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

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)  Resources 
Acute sore throat Sore throat lozenges and sprays    Patient information leaflet
Infrequent cold sores of the lip

Aciclovir cream

Zovirax cold sore cream 

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

Patient information leaflet

Sodium cromoglicate eye drops

Octrivine-antistin eye drops

  Patient information leaflet
Coughs, colds and nasal congestion

Simple linctus, pholcodine linctus

Pseudoephedrine nasal sprays and oral preparations

Xylometazoline and ephedrine nasal spray and drops

 

Patient information leaflets:

Coughs

Cold and nasal

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

Simeticone liquid 

Dimeticone liquid

  Patient information leaflet
Colief liquid Confirmed lactose intolerance only Patient information leaflet
Mild cystitis

Potassium citrate mixture or sachets

Cranberry products 

  Patient information leaflet


 Minor conditions suitable for self care

 Condition Example products (not exhaustive)   Specific Exceptions (for general exceptions see full policy) Resources 
Mild irritant dermatitis Emollient creams and lotions   Patient information leaflet
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)
Patient information leaflet

Dandruff

(mild scaling of the scalp)

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

Loperamide

Oral rehydration sachets 

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

Excessive sweating

(hyperhidrosis) 

Aluminium chloride 20% solutions (e.g. Driclor, Anhydrol Forte)    Patient information leaflet
Head lice  Dimeticone, malathion, cyclomethicone, permethrin shampoos and liquids  Children under 6 months of age  Patient information leaflet
Indigestion and heartburn  Peptac, Gaviscon    Patient information leaflet
Infrequent constipation  Senna, lactulose, macrogol sachets  Children where dietary and lifestyle changes have not been sufficient  Patient information leaflet
Infrequent migraine  Analgesics, migraleve, triptans  Patients with severe or recurrent migraines  Patient information leaflet
Insect bites and stings  Antihistamine oral and topical preparations, calamine lotion    Patient information leaflet
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)
Patient information leaflet
Mild acne Benzoyl peroxide creams and gels    Patient information leaflet
Mild dry skin Emollient creams and lotions    Patient information leaflet
Sunburn due to excessive sun exposure Emollients, oral and topical antihistamines, analgesics    Patient information leaflet
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)  Patient information leaflet

Mild to moderate hayfever/   seasonal rhinitis

 Antihistamines, nasal sprays, eye drops   Patient information leaflet
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
Patient information leaflet
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  

Patient information leaflets:

Aches and sprains

Discomfort/fever

Headaches

Period pain

Back pain

Mouth ulcers Local anaesthetic gels, hydrocortisone buccal tablets

Exceptions for hydrocortisone buccal tablets:

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

Mouthwashes

Toothpaste 

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


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.


Patient information leaflet
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)

Patient information leaflet

Derby and Derbyshire CCG

Derby and Derbyshire CCG