Plans to restrict access to drugs will put vulnerable patients at risk, BMA argues

BMJ 2018; 360 doi: (Published 08 March 2018) Cite this as: BMJ 2018;360:k1115
  1. Gareth Iacobucci
  1. The BMJ

Proposals to restrict access to drugs that can be bought over the counter for minor, short term conditions will put vulnerable patients at risk, the BMA has warned.

NHS England is consulting on plans to issue national guidance to clinical commissioning groups (CCGs) on limiting GPs’ prescribing of over-the-counter products for 35 minor or self limiting conditions, as part of a push to save money and tackle unwarranted variation in prescribing.12

But in its response to the consultation, which closes on 14 March, the BMA said that the proposals would disadvantage vulnerable patients such as people with disabilities, capacity problems, or learning difficulties; older people; and people living in rural areas.3

Though the consultation recognised the need to ensure that vulnerable patients could continue to obtain drugs, the BMA warned, “GPs would be placed in the unacceptable position of having to make value judgements about the likelihood of patients being able to access the required medication if an FP10 [prescription form] is not provided, and errors of judgement, complaints, and missed treatments would be inevitable.”

The BMA also expressed specific opposition to restricting treatments for minor ailments where patients could take care of themselves, on the grounds that GPs would be in breach of their General Medical Services (GMS) contract if they refused to issue prescriptions for conditions such as contact dermatitis, diarrhoea, and minor burns.

“The BMA supports efforts to empower and encourage patients to self care, and would encourage prescribers to advise patients that treatments can be purchased over the counter. However, where a GP has recommended a treatment to a patient, there is a duty under the GMS regulations to provide an FP10, and a GP refusing one when requested could be subject to complaint,” it said.

The BMA’s response said that some patients in rural areas might not have access to a pharmacy, and it warned that if the proposals were accepted an exception would need to be made to allow dispensing doctors to supply treatments for minor ailments.

The BMA said that it opposed restricting access to treatments for self limiting conditions such as Herpes simplex infections, haemorrhoids, and mild cystitis that produce symptoms that require treatment. “This should not be a determinant of eligibility for NHS care,” the response said.

It did agree with the principle of restricting treatments for certain self limiting conditions such as acute sore throat, coughs and colds, and infant colic but said that this should be done by blacklisting the drugs rather than relying on GPs not to prescribe them.

The BMA also agreed with NHS England’s proposals to restrict access to treatments of low clinical effectiveness such as probiotics, vitamins, and minerals but said that these items should also be added to a blacklist.


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