patients with the right information and how to access the support they need, including being alert to ‘red flag’ symptoms.

Effective implementation

I have some concerns about the guidance. As patients have products removed from their prescriptions, there may be a tendency for POM equivalents to be given instead, increasing the costs to the NHS. Some patients may seek to ‘self-care’ online or from an outlet where professional advice and support is unavailable. Potential worsening of their condition or developing symptoms of concern may go unnoticed. For this guidance to be implemented safely, integration of pharmacy within the system and communication between healthcare professionals and with patients is essential.

Deborah Evans is Managing Director of Pharmacy Complete, a specialist consultancy and training company working with pharmacy. Go to