We won’t be able to prescribe the below , they are available OTC –
- probiotics
- vitamins and minerals, except:
- when the patient has a medically diagnosed deficiency, including for those patients who may have a lifelong or chronic condition, or have undergone surgery that results in malabsorption. Continuing need should however be reviewed on a regular basis. Maintenance or preventative treatment is not an exception
- calcium and vitamin D for osteoporosis
- prescription-only vitamin D analogues such as alfacalcidol
- malnutrition including from alcoholism )
- patients suitable to receive Healthy Start vitamins, which are available to pregnant and breastfeeding people, people with a child under 1 year old, and children under the age of 4 (note: this is not on prescription but commissioned separately).
Self-limiting conditions
Recommendation
Do not prescribe unless the patient has:
- symptoms that suggest the condition is not minor
- ‘red flag’ symptoms (for example, indigestion with very bad pain).
Items to which the recommendation applies
The recommendation applies to over the counter (OTC) items used to treat the following:
- acute sore throat
- infrequent cold sores of the lip – the recommendation does not apply to immunocompromised patients
- conjunctivitis
- coughs, colds and nasal congestion
- cradle cap – the recommendation does not apply if the condition is not improving and is causing the infant distress
- haemorrhoids
- infant colic
- mild cystitis.
Minor conditions suitable for self-care
Recommendation
- managing a long-term condition (for example, regular pain relief for chronic arthritis or treatments for inflammatory bowel disease)
- treating more complex forms of minor illnesses (for example, severe migraines that are unresponsive to OTC medicines)
- managing presentations of symptoms that suggest the condition is not minor
- ‘red flag’ symptoms (for example, indigestion with very bad pain)
- patients with complex conditions (for example, immunosuppressed patients)
- treating an adverse effect or symptom of a more complex illness
- treating a minor condition suitable for self-care that has not responded sufficiently to an OTC item
- circumstances where the prescriber’s clinical judgement is that these are exceptional and warrant deviation from the recommendation to use self-care
- individual patients where the prescriber considers that the patient’s ability to self-care is compromised because 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
- circumstances where the product licence does not allow the item to be sold OTC to certain groups of patients. These may vary by medicine, but could include babies, children and/or women who are pregnant or breastfeeding. Community pharmacists will be aware of what these are and can advise accordingly.
Being exempt from paying a prescription charge does not automatically warrant an exception to the guidance. Consideration should also be given to safeguarding issues.
Items to which the recommendation applies
The recommendation applies to OTC items used to treat the following conditions:
- mild irritant dermatitis
- dandruff
- diarrhoea – the recommendation to not prescribe does not apply to children
- dry eyes or sore tired eyes
- earwax
- excessive sweating
- head lice
- indigestion and heartburn
- infrequent constipation
- infrequent migraine
- insect bites and stings
- mild acne
- mild dry skin
- mild to moderate hay fever or seasonal rhinitis
- minor burns and scalds
- minor conditions associated with pain, discomfort or fever
- mouth ulcers
- nappy rash
- oral thrush
- prevention of dental caries
- ringworm or athlete’s foot – the recommendation to not prescribe does not apply in cases of lymphoedema or history of lower limb cellulitis
- sunburn due to excessive sun exposure
- sun protection – the recommendation to not prescribe does not apply in cases of Advisory Committee on Borderline Substances approved indication of photodermatoses, where skin protection should be prescribed
- teething or mild toothache
- threadworms
- travel sickness
- warts and verrucae