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Prescribing medicine for minor ailments and illnesses and the Pharmacy First Minor Ailments Scheme
This survey closed on the 9th September.
In the year prior to June 2017, the NHS spent approximately £569 million on prescriptions for medicines, which could otherwise be purchased over the counter (OTC), from a pharmacy and/or outlets such as petrol stations or supermarkets.
These prescriptions include items for a condition:
- that is considered to be self-limiting and so does not need treatment as it will heal or be cured of its own accord;
- which lends itself to self-care
These prescriptions can also include other common items:
- that can be purchased over the counter, sometimes at a lower cost than that which would be incurred by the NHS
- for which there is little evidence of clinical effectiveness
We also reviewed whether to continue the Pharmacy First Minor Ailments Scheme which is where a city patient can have an appointment selected pharmacies to get advice about a minor illness or ailment, and can receive medication without visiting a GP.
Leicester City CGG undertook a six-week engagement exercise, during 2018, to gather public opinion on the two proposals regarding the prescribing of OTC medicines and the Pharmacy First Minor Ailments Scheme. The feedback would help to:
- educate people about the rationale behind why items will not routinely be prescribed and to summarise the findings of the NHS England consultation
- listen to any concerns and prepare our patients for the changes so that they’re not impacted when they visit their practice/pharmacy
- allow the CCG to determine whether people are generally in support of the proposals, so that appropriate communication and mitigation can be put in place before rolling out the initiative
- achieve behaviour change in patients by encouraging them to self-care
- understand the impact on patients, pharmacies and GP practice staff if we took the decision to stop the Pharmacy First Minor Ailments Scheme
During the six week engagement period we received 185 completed surveys. The majority of respondents were aware that medication for the minor ailments listed could be purchased over the counter and declared that they were happy to do so.
Although most people were aware what the term “self-limiting” meant, many disputed whether some of the conditions listed were actually self-limiting.
Although most people felt that medications for self-limiting conditions should not be prescribed, they did raise a number of concerns. The main concerns were about the possibility of misdiagnosis in self-care and the ability of patients to afford medication. A number of groups of people were highlighted, most common being those on low-income and the elderly. It was also identified that most people used the pharmacy as their first port of call when suffering from a minor ailment. When looking at groups of people who would be most affected by the changes, these were predominantly children, the elderly and people on a low income. There was also reference to a risk that patients with learning disabilities or those whose first language isn’t English may not fully understand the changes. The major concerns raised regarding the changes were costs to those on low incomes, possible misdiagnosis and prolonged suffering if symptoms are left untreated.
Pharmacy First Minor Ailment Scheme
Only a small proportion of those that we engaged with had used the Pharmacy First Minor Ailment Scheme. However, the majority felt that they were unsure about, or did not support, stopping the minor ailment scheme. The main concerns raised were that of cost to the patient and the consequences to those who cannot afford it. It was further noted that many people were unaware of the scheme and that, if awareness and coverage across the city was raised, the scheme would be better utilized. It was felt that removal of the scheme would result in increased pressure on GP surgeries and other parts of the health system, such as A&E.
A report on the engagement results and recommendations for next steps was presented to Leicester City CCG’s Integrated Governance Committee in October 2018. The outcome of the discussion saw the Committee approve the implementation of NHS England’s guidance on the prescribing of medication for self-limiting conditions.
The national direction of travel for the NHS is to encourage patients to play a wider role, and be equal partners, in their health and well-being. This is underpinned by the NHS guidance entitled: Conditions for which over the counter items should not routinely be prescribed in primary care.
This guidance was produced following NHS England carrying out a nationwide public consultation between December 2017 and March 2018.
NHS England has also produced a useful “Frequently asked questions” to accompany the guidance.
From the feedback we received, there were concerns raised that some of these condition are not short-term and self-limiting, but are in fact longer-term problems, for example dry eyes. The guidance is clear that it only applies to short-term conditions. Long term ailments are not affected.
Concerns were also raised around misdiagnosis by patients. Patients and the public can be assured that expert advice and guidance on minor ailments can be sought from community pharmacists, many of whom are open early morning, late nights and also on weekends and bank holidays. All advice and guidance is free and pharmacists have undergone five years of training to offer expert impartial advice.
Concerns were also raised that language may be a barrier to accessing or understanding the changes. Leicester is a diverse city and many of our community pharmacies and GP practices have staff that can speak many different languages.
A key element of the feedback was around patients having the financial ability to afford to purchase treatments over the counter. Many of the conditions covered in the guidance are self-limiting, this means that these conditions will get better by themselves and do not require any treatment to be purchased, for example coughs. Other products that the NHS will now no longer support for prescribing have very little evidence of effectiveness, such as certain vitamin and mineral supplements. Other conditions affected may benefit from treatment which you can purchase over the counter and which are relatively cheap; pharmacists will be able to advise you on the most appropriate products. The guidance is also very clear that in certain cases the GP may use his/her clinical discretion and prescribe certain treatments where appropriate.
We also took the opportunity to engage with the public about the Pharmacy First Minor Ailment Scheme. This scheme has been in place for over 10 years; however, recently the number of pharmacies actively offering the scheme has fallen dramatically, resulting in an unequal access to the scheme across the city. We also heard that 71% of participants advised they were happy paying for over the counter medication to treat short-term illnesses and conditions and 67% of participants agreed that medication for self-limiting conditions should not be prescribed by GP practices. We also heard that messages to patients needed to be consistent. Many of the conditions that form part of the scheme are covered by the NHS Guidance and the same guidance from NHS England advised that CCGs may take this time to review current commissioned schemes.
There is both national and local momentum to support the self-care agenda and empower patients to take a greater role in the management of their health. For these reasons the Pharmacy First Minor Ailment Scheme was decommissioned on the 31st March 2019. As detailed above, GPs may use their clinical discretion and prescribe certain treatments where appropriate.