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:
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).
|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||
Zovirax cold sore cream
|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|
|Colief liquid||Confirmed lactose intolerance only|
Potassium citrate mixture or sachets
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:
(mild scaling of the scalp)
|Shampoos including antifungal, antiseptic, selenium and coal tar|
Oral rehydration sachets
|Dry eyes/ sore tired eyes||Hypromellose eye drops, carbomer 980 gel|
|Earwax||Olive oil, sodium bicarbonate ear drops|
|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|
Exceptions for hydrocortisone cream:
|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:
|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:
|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)|
|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|
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)