Over-the-counter medication. Prescribing guidance for over-the-counter medicines

NHS England guidance was updated in March 2024 and provides recommendations for items that are available over the counter (OTC) and should not be routinely prescribed in primary care because:

  • there is limited evidence of clinical effectiveness for the item, for example, probiotics and vitamins and minerals,
  • the item would be prescribed for a condition that is self-limiting and will clear up on its own without the need for treatment such as sore throats, coughs, colds and viruses,
  • the item would be prescribed for a condition that is appropriate for self-care. These conditions include, for example, indigestion and mouth ulcers.

Self-care

NHS Devon is encouraging people to have the confidence to look after themselves when they can in line with NHS England guidance.

This gives people greater control of their own health without the need to visit their GP for minor ailments. It also allows GPs to focus on caring for patients who may have complex needs.

By using our resources more cost-effectively, we can continue to improve health outcomes across Devon and ensure sustainability of the NHS in the long-term.

The NHS website contains information and advice for a whole range of conditions to help facilitate self-care.

Our ‘Treatment Starts at Home’ campaign also supports people to access the right service for their needs.

Community pharmacy

Pharmacists and pharmacy teams are trained to help you manage minor health conditions and can suggest suitable medicines that can be bought over the counter if needed. 

Pharmacists have the knowledge and skills to help with many healthcare conditions. If your condition is more serious, the pharmacist is trained to signpost you quickly to the right medical care. To find your closest pharmacy click here.

In addition to general advice and treatment for minor ailments, the national NHS England- Pharmacy First service now enables community pharmacy to supply some prescription-only medication, where clinically appropriate, for 7 common conditions (sore throat, infected ears, impetigo, shingles, infected insect bites, sinusitis and uncomplicated urinary tract infections in women) without the need for a GP appointment and a prescription.

Minor conditions and items for which prescribing is restricted

Self-limiting illnesses:

  • Acute sore throat
  • Infrequent cold sores of the lip – the recommendation does not apply to immunocompromised patients  
  • Conjunctivitis
  • Coughs, colds and nasal congestion
  • Cradle Cap (Seborrhoeic dermatitis – infants)- the recommendation does not apply if the condition is not improving and is causing the infant distress.
  • Haemorrhoids
  • Infant colic
  • Mild cystitis

Minor illnesses suitable for self-care:

  • mild irritant dermatitis
  • dandruff
  • diarrhoea – the recommendation to not prescribe does not apply to children
  • dry eyes or sore tired eyes
  • earwax
  • excessive sweating
  • head lice
  • indigestion and heartburn
  • infrequent constipation
  • infrequent migraine
  • insect bites and stings
  • mild acne
  • mild dry skin
  • mild to moderate hay fever or seasonal rhinitis
  • minor burns and scalds
  • minor conditions associated with pain, discomfort or fever
  • mouth ulcers
  • nappy rash
  • oral thrush
  • prevention of dental caries
  • ringworm or athlete’s foot – the recommendation to not prescribe does not apply in cases of lymphoedema or history of lower limb cellulitis
  • sunburn due to excessive sun exposure
  • sun protection – the recommendation to not prescribe does not apply in cases of Advisory Committee on Borderline Substances approved indication of photodermatoses, where skin protection should be prescribed
  • teething or mild toothache
  • threadworms
  • travel sickness
  • warts and verrucae

Items of limited clinical effectiveness:

  • Probiotics: there is insufficient clinical evidence to support prescribing of probiotics within the NHS for the treatment or prevention of diarrhoea of any cause.
  • Vitamins and minerals: vitamins and minerals are essential nutrients which most people can and should get from eating a healthy, varied and balanced diet. In most cases, dietary supplementation is unnecessary.

Who does the guidance apply to?

The guidance applies to everyone unless they are covered by the general recommendation or condition-specific exceptions listed in the guidance. People who receive free prescriptions are not automatically exempt from the guidance.

Recommendation

Do not prescribe unless for:

  • managing a long-term condition (for example, regular pain relief for chronic arthritis or treatments for inflammatory bowel disease)
  • treating more complex forms of minor illnesses (for example, severe migraines that are unresponsive to OTC medicines)
  • managing presentations of symptoms that suggest the condition is not minor
  • ‘red flag’ symptoms (for example, indigestion with very bad pain)
  • patients with complex conditions (for example, immunosuppressed patients)
  • treating an adverse effect or symptom of a more complex illness
  • treating a minor condition suitable for self-care that has not responded sufficiently to an OTC item
  • circumstances where the prescriber’s clinical judgement is that these are exceptional and warrant deviation from the recommendation to use self-care
  • individual patients where the prescriber considers that the patient’s ability to self-care is compromised because of medical, mental health or significant social vulnerability to the extent that their health and/or wellbeing could be adversely affected if reliant on self-care
  • circumstances where the product licence does not allow the item to be sold OTC to certain groups of patients. These may vary by medicine, but could include babies, children and/or women who are pregnant or breastfeeding. Community pharmacists will be aware of what these are and can advise accordingly.

Information Leaflets