Over the counter medicines

NHS Birmingham and Solihull CCG's policy Conditions for which over the counter items should not routinely be prescribed in primary care is mostly made up of a list of clinical conditions where we are asking patients and prescribers to take a different approach. You can view the list of Conditions covered by this policy in the section below.

In the past, patients would sometimes consult a doctor or nurse in their GP practice and receive a prescription to treat one of these conditions. However, these conditions can usually be treated via self-care, which may involve talking to a pharmacist and possibly buying an over the counter product to help manage the condition.

This means that:

• Fewer appointments in general practice will be taken up dealing with conditions which are suitable for self-care
• Patients can take more control over their own health, using the skills of highly-trained community pharmacists if they wish to do so
• NHS resources can be re-focussed towards other treatments e.g. new medicines to prevent strokes, better medicines to improve breathing, a wider variety of treatments for diabetes.

All clinical commissioning groups in England will be implementing similar policies on over the counter medicines. You can find out more on the NHS website here.

The Conditions for which over the counter items should not routinely be prescribed in primary care policy covers the following conditions:

• Acute sore throat
• Conjunctivitis
• Coughs, colds and nasal congestion
• Cradle cap (seborrhoeic dermatitis – infants)
• Dandruff
• Diarrhoea (adults)
• Dry eyes/sore (tired) eyes
• Earwax
• Excessive sweating (hyperhidrosis)
• Haemorrhoids
• Head lice
• Indigestion and heartburn
• Infant colic
• Infrequent cold sores of the lip
• Infrequent constipation
• Infrequent migraine
• Insect bites and stings
• Mild acne
• Mild cystitis
• Mild dry skin
• Mild irritant dermatitis
• Mild to moderate hay fever/seasonal rhinitis
• Minor burns and scalds
• Minor conditions associated with pain, discomfort and/fever. (e.g. aches and sprains, headache, period pain, back pain)
• Mouth ulcers
• Nappy rash
• Oral thrush
• Prevention of dental caries
• Ringworm/athletes foot
• Sunburn
• Sun protection
• Teething/mild toothache
• Threadworms
• Travel sickness
• Warts and verrucae

Other items covered by the policy

• Probiotics
• Vitamins and minerals

The Conditions for which over the counter items should not routinely be prescribed in primary care policy applies to everyone. However, there are a range of exceptions included within it. Please see the section below Are there exceptions to the policy? for more information.

General exceptions to the policy:

There are certain scenarios where patients should continue to have their over the counter medicine prescribed and these are outlined below:

• Patients prescribed an over the counter medicine for a long term condition (e.g. regular pain relief for chronic arthritis or treatments for inflammatory bowel disease)
• For the treatment of more complex forms of minor illnesses (e.g. severe migraines that are unresponsive to over the counter medicines)
• For those patients that have symptoms that suggest the condition is not minor (i.e. those with red flag symptoms for example indigestion with very bad pain)
• Treatment for complex patients (e.g. immunosuppressed patients)
• Patients prescribed over the counter medicines to treat an adverse effect or symptom of a more complex illness and/or prescription only medication
• 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. 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 over the counter product
• Patients where the clinician considers that the presenting symptom is due to a condition that would not be considered a minor condition
• Circumstances where the prescriber believes that in their clinical judgement, exceptional circumstances exist that warrant deviation from the recommendation to self-care
• Individual patients where the clinician considers that their ability to self-manage is compromised as a consequence of medical, mental health or significant social vulnerability to the extent that their health and/or wellbeing could be adversely affected, if reliant on self-care. Consideration should also be given to safeguarding issues.

Being exempt from paying a prescription charge does not automatically warrant an exception to the guidance. The general exceptions do not apply for vitamins, minerals, probiotics and those self-limiting conditions where there is limited evidence of clinical effectiveness for the treatments used.

Specific exceptions to the policy:

• Condition-specific exceptions are included (if applicable) under the relevant item and/or condition.

These have been categorised as items of limited clinical effectiveness i.e. they provide little or no benefit to most people who take them. However, there is evidence that they are of benefit in some conditions and these are set out in the exceptions in the product-specific section of the Conditions for which over the counter items should not routinely be prescribed in primary care policy.

Vitamins and minerals exceptions:

• Treatment of medically diagnosed deficiency in patients with a life-long or chronic condition (which affects vitamin and/or mineral levels) or who have undergone surgery that results in malabsorption. Continuing need should be re-assessed on a regular basis
• Treatment of medically diagnosed deficiency (maintenance or preventative treatment in people other than those listed above is not an exception)
• Calcium and Vitamin D for osteoporosis
• Malnutrition, including alcoholism.

Probiotics exceptions:

• For the maintenance of antibiotic induced remission of ileoanal pouchitis in adults.

Other than for these exceptions, vitamins, minerals or probiotics should not routinely be prescribed. The general exceptions do not apply to these products.

Please see Are vitamins, minerals and probiotics included?

The Conditions for which over the counter items should not routinely be prescribed in primary care policy allows for treatment when a blood test has shown that a person has a very low level of Vitamin D. Your doctor or nurse will write a prescription for Vitamin D to bring the levels back up to normal. After this, you will be advised and encouraged to arrange for your own supply to keep blood levels up.

You can read the NHS guidance here, which also includes advice and guidance regarding specific patient groups such as babies, children and low income families.

• You can visit your local pharmacist for face-to-face advice on self care without the need for an appointment
• Call NHS111 24 hours a day, seven days a week for help and advice
• Advice is also available online from the NHS website.

Over the counter medicines are available from your local pharmacy, as well as from supermarkets and other shops.

There are a number of exceptions in the Conditions for which over the counter items should not routinely be prescribed in primary care policy. 

See Are there exceptions to the policy? for more details.

Age is not an exception to the Conditions for which over the counter items should not routinely be prescribed in primary care policy. However, you may meet one of the exception criteria in the policy. See Does the policy apply to everyone? and Are there exceptions to the policy? for more details.

There are a number of exceptions in the Conditions for which over the counter items should not routinely be prescribed in primary care policy. 

See Are there exceptions to the policy? for more details.

Exemption from prescription charges is not an exception to the Conditions for which over the counter items should not routinely be prescribed in primary care policy. However, you may meet one of the exemption criteria in the policy. See Does the policy apply to everyone? for more details.

Yes, age is not an exception to the Conditions for which over the counter items should not routinely be prescribed in primary care policy. However, you may meet one of the exception criteria in the policy. See Does the policy apply to everyone? and Are there exceptions to the policy? for more details.

There are a number of exceptions in the Conditions for which over the counter items should not routinely be prescribed in primary care policy. 

See Are there exceptions to the policy? for more details.

Some medicines can only be bought over the counter if the patient meets certain criteria. Please talk to your pharmacist and ask if this applies to you. If it does, the situation is covered by one of the exception criteria. See Are there exceptions to the policy? for more details.

Yes. Please ask your child’s school or nursery for an Administration of OTC medicines consent form. Further information is available by reading Administration of medicines in schools and early years settings guidance.

The Conditions for which over the counter items should not routinely be prescribed in primary care policy has a list of exceptions where over the counter medicines will continue to be prescribed. In this case, the exception below will apply:

"Patients prescribed an over the counter medicine for a long term condition (e.g. regular pain relief for chronic arthritis or treatments for inflammatory bowel disease)".

Yes. Pharmacists are highly-trained healthcare professionals who can provide advice on all aspects of medicines use.

There are lots of pharmacies in Birmingham and Solihull, many of which are open at weekends and late into the evening - you can find your nearest one here. If you have limited mobility, it may be possible to ask a friend or family member to buy routine over the counter medicines on your behalf.

If you are fully house-bound and have no other way of receiving the treatment you need, you may meet one of the exemption criteria in the Conditions for which over the counter items should not routinely be prescribed in primary care policy. See Are there exceptions to the policy? for more details.

Hospitals have been advised of the Conditions for which over the counter items should not routinely be prescribed in primary care policy and are expected to respect it.

Yes, they have been told about the Conditions for which over the counter items should not routinely be prescribed in primary care policy and asked to support it. We are advising people with the minor conditions listed in Conditions covered by this policy to visit their local pharmacy for advice. Please do not attend out of hours or A&E services just to try to get over the counter medicines.

Dentists and optometrists (opticians) have also been told about the policy and asked to support it.

The Pharmacy First scheme was discontinued earlier this year. Other similar schemes are under review.

Yes. The Conditions for which over the counter items should not routinely be prescribed in primary care policy will be reviewed by June 2020. However, it will be updated before that if there is a change in the clinical evidence underpinning the policy, a change in national guidance or some other important need for review.

You can contact the Complaints Team at NHS Birmingham and Solihull CCG by:

• Calling 0121 203 3313
• Emailing This email address is being protected from spambots. You need JavaScript enabled to view it.
• Write to: NHS Birmingham and Solihull Clinical Commissioning Group, Complaints Department, Attwood Green Health Centre, 4^th Floor, 30 Bath Row, Birmingham, B15 1LZ

More information is available on our Compliments, Concerns and Complaints page.