Important announcement from Audlem Medical Practice

Changes to Prescribing

Items that are available over the counter at Pharmacies

Between December 2017 and February 2018 NHS England had an open consultation which has led to new guidance regarding the prescription of medicines available over the counter. We have discussed this with our Clinical Commissioning Groups Medicines Management Team, at the local Prescribing Leads Meeting, with our GP Network colleagues and as a Practice we feel we have an obligation to follow this relevant guidance (Regulation 94 National Health Service General Medical Services Contracts) which has the intention of redirecting scarce NHS funding to areas of most need and clinical benefit.

Attached is a list of treatments that are available over the counter from pharmacies and other retailers that we propose to stop prescribing from 1st November 2019. We have reviewed the full NHS England guidance and conditions/medications listed, and removed certain items that we feel it may be appropriate to prescribe, as well as adding exceptions that we believe are appropriate due to clinical need. Before we implemented this new policy we also felt it would be right to inform our patients in advance of the change and consult locally on their views. We would suggest that the only exceptions, other than for the clinical reasons indicated in the list, would be patients on our practice palliative care register and patients for whom the required treatments are not available without a prescription due to pharmacy restrictions.

Should you wish to let us know your views about this proposed change, with any constructive comments or suggestions, then please either write to Mrs Diana Ryan at the practice, or send an email to audlem.practice@nhs.net or via your Patient Participation Group before 5pm on Thursday 10th October. We will then review all the feedback received and prepare a response to common and important themes raised and finalise the Practice policy on this.

We hope that you understand that we are not suggesting any of the treatments on the list are not valuable to certain individuals, but that limited NHS funding cannot cover everything and should be directed to areas of most clinical need and impact.

With best wishes

Dr Pete Leftwick
Dr Nancy Verso
Dr Dave Holden

Over the counter items available at Pharmacies

The following items (but see exceptions) will no longer be prescribed with effect from November 1st 2019

1) Vitamins/multivitamins - exceptions:
.. a) vitamin C to aid iron absorption on consultant advice
.. b) vitamin B strong in alcoholic liver disease (<1 year only, on consultant advice)
.. c) folic acid 5mg (NOT 400mcg)
.. d) calcium and vitamin D preparations for osteoporosis prevention/treatment
2) Lozenges or sprays for sore throats
3) Topical antiviral cream for 'cold sores'
4) Cough linctus, saline nose drops, vapour rubs, cold/flu remedies
5) Paracetamol - exceptions:
.. a) Short term use – 6 or more a day for >1 week up to 8 weeks
.. b) Long term use – 4 or more a day
6) Emollients – exceptions:
.. a) Eczema requiring regular or intermittent steroid cream use or immunosupressants
.. b) Varicose eczema with a history of previous ulceration/cellulitis or high risk of same
.. c) Psoriasis
.. d) Barrier creams
7) Simethicone/dimeticone/infracol for colic in babies
8) Antifungal or antidandruff shampoos - exceptions:
.. a) one off short term use for seborrhoeic dermatitis
9) Anti-diarrhoea medication eg loperamide/codeine/rehydration sachets - exceptions:
.. a) Long term bowel conditions causing chronic diarrhoea
10) Ear drops for wax eg olive oil, sodium bicarbonate
11) Laxatives - exceptions:
.. a) Ispaghula husk in diverticular disease
.. b) Regular usage > alternate days
12) Antacids - exceptions:
.. a) Patients appropriately investigated and symptoms not controlled on maximal treatment
13) Aluminium chloride anti-antiperspirant
14) Topical creams for bites, stings, mild transient inflammation, superficial infection and wound care (antiseptics), sun protection and mild sun burn
15) Topical treatments for acne - exceptions
.. a) creams containing retinoid or antibiotic
16) Ibuprofen - exceptions
.. a) Short term use – 1200mg or more a day for >1 week up to 8 weeks
.. b) Long term use – 800mg or more a day
17) Mouthwashes and toothpastes - exceptions
.. a) Short term mouthwash use eg post surgery/trauma
18) Antifungal/yeast creams and sprays - exceptions:
.. a) recurrent intertrigo/thrush
.. b) immunosupressed patients
19) Topical treatments for warts and veruccae
20) Medication for travel sickness
21) Treatment for threadworms
22) Treatment for head lice
23) Topical treatment for teething/toothache
24) Hayfever treatment including seasonal antihistamines, nasal sprays and eye drops
25) Probiotics and antispasmodics for bowel symptoms – exceptions
.. a) regular use of antispasmodic for IBS > alternate days
26) Sodium/potassium citrate for cystitis
27) Treatment for mild conjunctivitis

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