Spotlight: Small package, big impact: how the OTC Directory has shaped GPs role in self care

Published on: 6th November 2019

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In October 2019, PAGB published the latest edition of its popular OTC Directory which lists over 900 products across 20 therapeutic categories. Within days it was in the hands of over 36,000 GPs, as well as practice nurses, pharmacists, pharmacy and medical students, CCG leads and other healthcare professionals. Requests for additional copies are already coming in – around a hundred received at time of writing.

 

Nikki Kennedy

Meeting a need

As the only directory of consumer healthcare products available to GPs, the OTC Directory is particularly valued by practices, which continue to see high demand for advice on symptoms that would be appropriate for self care.

NHS England estimates that there are around 57 million GP consultations each year for minor ailments, adding to pressure on already stretched primary care services. This is not a new problem; back in 1993, when the OTC Directory was first introduced, GPs were looking for ways to reduce people’s dependence on their services but reported low awareness of OTC products. Research by Taylor Nelson in 1992 found that on average GPs could recall the names of only six OTC medicines. On its introduction, the OTC Directory was welcomed by the Royal College of General Practitioners and the Medical Services Prescribing Subcommittee, which confirmed that GPs would not be in breach of their contract if they recommended OTCs.

Speaking at PAGB’s AGM in 1993, Dr Brian Mawhinney, Minister of Health said:

There is a widely-held misconception that a GP’s Terms of Service in the NHS prevents him or her from recommending an over-the-counter product to a patient… GP’s obligations are in all cases dependent on the consent of the patient… What is important is that patients should be offered the choice between a prescription under the NHS and a recommendation to purchase a product over-the-counter.

Fast-forward two decades and there is still a need and a demand for OTC product information. Whilst there is greater understanding of the role of self care, behaviour change has been slow to follow. PAGB’s Self Care Nation survey (2016) found that 92% of UK adults think it is important to take more responsibility for their own health to help ease the burden on the NHS but in the 12 months prior to the survey over one third (34%) had visited a GP about self-treatable conditions.

The OTC Directory launched in 1993 to address a gap in GPs’ knowledge about OTC Medicines. Compiling the first book must have been a challenge, but PAGB and its publishing partner Communications International Group (CIG) rose to it and continue to work together today. So, has anything changed? Recent research undertaken by RB for PAGB showed that GPs still meet with resistance from patients over self care – how do they manage to support people to self care against ingrained behaviour and expectations that perpetuate the idea that a prescription from the GP is the answer to any ailment?

OTC Directories 1993 - 2018

Interviews with GPs in 2019, revealed that they continue to face challenges around consultation time, patient expectations, free prescriptions, and their own risk aversion, all of which can be a barrier to having a self care conversation and recommending purchasing a product. GPs are only human and sometimes it’s simply quicker and easier to prescribe than to challenge someone who’s already sitting across the desk.  This behaviour was highlighted in PAGB commissioned qualitative research from 2009 by TNS Kantar.  It’s interesting to see the barriers to self care are still the same ten years later.

However, GPs are increasingly self care aware and want to see a future where people don’t come to them for self-treatable conditions.

Levers and drivers in self care

The availability of new products, in new therapeutic categories, creates further opportunities for self care; and the OTC Directory provides a comprehensive guide to what’s available. Combine this with excellent resources from the Self Care Forum on how to conduct a self care consultation, and new resources from CCGs, and GPs are better equipped than ever to support self care.

There’s no doubt that the NHS needs more people to self care.  NHS England/NHS Clinical Commissioners guidance to CCGs in 2018 marked a new wave of restrictions on prescribing items which are available over the counter, and has prompted CCGs to implement their own policies, some of which go further than the guidance. Multidisciplinary working across Primary Care Networks should help embed self care practice as GPs work more closely with other healthcare professional colleagues including pharmacists.

In this year’s edition of the directory, a partnership with RB and Boots meant that GPs received a bumper self care pack including a guide to Boots pharmacy services and a recommendation prescription pad to give self care advice to people presenting with symptoms of a self-treatable condition.

The popularity of the recommendation prescription is immediately evident and PAGB is making available the materials for download from www.otcdirectory.co.uk in the first instance. This is a promising indication that our policy campaign on introducing recommendation prescriptions in the NHS will have the backing of healthcare professionals (HCPs), giving it an excellent chance of success.

Fit for the future

So what’s next for the OTC Directory?  As the NHS is slowly dragged into a digital future, with the promise of greater systems integration, electronic health information and paperless prescribing, we want to ensure that healthcare professionals have ready access to reliable up-to-date information about consumer healthcare products and self care advice.

From its early online iteration as ‘Medicines Chest’ to a relaunched otcdirectory.co.uk, PAGB continues to develop the Directory online. Our research among HCP users showed a 50/50 split in preference for the print and digital versions, reflecting the challenges of day to day practice and personal preference.

Will GPs and pharmacists still reach for a copy of the OTC Directory from the bookshelf in 2024? Probably not, it’s much more likely that they’ll want to access that information digitally and give recommendations on self care products at the touch of a button.

The OTC Directory is already online at www.otcdirectory.co.uk giving healthcare professionals instant access at any time, on any device but we won’t stop there. PAGB’s report, Self care and technology: Harnessing the potential of technology to transform self care, made recommendations for embedding self care through digital transformation, one of which is to get the OTC Directory into NHS systems.

Of course, a future where people seek advice from the appropriate healthcare professional – in many cases a pharmacist – or are well enough equipped to treat their symptoms independently, is the ultimate aim. But we’re not there yet and there’s still a role for healthcare professionals across the NHS to support people with advice on self treatment.  

The digital transformation of healthcare, and society in general, requires all of us to think differently and focus on the future of self care. The OTC Directory is a big part of PAGB’s history and its legacy will continue.

By Nikki Kennedy, PAGB’s Communications Manager 

The OTC Directory is just one of the initiatives that PAGB published as part of its work to progress self care in the population.  If you would like to find out more about PAGB’s Self Care Journey spanning five decades read this Spotlight article. 

Qualitative Research Interviews: Feedback from doctors

On OTC Directory

“I’m guilty of prescribing OTC meds due to uncertainty if it can actually be bought.  This directory is straightforward, I should no longer have this problem.” 

“We got a pharmacist in-house who started 1 year back who advised all GPs to start using the PAGB-OTC Directory, instead of issuing patients with an NHS prescriptions. Initially this was out of the norm for us, and patients, but I am getting used to it and so are my patients.” 

“Patients like a specific brand name, they feel more confident they have the right product and that it will work.”

“Patients always ask me what exact product I would recommend, they write it down.”

 

On recommendation prescriptions

“Great idea. Verbal advice can be misunderstood or forgotten” 

“I think GPs sometimes prescribe medications in order to finish their consultation…this would offer a solution” 

Qualitative research on self care and role of the OTC Directory undertaken by Wonder Research, for RB and PAGB, April/May 2019

 

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