Background

Over-the-counter products can be bought without a prescription from a pharmacy.

• Some over-the-counter medications are only sold after discussion with the pharmacist, whereas other medicines can often be found in supermarkets or health stores.
• These types of items are for conditions which are self-limiting. (A condition that resolves on its own, and has no long-term effects on health)
• NHS England advises these should be bought over the counter where possible, not prescribed, to support patients in self-care of minor ailments. It also saves the NHS approximately £569 million annually which can be reinvested into other forms of care.

Difficult Conversations

Every year the local ICB expects us to reduce the spending on medication which doesn’t need a prescription to purchase, even if the patient is exempt from prescription charges or has a pre-payment certificate.

The following ideas may be useful during conversations when a patient is insistent that they should receive a prescription, even if they don’t meet the criteria:

• Pharmacy first scheme may give medication at no cost to the patient, if eligible
• Many items will be available from supermarkets, and high-street discount stores
• The issue is self-limiting, and medicine isn’t always necessary

Which Conditions Shouldn’t be Prescribed For?

If the condition is suitable for self-care or is self-limiting:

• Refer to the PrescQIPP Quick Reference Guide for advice to give, exceptions, examples of medications, and any OTC restrictions
• Signpost the patient to a local pharmacy, and provide appropriate self-care advice
• Alternatives for patients who aren’t able to or don’t want to go to local pharmacies include mobile apps or websites where medication can be ordered. For example: Healistic, Pharmacy2u, or Well are all solutions that work well locally and deliver medications directly to patients.
• Patients can be directed to nhs.uk or patient.co.uk

as a general rule, if a medication can be bought OTC, then we should not be prescribing. Examples of these common medicines include:

• Vitamin D and other vitamins
• antihistamines
• Coughs and cold remedies
• Pain medication for acute symptoms
• emollients for dry skin
• eye drops for dry eyes - e.g Hylo-Tears, Hypromellose

During medication reviews, the pharmacist should be having these conversations with patients, taking the medication off repeat and directing them to their pharmacy/health store to purchase. Additionally, for certain patients who are exempt from prescription charges, they can get certain medications free of charge via the pharmacy first scheme.

Pharmacy First Scheme

Patients may wish to call in advance to ensure the service is available

• Southwark Participating Pharmacies
• Lambeth Participating Pharmacies
• Lewisham Information (Currently no list of participating pharmacies)