Self Care

Self-care is widely acknowledged as an important solution to managing demand and keeping the NHS sustainable. Supporting people to self-manage common conditions such as coughs and colds could help bring down the 57 million GP consultations each year for minor ailments, a situation which costs the NHS approximately £2 billion and takes up to an hour a day on average for every GP.


Promoting the concept of self-care and increasing the awareness that there are alternatives to making GP appointments, or attendance at OOHs or A&E departments with minor conditions, will encourage patients to explore self-care in the future, so changing the culture of dependency on the NHS.

Derby and Derbyshire CCGs spent over £3Million in 2015/2016 on some of the medicines that are available to purchase over-the-counter (OTC). It is recognised that much of this cost is attributable to long-term or complex conditions, but considerable spend is also for conditions that may be considered suitable for self-care.


Removing medications for certain conditions from routine prescription releases money to treat conditions such as heart disease and diabetes and helps maintain financial balance in the health economy. Medications no longer routinely prescribed are for conditions that:

  • may be considered to be self-limiting, so they do not need treatment as they will get better of their own accord or
  • are suitable for self-care, so that the person suffering does not normally need to seek medical advice and can manage the condition by purchasing OTC items directly (table 1 has examples of medicines that fall into these categories).

Exceptions can be found in the full Self Care policy here

Items which should not be routinely prescribed across Derbyshire can be found here

Condition specific patient information leaflets can be found here

 

Table 1. Examples of medicines that can be purchased over-the-counter for the treatment of self-limiting conditions and those conditions deemed suitable for self-care. (Note: this list and examples given is not exhaustive).

 Self-limiting Conditions

Condition Example products (not exhaustive) Specific Exceptions (for general exceptions full policy) 
Acute sore throat Sore throat lozenges and sprays   
Infrequent cold sores of the lip

Aciclovir cream

Zovirax cold sore cream 

Immunocompromised patients 
Conjunctivitis (also see hayfever below) Chloramphenicol eye drops or ointment    Children patient under 2 years of age

Sodium cromoglicate eye drops

Octrivine-antistin eye drops

 
Coughs, colds and nasal congestion

Simple linctus, pholcodine linctus

Pseudoephedrine nasal sprays and oral preparations

Xylometazoline and ephedrine nasal spray and drops

 
Cradle cap Olive oil, cradle cap shampoos  If causing distress to infant and not improving 
Haemorrhoids Anusol cream, ointment or suppositories   
Anusol HC cream, ointment or suppositories Patient less than 18 years of age 
Infant colic

Simeticone liquid 

Dimeticone liquid

 
Colief liquid Confirmed lactose intolerance only
Mild cystitis

Potassium citrate mixture or sachets

Cranberry products 

 


 Minor conditions suitable for self care

 Condition Example products (not exhaustive)   Specific Exceptions (for general exceptions see full policy)
Mild irritant dermatitis Emollient creams and lotions  
Mild corticosteroid creams (e.g. hydrocortisone)

Exceptions for hydrocortisone cream:

  • Children under 10 years
  • Pregnant women
  • When required for use on the face, anogential region, broken or infection skin (including cold sores, acne and athlete's foot)

Dandruff

(mild scaling of the scalp)

Shampoos including antifungal, antiseptic, selenium and coal tar  
Diarrhoea (adults)

Loperamide

Oral rehydration sachets 

Children 
Dry eyes/ sore tired eyes Hypromellose eye drops, carbomer 980 gel  
Earwax Olive oil, sodium bicarbonate ear drops   

Excessive sweating

(hyperhidrosis) 

Aluminium chloride 20% solutions (e.g. Driclor, Anhydrol Forte)   
Head lice  Dimeticone, malathion, cyclomethicone, permethrin shampoos and liquids  Children under 6 months of age 
Indigestion and heartburn  Peptac, Gaviscon     
Infrequent constipation  Senna, lactulose, macrogol sachets  Children where dietary and lifestyle changes have not been sufficient 
Infrequent migraine  Analgesics, migraleve, triptans  Patients with severe or recurrent migraines 
Insect bites and stings  Antihistamine oral and topical preparations, calamine lotion   
Topical corticosteroids

Exceptions for hydrocortisone cream:

  • Children under 10 years
  • Pregnant women
  • When required for use on the face, anogenital region, broken or infected skin (including cold sores, acne and athlete's foot)
Mild acne Benzoyl peroxide creams and gels   
Mild dry skin Emollient creams and lotions   
Sunburn due to excessive sun exposure Emollients, oral and topical antihistamines, analgesics   
Sun protection Sun creams such as Uvistat, Sunsense, etc.   ACBS approved indication of protection from UV radiation in abnormal cutaneous photosensitivity (i.e. where skin protection should be prescribed) 

Mild to moderate hayfever/   seasonal rhinitis

 Antihistamines, nasal sprays, eye drops  
Minor burns and scalds Antiseptic creams, analgesics 

More serious burns always require professional medical attention. Burns requiring hospital A&E treatment include but are not limited to:

  • all chemical and electrical burns
  • large or deep burns
  • burns that cause white or charred skin
  • burns on the face, hands, arms, feet, legs or genitals that cause blisters
Minor conditions associated with pain, discomfort and/or fever (e.g. aches and sprains, headaches, period pain, back pain) Analgesics, NSAIDs, topical anti-inflammatory preparations  
Mouth ulcers Local anaesthetic gels, hydrocortisone buccal tablets

Exceptions for hydrocortisone buccal tablets:

  • Children under 12 years of age
Nappy rash Barrier preparations such as Sudocrem, metanium  
Oral thrush Daktarin oral gel  Infants less than 4 months old (Note that Daktarin oral gel is only licensed for 4 months and older) 
Dental products

Mouthwashes

Toothpaste 

 
Ringworm/ athlete's foot Topical preparations containing miconazole, clotrimazole etc.   Lymphoedema or history of lower limb cellutitis 
Teething/ mild toothache  Teething gels, paracetamol, ibuprofen   
Threadworms Mebendzole  Children under 2 years of age. Not licensed for OTC sale
Travel sickness Cinnarizine, hyoscine   
Warts and verrucae  Salicyclic acid containing products, glutaraldehyde  Treatment of anogential warts


Table 2. Examples of medicines that have little evidence of benefit (Note: this list and examples given is not exhaustive)

Product category Example of products (not exhaustive) Specific Exceptions (for general exceptions see full policy) Resources
Probiotics

 VSL#3,

lactobacillus,acidophilus

VSL#3 classified as a BLACK drug as not recommended or commissioned as the ACBS had withdrawn their approval.

.

No routine exceptions have been identified.


Vitamins and minerals Pharmacy own brands of vitamins/ multivitamins (i.e. Boots, Lloyds, Superdrug, Valupak), Haliborange, Sanatogen, Fruitivits Sachets, Spatone, Seven Seas, Lamb, Vita E, Osteocaps, Osteocare, Redoxon, Centrum

Vitamin D (high strength) for proven vitamin D deficiency. Calcium and vitamin D for osteoporosis or osteopenia. Vitamin D for patients with hyperparathyroidism, hypercalcaemia and patients receiving parenteral osteoporosis treatment as per the JAPC position statement on self-care with vitamin D*. NB maintenance or preventative treatment is not an exception.

Vitamin B Compound Strong to be classified RED for hospital use for short course post alcohol acute admission/refeeding syndrome. BLACK for all other indications.  

Vitamin B12 deficiency. Post bariatric surgery – only as specified in the JAPC guideline on monitoring and medication after bariatric surgery - link

Vitamin supplements for premature and low birth weight babies as advised by hospital.

Patients suitable to receive Healthy start vitamins for pregnancy or children between the ages 6 months to their fourth birthday. (NB this is not on prescription but commissioned separately)


Derby and Derbyshire CCG

Derby and Derbyshire CCG