Interview: Michelle Riddalls on the future of OTC

Michelle Riddalls has been leading PAGB as CEO since 2020, and the impact of her work both within the organisation and the wider healthcare sector has been transformative. Aside from her job as an advocate for the over-the-counter (OTC) sector both nationally and internationally, she played an instrumental role in ensuring the continued supply of medicines to Northern Ireland, post Brexit, via her contribution to the implementation of the Windsor Framework. As her achievements are formally recognised with an OBE this week, she tells Saša Janković about her plans to reshape the OTC industry.

Saša Janković (SJ): We’ve seen the work you’ve done over the last five years at PAGB, Michelle – especially in being the voice of the OTC sector when it came to developing the Windsor Framework – so where are you setting your focus now?

Michelle Riddalls (MR): I’ve been concentrating on bringing together the DHSC, the MHRA and pharmacy associations to identify prescription-only medicines (POMs) suitable for reclassification to pharmacy (P), over-the-counter (OTC) or general sales list (GSL) status. This would mean patients could access more medicines in a quicker and more convenient way, reducing pressure on GPs and A&E services, saving the NHS money, and empowering people to self care to better manage their own health.

In fact, our 2023 report with Frontier Economics showed that OTC self-care already saves the NHS around £6.4 billion every year, so if we could reclassify just 5% of prescriptions, we could save a further £1.4 billion annually, simply by enabling people to treat self-limiting conditions like thrush, hayfever or eczema without needing a GP appointment.

SJ: What impact could this have on dispensing and prescribing?

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MR: I think reclassification gives pharmacists another tool in their armoury to help patients, even if they’re not independent prescribers. With Pharmacy First a lot of the current supply is done under PGDs, which can come with a lot of bureaucracy and time constraints. But when you’re supplying an OTC medicine you don’t have those same hurdles; it’s much more straightforward and accessible, both for the pharmacist and the patient.

It’s not about having to choose between prescribing and reclassification. The two approaches can work alongside each other. For example, when medicines are switched to OTC, companies usually provide training and resources to support pharmacists, which doesn’t always happen with prescribing. I was involved in the switch of Viagra and the contraceptive pill, and in both cases, a lot of support was put in place, and that can have a big impact. With Viagra in particular we saw that it helped engage more men in the healthcare system who might not have gone to their GP but felt comfortable accessing help through the pharmacy.

SJ: Do you think pharmacists are well enough informed about OTC, or does more work need to be done there and with GP practices as well?

MR: I think there’s a lot of really good information and resources out there for pharmacists and GPs about OTC products, especially from the companies behind the brands.

However, I do think there’s more to be done in terms of engagement – not just with pharmacy teams, but also with GP practices. The information might be available, but they say finding the time and space to sit down and access it is a challenge, especially in busy community settings. That’s something we, as PAGB or as industry, can’t necessarily solve, but we can continue to provide accessible, high-quality resources.

SJ: Would you say the increase in community pharmacy provision through Pharmacy First had a discernible impact on OTC sales?

MR: We’ve heard from some of the pharmacy associations and stakeholders that there’s been an uptick in OTC sales as a result of Pharmacy First, although we don’t yet have concrete figures to back that up. What we do know is that when people come into pharmacy and aren’t eligible for treatment under the service – if they don’t meet the criteria for antibiotics, for example – there’s still an opportunity to support them with self-care advice and OTC products.

That’s one of the key benefits of expanding access through Pharmacy First and reclassification: even if someone can’t be treated via a formal pathway, they can still walk away with something to help manage their symptoms. Plus OTC sales can offer financial benefits for pharmacies – especially when it comes to newly switched products, which often have good margins – and that can support the sustainability of the sector as a whole.

SJ: And looking ahead, what areas are growing in OTC and what are your future predictions around this market?

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MR: There are a few key areas I see growing in OTC, based on the data we get from sources like NielsenIQ (NIQ). Vitamins and supplements have been a major growth driver, along with probiotics, sleep support and, increasingly, weight management, which isn’t surprising given the interest around products like Wegovy and Mounjaro.

Looking ahead, I think self-diagnostics is a really exciting area. People are used to using tests at home, so I can see a future where someone could use a self-diagnostic kit, get a result, and then access an appropriate OTC medicine through a pharmacy without needing to see a doctor.

I’m also really interested in widening access to existing OTC products. A lot of switches that happened years ago were made with quite tight restrictions but now we’ve got decades of safety data so why not revisit those and see where we can expand indications or include a broader patient population? That’s a real opportunity to serve more people safely with products we already know work well.

SJ: I can’t let you go without asking your reaction to the publication of the new NHS 10 Year Plan – and where you see a role for preventative self care and OTC in that?

MR: I was really pleased to see the new NHS 10 Year Plan finally published, especially because we’d done a lot of work behind the scenes to ensure self care was recognised within it as a crucial part of moving from treatment to prevention, and from hospital to community care.

One of the things I was especially happy about was the plan’s commitment to integrating self care into the NHS app, with signposting to well-evidenced consumer healthcare products, and it’s also encouraging to see the plan highlight the consumer healthcare sector as part of the life sciences industry, as that kind of acknowledgement really matters.

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Now, the focus needs to shift to implementation, and we are ready to work with the Department of Health, MHRA and others to help bring that vision to life – because making self care a core part of the healthcare system isn’t just a win for the NHS, it’s a win for patients too.