Over the counter medicines position statement

Position statement for prescribing preparations available to buy over the counter (OTC) for self-care. 

NHS Enfield Clinical Commissioning Group (CCG) is committed to delivering best value by ensuring that we use our resources well. Therefore to help us to support the cost effective, evidence based use of medicines, Enfield CCG no longer supports the routine prescribing of health supplements and medications that can be bought over the counter for self-limiting, short-term illnesses and minor conditions.

By managing minor health needs through self-care, it will help to ease the pressure on the NHS. Self-care is about avoiding becoming ill and seeking help when needed. This is line with the NHS England Guidance for CCGs. 'Conditions for which over the counter medicines should not be routinely prescribed in primary care': https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

What treatments and preparations are included?

  • Pharmacy Only (P) and General Sales Lists (GSL) treatments that can be purchased over the counter from a pharmacy with or without advice.
  • GSL treatments (including a patient information leaflet) that can be purchased from other retail outlets such as supermarkets, petrol stations, convenience and discount stores.
  • Treatments that are used to treat a condition that is considered to be self-limiting and so does not need treatment as it will heal/resolve by itself; and/or
  • Treatments that are used to treat a condition which lends itself to self-care, i.e. that the person suffering does not normally need to seek medical care and/or treatment for the condition.

Examples of treatments available over the counter which should no longer be routinely prescribed on the NHS in Enfield: (This list is not exhaustive)

Our list: 

  • Acne treatment
  • Analgesic/pain relief treatment (short term pain, fever, headache, muscle/joint injury, infrequent migraine)
  • Anti-inflammatory gels e.g. ibuprofen for short term use
  • Anti-fungal treatment (athlete’s foot, oral and vaginal thrush, ring worm, dandruff)
  • Antiperspirant treatment (excessive sweating)
  • Antiseptic creams and treatment for minor burns and scalds
  • Cold sore treatment
  • Colic treatment
  • Constipation treatment for short term use
  • Cough, cold and sore throat treatment
  • Cradle cap treatment
  • Diarrhoea treatment for short term use
  • Ear wax remover
  • Emollient bath oils and shower gels
  • Eye treatments/lubricating products (Conjunctivitis/ dry eyes)
  • Fluoride containing products for prevention of dental caries
  • Haemorrhoid (piles) treatment
  • Hayfever treatment
  • Head lice treatment
  • Herbal and complementary treatments
  • Homeopathic preparations
  • Indigestion and heartburn (dyspepsia) treatment
  • Mild cystitis treatment
  • Moisturising Creams, gels, ointments and balms for dry skin with no diagnosis.
  • Mouth ulcer treatment and treatment for teething
  • Mouthwash e.g. Corsodyl 
  • Nappy rash treatment
  • Probiotics
  • Rubefacients
  • Sunburn treatment
  • Suncream
  • Threadworm treatment
  • Topical steroid treatment for insect bites/stings, contact dermatitis, nappy rash
  • Travel sickness treatment
  • Vitamins and minerals including low dose Vitamin D and Lutein and antioxidants
  • Wart and verruca treatment 

What general exclusions apply?

  • Medicines that can only be obtained with an NHS prescription - Prescription Only Medicines (POM)
  • Where an OTC medicine is outside of its marketing authorisation, also known as “off-label use” or “unlicensed use”. For example when it is not licensed for use during pregnancy or where age or existing medical condition restrictions apply.
  • Where an OTC medicine is being prescribed for a long-term (chronic) condition e.g. regular analgesia in osteoarthritis.
  • Frail or housebound patients.
  • Where there are possible safeguarding concerns including, but not limited to, children, where there might be concerns that treatment might otherwise not be provided.

Guidance for prescribers
General Medical Council (May 2013) guidance 'Good practice in prescribing and managing medicines and devices' states the following:

  • “‘Prescribing’ is used to describe many related activities, including supply of prescription only medicines, prescribing medicines, devices and dressings on the NHS and advising patients on the purchase of over the counter medicines and other remedies”.
  • The Self Care Forum has produced numerous resources that can be used by healthcare professionals to help support people to self-care.

Patients should be advised that:

  • Community pharmacists can offer advice on how to manage short term illnesses and minor conditions, when to seek medical advice, and what to take if they take other medications. Patients do not need to make an appointment to see the pharmacist, and many pharmacies are open late nights and at the weekend.
  • If their problem is more serious and needs the attention of another healthcare professional such as their GP, the pharmacist will advise them on this.
  • The NHS recommends everyone keeps a well-stocked medicine cabinet with self- care medicines. Find out more here: https://www.nhs.uk/live-well/healthy-body/your-medicine-cabinet/

Try to ensure your medicine cabinet has all the basics:

  1. Painkilllers, such as paracetamol or ibuprofen
  2. Antihistamine for allergies
  3. Bandages
  4. Rub-on anti-inflammatory painkillers
  5. Oral rehydration salts
  6. Indigestion remedies
  7. Laxatives
  8. Anti-diarrhoea medicine
  9. Cream or spray to treat insect bites and stings or cuts and grazes
  10. Plasters and dressings
  11. A thermometer (digital, underarm and or ear thermometer)

Make sure medicines in your cabinet are still okay to use.  If medicines are past their use-by date, do not use them. Always keep medicines out of the reach and sight of children.

What if my child needs medicines while at school?
Write to the school giving permission for your child to take the medicine.  Guidance from the Department of Education makes it clear that a child can take non-prescription self-care medicines with written permission from a parent or guardian.  It is not necessary for GPs to write to schools to confirm that it is appropriate to administer self-care medicines.

The age at which children are ready to take their own medicines varies. As children grow and develop, they should be encouraged to participate in decisions about their medicines and take responsibility for their own medicines.