Prepare for a surge in over-the-counter (OTC) sales. That’s if an ever growing number of clinical commissioning groups (CCGs) have their way.
At the last count, at least 19 have been turning the thumbscrews on GPs to stop prescribing medicines which are available over-the-counter.
As a result, we GPs are finding ourselves caught between a rock, a hard place, and an even harder place – triangulated amid the competing tensions of CCG pressure, disgruntled patients and our contractual and General Medical Council (GMC) obligations.
And CCGs aren’t restricting the pressurising to OTC treatment – many are extending the concept to medications with a weak or non-existent evidence base, or which offer poor value-for-money.
Add to this the complicating factors that many patients get their prescriptions free, that some pharmacists encourage them to beg their GP for a script and that different docs will adopt different stances according to their degree of thick-skinnedness, and you have the potential for confusion and chaos.
Except it’s not potential, it’s actually happening.
We live in hope that NHS England’s current consultation on rationalising and restricting prescribing will provide clear national guidance – and, thereby, offer consistency to patients and protection to prescribers.
Taking firm decisions to blacklist centrally rather than leaving policy to local whimsy would be a step in the right direction. But even then, a consensus will be tricky.
Blacklisting OTC paracetamol, for example, is fine to stop parents using the NHS to subsidise a stock childhood medicine cabinet item, but less so in the case of an elderly patient with genuinely disabling arthritis.
Besides, we’ve seen recently how prohibitively priced OTC treatment can be, as any cash-strapped emergency-contraception-seeking woman will tell you.
Meanwhile, we just have to muddle on through – pinning our hopes on pinned-up notices saying, ‘Please don’t ask for OTC treatment as refusal may offend.’ Or provoke a complaint.