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National rules are needed about restriction of NHS prescriptions for drugs available over the counter

A recent news article in the BMJ reported that many clinical commissioning groups (CCGs) in England are trying to restrict NHS prescriptions for drugs that are also available over the counter (OTC). This would include, for example, drugs such as antihistamines. This raises a number of issues. Firstly, CCGs have no legal power to limit the prescribing of drugs by GPs (although many CCGs and GPs don’t seem to know this). The only drugs that GPs are not allowed to prescribe are those listed in Part XVIIIA of the NHS Drug Tariff (sometimes referred to as the ‘blacklist’). 

Secondly, rather than going through a formal process and asking the Department of Health to place additional drugs on the ‘blacklist’, CCGs seem content to let doctors decide who should have these drugs on NHS prescription and who should not. This will inevitably lead to considerable variation between GPs in their propensity to prescribe these drugs, thereby leading to ‘postcode prescribing’. 

Thirdly, it also raises legal issues in that if there is a complaint about the failure to issue a prescription for a drug the CCG does not want GPs to prescribe, it will be the GP and not the CCG who will be at risk and who will have to defend any complaint made by the patient or their representative (many GPs seem unaware of this and seem to think – mistakenly – that if they are following a CCG policy they will somehow be protected against complaints).

Each CCG carrying its own evidence review, public and professional consultation, and developing its implementation policy also results in considerable duplication of effort. At a time when the NHS has been asked to make considerable efficiency savings, we can't afford to waste financial, managerial and clinical resources on this scale.

Finally, such restrictions may disproportionately affect poorer patients who will be less able to pay for OTC drugs. 

If CCGs think the NHS can no longer afford to prescribe certain drugs, then they should group together and raise this issue with the Department of Health and NHS England; and ask them to add these drugs to the list of drugs that cannot be prescribed on the NHS.

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