1. Over The Counter OTC & Gluten Free Foods Policy update for NHS staff
Herefordshire CCG & Providers
1st October 2018

2. OTC and gluten free foods update
OTC medicines &Gluten Free foods
Added to Herefordshire Treatment Policy
i.e. low priority for funding
not to be routinely prescribed
Herefordshire patients 1st October 2018
Align with Worcestershire, Shropshire and Gloucestershire
Wales low use OTCs on “free prescriptions for all”

3. What are Over The Counter (OTC) medicines ?
Some are General Sales List (GSL) medicines
Antihistamines, paracetamol, ibuprofen, emollients
Non medicines , devices
Widely available at supermarkets, convenience shops, discount shops
Wide range of prices <£5, pharmacy, supermarket to discount shops
Pharmacies can provide medicines advice and supply a wider range & larger packs
Exceptions Some OTC medicines may be restricted due to license e.g. larger pack sizes, or cannot be sold to some groups e.g. in pregnancy or for children

4. Why shifting OTC to self care?
Free up NHS capacity and is part of care navigation approach to
minor ailments self care
Community pharmacy advice & supply
Free up primary care time for complex long term conditions
NHS saving in staff resources & prescribing costs over £1m/year to be reinvested in patient care
In line with NHSE national consultation 2017
In line with local CCGs ie Worcestershire & Gloucestershire
Prescription Exemption status – most items cost less than a few pounds & are readily available at many retail outlets
Note - there are some exceptions

5. In line with national guidance, HCCG proposes exceptions to the policy :
patients prescribed an OTC medicine for a long term or more complex condition. There are some grey areas eg
elderly on regular paracetamol 100s
patients on prescription only items eg antihistamines
recommended by NHS specialists eg cancer care
where a clinician considers that a patient’s wellbeing could be affected due to
health,
mental health or
significant social vulnerability

6. What's available Local Store Rural village OTC range Indigestion
Coughs & colds
Teething
Analgesia
Children's options

7. Common OTC patient costs vary
OTC price range
Lowest*
Higher**
Antihistamines ie cetirizine, loratadine, many others (30 pack)
89p
£7 plus
Ibuprofen suspension 100ml
99p
£3.99
Paracetamol suspension 100ml
£1.20
£3.79
Bongela teething gel
 £2.49
£3.99 
Infacol
 £2.95
£3.13 
Dentinox colic drops
£2.29
£2.85
Aciclovir cold sore cream
59p
£4.89 
* Local survey discount shops **RRP or other

8. Outcomes from other areas
Reduced demand for appointments & prescriptions across all care areas
Freeing up capacity in primary care & community services
Realign capacity eg more patient support for long term conditions
Promote self care
Less patient dependency
Greater Equity
Well received to support NHS pressures

9. Local engagement survey 2018, 200+ responses
1. Do you agree that we should restrict prescribing medicines for short-term minor conditions and ailments?

10. Support for HCPs & patients
HCCG Web site information
Web Quick reference guidance for HCPs from NHSE & NHS clinical commissioning
Patient information posters & leaflets eg hayfever, colic
Care Navigation EMIS templates and “A-Z of how your pharmacist can help you”
HCCG Communications e.g. press release, Twitter.

11. Self Care Resources at GP practices, pharmacies, community hospitals
Herefordshire posters & PILs
Or See Herefordshire CCG web pages
optimisation/prescribing-guidelines/low-priority-medicines/over-the-counter- products-otc

12. Gluten Free Food on prescription
Herefordshire no longer supports the supply of GF foods on prescription:
Freely available in various outlets
Cost less & much less than on prescription
Reduce NHS waste expired products eg bread
Increase equity <20% coeliacs use prescriptions
exceptions to the policy as per NHSE OTC
Coeliac pathway focusing on identifying unknown people and also annual reviews
Note – NHS England plans to retain key products eg bread and mixes

13. 2. Do you agree that we should stop prescribing gluten free foods?