Education And Debate

Over the Counter Drugs: The interface between self medication and the NHS

BMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7032.688 (Published 16 March 1996) Cite this as: BMJ 1996;312:688
  1. D Huw V Thomas, general practitionera,
  2. Peter R Noyce, professor of pharmacy practiceb
  1. a St John's Health Centre, St John's, Woking GU21 1TD
  2. b Department of Pharmacy, University of Manchester, Manchester M13 9PL
  1. Correspondence to: Professor Noyce.

    Cost and convenience seem to be major factors in determining whether, given the choice, patients purchase a medicine over the counter or obtain it on prescription. With current arrangements, exemption from prescription charges provides an incentive to continue to obtain products on NHS prescription even when they are available over the counter. There is therefore no simple relation between the availability of over the counter medicines and the level of prescribing of deregulated products. The appropriate use of over the counter medicines—particularly those that have only recently been deregulated—places a burden of care on community pharmacists and calls for closer working relationships with general practitioners. In particular, systems for referral and for recording details of both prescribed and over the counter medicines need to be developed, and a direct route needs to be established for community pharmacists to report adverse drug reactions to over the counter products.

    Reclassification of prescription medicines—by making them available through pharmacies without a prescription—provides the opportunity for consumers to purchase a wider range of medicinal products without making a demand on NHS resources. There is, however, no simple relation between availability of over the counter medicines and demand for NHS prescriptions. Much depends on consumer behaviour, which in turn is influenced by many factors. Thus the interface between self medication and the NHS is complex. To explore the influence of deregulation of medicines on NHS prescribing, this article presents analyses of consumer behaviour in using medicines and prescribers' attitudes to over the counter medication and collates findings from research.

    Factors influencing consumer behaviour

    Surveys by the British Market Research Bureau, in 1987 and 1994, provide some insight into how people respond to common ailments.1 2 Table 1 lists the most common conditions that people report treating with over the counter medicines. The 1987 survey covered some 6000 episodes …

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