Guidance released today by NHS England (NHSE) has called for community pharmacists to play a role in reducing prescribing of over the counter (OTC) items for minor and self-limiting conditions.

Though it acknowledged that some patients ‘may not be able to self-care’ for reasons including ‘medical, mental health or social vulnerability’.

It therefore recommended integrated care boards (ICBs) ‘consider implementing services and pathways that mitigate potential negative effects on patients at risk of health inequalities from this guidance’.

This follows calls from several pharmacy bodies to expand Pharmacy First to include the supply of OTC medicines when required.

The guidance said that OTC items should not be prescribed for self-limiting conditions and those suitable for self-care, except in more complex, severe or long-term cases. Probiotics and vitamins and minerals, except in certain circumstances, also should not be prescribed.

‘Community pharmacists can play an important role in reducing prescribing of OTC items for minor and self-limiting conditions,’ the NHSE guidance added.

It also suggested that community pharmacists can advise on circumstances where the product licence does not allow the item to be sold OTC to certain groups of patients.

And it highlighted that under the recently introduced Pharmacy First service, community pharmacists can advise patients on self-care or recommend an OTC item for purchase, as well as supplying certain OTC and prescription-only medicines via clinical protocol and patient group directions if necessary.

‘This frees up GP appointments and emergency departments to focus on patients who need their help most and ensures that patients are not inappropriately prescribed OTC items for minor and self-limiting conditions,’ the guidance said.

But it added: ‘Some patients may not be able to self-care due to significant medical, mental health or social vulnerability. ICBs should consider implementing services and pathways that mitigate potential negative effects on patients at risk of health inequalities from this guidance.’

James Davies, director for the Royal Pharmaceutical Society (RPS) in England, commented: 'Pharmacists play a key role in supporting self-care and reducing overprescribing. However, self-care should not mean ‘no care’, and no patient should face a financial barrier to accessing the medicines they need.

And he noted the document's statement that 'the recommendations do not override the individual responsibility of healthcare professionals to support their patients in agreeing the most appropriate treatment options for them, through taking a shared decision-making approach.'

In addition to ICBs needing to ensure that the policy 'does not risk widening health inequalities', Mr Davies said that local pharmacy leaders 'will need the time, resource and support to help develop pharmacy services that work for patients.'

And Malcolm Harrison, chief executive of the Company Chemists' Association (CCA) said that the longstanding NHSE policy of reducing OTC prescribing 'has not been successfully implemented across the country due to variation in patient needs, particularly in areas of higher deprivation.'

He added: 'We know from evidence in Wales that NHS-funded access to OTC medicines is often used most by those living in areas of higher deprivation.

'Expanding Pharmacy First to include these medicines would allow the NHS to divert patients who need access to OTC medicines out of general practice, and target limited NHS resources to those who need it most.'

A ‘manifesto for community pharmacy’ recently released by four pharmacy bodies including the RPS called for the roll-out of an enhanced Pharmacy First service in England that would allow community pharmacists to supply over-the-counter medicines when required, as is already the case in Scotland, Wales, and some parts of England on a locally commissioned basis.

A self-care scheme to make OTC medications free from a pharmacy to low income patients was proposed by Community Pharmacy North East London in July 2022, following an increase in patients saying that they could not afford to purchase the over-the-counter medicines that they were recommended.

When patients were unable to pay, pharmacies had to refer them to general practice to get a prescription so that they would be eligible to receive the items for free on the NHS – causing ‘rigmarole’ for the patient and ‘a waste of so many NHS resources’ including GP time, according to Community Pharmacy North East London chief executive Shilpa Shah.

The locally commissioned service was eventually signed off in November of last year.