As in all areas, the GP has discretion whether or not to comply and will make an informed clinical judgement depending on the circumstances. There are also established exceptions which he or she may take into account. These are as follows: 

• Patients prescribed an OTC treatment for a long-term condition (e.g. regular pain relief for chronic arthritis or treatments for inflammatory bowel disease).
• For the treatment of more complex forms of minor illnesses (e.g. severe migraines that are unresponsive to over the counter medicines).
• For those patients that have symptoms that suggest the condition is not minor (i.e. those with red flag symptoms for example indigestion with very bad pain.)
• Treatment for complex patients (e.g. immunosuppressed patients).
• Patients on prescription only treatments.
• Patients prescribed OTC products to treat an adverse effect or symptom of a more complex illness and/or prescription only medications should continue to have these products prescribed on the NHS.
• Circumstances where the product licence doesn’t allow the product to be sold over the counter to certain groups of patients. This may vary by medicine, but could include babies, children and/or women who are pregnant or breast-feeding. Community Pharmacists will be aware of what these are and can advise accordingly.
• Patients with a minor condition suitable for self-care that has not responded sufficiently to treatment with an OTC product.
• Patients where the clinician considers that the presenting symptom is due to a condition that would not be considered a minor condition.
• Circumstances where the prescriber believes that in their clinical judgement, exceptional circumstances exist that warrant deviation from the recommendation to self-care.
• Individual patients where the clinician considers that their ability to self-manage is compromised as a consequence 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.

Note that being exempt from paying a prescription charge does not automatically warrant an exception to the guidance.

• Some of these conditions are considered to be self-limiting i.e. they will get better themselves and so do not need treatment.
• Most of these conditions lend themselves to self-care i.e. the person does not normally need to seek medical advice and can manage the condition by purchasing over the counter items.
• By keeping a selection of essential medications at home you can treat the symptoms of these conditions in a timely manner.
• Community pharmacists can offer advice on how to manage the symptoms of these conditions, when to seek medical advice, and what to take if you are on other medication. You do not need to make an appointment to see the pharmacist and many pharmacies are open late nights and at the weekend when the surgery is closed.
• Helpful advice in managing these conditions can also be found at:

• See your GP if the condition does not resolve after using over the counter products for the recommended period of time by your pharmacist.
• There are exceptions to this position which includes patients with complex illness or long-term conditions. Please see:

NHS England » Prescribing of over the counter medicines is changing: patient leaflets

• Non-prescription medicines (over the counter medicines) do not require any written consent from a GP or other healthcare professional to allow school and childcare provider staff to administer them.

Medicines in Schools and Nurseries

Schools and childcare providers sometimes ask parents/carers to obtain prescriptions or written permission from a GP for over the counter medication such as paracetamol before they will administer to the children in their care. To support implementation of this, the CCGs would like to clarify the interpretation around the current guidance around use of medicines in nurseries and schools.

• Schools and nurseries can only administer prescription medicines to a child when they have been prescribed by a doctor, dentist, nurse or pharmacist.
• Non-prescription medicines (over the counter medicines) do not require any written consent from a GP or other healthcare professional to allow school and nursery staff to administer them.
• All medication must only be administered to a child under the age of 16 where written permission for that particular medicine has been obtained from the child’s parent or carer.

Nurseries:

The Department for Education revised their ‘Statutory Framework for the Early Years Foundation Stage’ guidance in April 2017 EYFS Statutory Framework 2017, which refers to the handling of medicines by EYFS providers.

Schools:

The 2015 Department for Education issued statutory guidance ‘Supporting pupils at school with medical conditions.’