NHS England have produced a list of items which should not be prescribed in general practice and can be bought over the counter in a local shop or pharmacy. As a result, NHS Dorset has asked that GP teams no longer prescribe items for the conditions listed below. This allows GP teams to focus on caring for people who have more complex needs.
- Acute sore throat
- Infrequent cold sores of the lip
- Conjunctivitis
- Coughs, colds and nasal congestion
Cradle cap
Haemorrhoids
Infant colic
Mild cystitis
Mild irritant dermatitis
Dandruff
Diarrhoea
Dry eyes
Earwax
Excessive sweating
Head lice
Indigestion and heartburn
Infrequent constipation
Infrequent migraine
Insect bites and stings
Mild acne
Mild dry skin/sunburn
Mild – mod hayfever/allergic rhinitis
Minor burns and scalds
Minor conditions associated with pain, discomfort and/fever
Mouth ulcers
- Nappy rash
Oral thrush
Prevention of dental caries (toothpaste)
Probiotics
Ringworm/athlete’s foot
- Teething/mild toothache
- Threadworm
Travel sickness
Warts and verrucae
Vitamins and minerals
Topical fungal nail treatments
Dry eyes
Where possible, cease prescribing for mild/moderate dry eye syndrome or sore tired eyes and encourage patients to buy products over the counter. If a product is deemed necessary, prescribe according to the Dorset guidance.
Most cases of dry eye syndrome/disease self-resolve. Self-care advice and treatment options are available over the counter and therefore prescriptions should not routinely be offered in primary care.
Use the SystmOne searches provided to identify patients prescribed:
- Products for mild dry eye which could be purchased over the counter
Advise patients that mild/moderate dry eye syndrome or sore tired eyes can be self-managed with good eyelid hygiene and avoidance of environmental factors. Recommend that lubricant eye treatments are available over the counter in a range of drops, gels and ointments.
Communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F4 Low acuity prescribing OTC
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing for dry eyes. These are available to buy from a pharmacy and should not routinely be prescribed. Your prescription for this item has been stopped. If you would like to continue with this treatment, NHS Dorset recommend it is purchased over the counter. If you would like to discuss this change further, please contact the surgery’s medicines team.”
Template patient letter – dry eyes OTC
Cold sore cream
Identify all repeat primary care prescriptions for aciclovir 5% 5g and cease prescribing.
Antiviral creams can be purchased from a pharmacy without a prescription, and if used correctly can ease symptoms and speed up the healing time. To be effective, these treatments should be applied as soon as the first signs of a cold sore appear. Using an antiviral cream after this initial period is unlikely to have much effect
Use the SystmOne search provided to identify repeat prescriptions for aciclovir 5% 5g. Deprescribe and communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F4 Low acuity prescribing OTC/Cold Sore
Template patient text message:
“We are writing to all the patients currently prescribed cold sore cream. NHS England has asked all GPs to cease prescribing this as the condition is appropriate for self-care using products bought from a pharmacy or supermarket. We have stopped your prescription, but please contact the surgery medicines team should you need further support.”
Fungal nail treatments
Topical fungal nail treatment deprescribing
Review all prescriptions for amorolfine 5% medicated nail lacquer or tioconazole 283mg/ml medicated nail lacquer and review suitability of on-going supply.
Topical fungal nail treatments are currently non-formulary. These treatments have a low cure rate, and treatment is required for three to six months.
Topical therapy should only be considered if the infection is mild and superficial or where oral treatment is contra-indicated or not tolerated. In these cases, patients should be advised to purchase over the counter (OTC) amorolfine 5% nail lacquer for the treatment of a maximum of 2 nails.
Use the SystmOne search provided to identify patients, review prescriptions, and consider deprescribing.
Communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F4 Low acuity prescribing OTC
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing for topical fungal nail infections. Your treatment is currently classed as non-formulary in Dorset because if offers a low cure rate, and as such should not be routinely prescribed. If you would like to continue with this treatment, NHS Dorset recommend it is purchased over the counter. If you would like to discuss this change further, please contact the surgery.”
Dorset Formulary – antifungal treatments
OpenPrescribing – antifungal nail treatment prescriptions in Dorset
Indigestion and heartburn
Review all repeat prescriptions for indigestion & heartburn medicines which can be bought as general sales list or pharmacy medicines and review suitability for on-going supply.
NHS England has identified indigestion & heartburn as conditions which should be managed with self-care. NHS Dorset has asked GP practices to stop prescribing these items.
Use the SystmOne search provided to identify prescriptions for review and communicate changes to affected patients.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F4 Low acuity prescribing OTC
Template patient text message
“NHS England has highlighted that remedies for indigestion & heartburn should no-longer be be supplied on a prescription, but instead should be bought from a shop or pharmacy. As such NHS Dorset has asked all GP teams to cease prescribing these items. If you would like to continue with these treatments please purchase them over the counter. This is to help the NHS budget to go further. We have updated your prescription but if you have any concerns, please contact the surgery.”
Mild dry skin
Cease prescribing topical skin preparations for mild dry skin. Instead, advise patients to buy these items over the counter or refer patients to their pharmacist.
NOTE: There are certain scenarios where patients should continue to have their treatments prescribed and these exceptions are outlined in the OTC guidance link below.
As per NHS England guidance, GPs should not prescribe items for patients that can be safely and appropriately purchased from a community pharmacy.
Run the SystmOne search provided to identify the patients who are receiving these items on repeat prescription.
Communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F4 Low acuity prescribing OTC
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of mild dry skin and sunburn preparations. These are available to buy from most supermarkets and pharmacies and therefore should not be routinely prescribed. If you would like to continue with this treatment, NHS Dorset recommend it is purchased over the counter. If you would like to discuss this change further, please contact the surgery.”
Emollients briefing (PrescQIPP)
Sunburn
Identify all repeat primary care prescriptions for suncream and cease prescribing.
NHS England advises that most people manage sun burn symptoms themselves or can prevent symptoms developing, using sun protection, by using products that can easily be bought in a pharmacy or supermarket.
Use the SystmOne search provided to identify repeat prescriptions for suncream. Deprescribe and communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F4 Low acuity prescribing OTC/Suncream
Template patient text message:
“We are writing to all the patients currently prescribed suncream. NHS England has asked all GPs to cease prescribing this as the condition is appropriate for self-care using products bought from a pharmacy or supermarket. We have stopped your prescription, but please contact the surgery should you need further support.”
Mild – Mod hay fever/allergic rhinitis
Cease prescribing of hay fever/allergic rhinitis preparations for mild to moderate conditions. Instead, advise patients to purchase these items over the counter.
NOTE: There are certain scenarios where patients should continue to have their treatments prescribed and these exceptions are outlined in the OTC guidance link below.
As per NHS England guidance, GPs should not prescribe items for patients that can be safely and appropriately purchased from a community pharmacy.
Run the SystmOne search provided to identify the patients who are receiving these items on repeat prescription.
Communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F4 Low acuity prescribing OTC
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of medicines for mild to moderate hay fever. These are available to buy from most supermarkets and pharmacies and therefore should not be routinely prescribed. If you would like to continue with this treatment, NHS Dorset recommend it is purchased over the counter. If you would like to discuss this change further, please contact the surgery.”
Minor conditions associated with pain, discomfort and fever
Cease prescribing for minor conditions associated with pain, discomfort and/or fever. e.g. aches and sprains, headache, period pain and back pain.
As per NHS England guidance most cases of conditions such as headaches, period pain, mild fever and back pain, can be treated at home with over-the-counter painkillers and lifestyle changes, such as getting more rest and drinking enough fluids. Patients should be encouraged to keep a small supply of OTC analgesics in their medicines cabinets at home so they are able to manage minor conditions at home without the need for a GP appointment.
NHS Dorset have asked GP teams to no-longer prescribe medication for these conditions.
Run the SystmOne search provided to identify the patients who are receiving these items on repeat prescription.
Communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs / PQS Finance 24 25 / F4 Low acuity prescribing OTC
Template patient text message:
“NHS Dorset has asked all GP teams to review prescribing of medications for minor conditions associated with pain & discomfort. Instead, these are available to purchase from supermarkets and pharmacies. If you would like to continue with this treatment, NHS Dorset recommend it is purchased over the counter. If you would like to discuss this change further, please contact the surgery.”
NHS UK – living well with pain
NICE CKS mild to moderate pain
Prevention of dental caries (toothpaste)
a) Review prescriptions for high strength 5000ppm sodium fluoride toothpaste & only prescribe for patients who are undergoing, or who have undergone radiotherapy or treatment with the Poole Hospital head and neck cancer team. For all other indications deprescribe and communicate changes to the patients involved.
b) Review prescriptions for lower strength sodium fluoride toothpaste and deprescribe. These can be purchased over the counter. Communicate changes to the patients involved.
Only high strength sodium fluoride toothpaste should be prescribed, and then, only for patients who are undergoing, or have undergone radiotherapy or treatment with the Poole Hospital head and neck cancer team.
For all other indications, lower strength fluoride toothpaste is acceptable and should be purchased.
Use the SystmOne searches provided to identify prescriptions for fluoride toothpaste and indication for use. Communicate the changes to patients involved.
SystmOne searches: SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F4 Low acuity prescribing OTC
Template patient letter – fluoride toothpaste – non H&N indication
Template patient text message – fluoride toothpaste – non H&N indication
“NHS Dorset has asked all GP teams to review prescribing of high fluoride toothpaste and only prescribe it for patients who have undergone/are undergoing head & neck cancer treatment. Standard strength fluoride toothpaste is suitable for other indications and can be purchased from a pharmacy and some supermarkets. If you would like to continue with this treatment, NHS Dorset recommend it is purchased over the counter. If you would like to discuss this change further, please contact the surgery.”
Template patient letter – fluoride toothpaste – non-formulary
Template patient text message – fluoride toothpaste – non-formulary
“We are writing to all the patients currently prescribed non-formulary fluoride toothpastes. NHS England has asked all GPs to cease prescribing these as they can be purchased from a pharmacy or supermarket. We have stopped your prescription, but please contact the surgery should you need further support.”
Vitamins and minerals
Cease prescribing vitamins and minerals which are available without a prescription (are available for purchase as an over the counter medicine), unless they are being supplied for a medically diagnosed deficiency.
As per NHS England guidance there is insufficient evidence to demonstrate the clinical effectiveness of vitamins and minerals. They are essential nutrients which most people can and should get from eating a healthy, varied and balanced diet. As such, NHS Dorset have asked GP teams to no-longer prescribe these items.
NOTE: this does not apply to prescription only supply of vitamin D analogues such as alfacalcidol or health start vitamins which are supplied without a prescription.
Run the SystmOne search provided to identify the patients who are receiving these items on repeat prescription.
Communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F4 Low acuity prescribing OTC
Template patient text message: “NHS Dorset has asked all GP teams to review prescribing of vitamins & minerals which which are available to purchase from supermarkets and pharmacies. If you would like to continue with this treatment, NHS Dorset recommend it is purchased over the counter. If you would like to discuss this change further, please contact the surgery.”
