Your feedback and how it was used

In 2018 we asked you to tell us what you thought about the national NHS guidance for GPs and other prescribers in relation to prescribing medication for conditions which were common, minor, short term things which could be treated through self-care. 

The closing date for feedback was September 2018. All your feedback was reported back to the Barnsley CCG governing body at a meeting in public on 13 September 2018. 

Click here to see all the papers from that meeting (item 16 on the agenda starting at page 348). The governing body approved the roll out of the guidance and thanked people for sending their feedback in.

What people told us

125 responses were received. We asked people what we needed to consider when rolling out the national guidance. The majority of people agreed with the proposals within the guidance. They fell into two groups; those respondents who agreed completely and those respondents who agreed but had concerns. The final, smaller group disagreed and shared some of the concerns. 

Of those people who agreed completely, they highlighted that the CCG needs to provide plenty of notice before implementing this change locally and that effective communications is key to implementing any change successfully. In terms of concerns expressed, the following key areas were amongst those stated:

• The GP decision needs to be based on the individual.
• We need to ensure that by implementing this guidance we aren’t widening inequalities and the ‘socially vulnerable’ exception is applied in cases where people are on a limited income.
• Concern over the counter medicines aren’t effective for some minor conditions.

The CCG has a role in signposting. We asked people what sort of ways they thought we could be providing better or more information and signposting on self-care in Barnsley and the following feedback was provided in relation to the following themes:

• Advertise what is happening and what it means for people and do it widely.
• Work with local people/ patient representative groups to develop the information and sense check it.
• Face-to-face conversations are key with doctors, nurses and pharmacy staff.
• Co-ordinate advice between pharmacies and GPs.

We asked people what we need to consider when applying this new guidance specifically in relation to our local PharmacyFirst scheme and the feedback we received broadly fell into the following areas:

• those people who use (patients) or provide (pharmacies) PharmacyFirst on a regular basis, value this and would like to see it stay the same;
• those people who use the scheme and would support changes to this in line with the new guidance;
• those people who have heard of the scheme but haven’t used it and;
• those people who have never heard of it.

The majority of feedback to this question came from patients and pharmacies in support of keeping the PharmacyFirst scheme as it is due to how effective this has proven to be from their personal experience. The feedback highlighted that for those people who have used PharmacyFirst they have found this to be a really useful scheme that often saves people taking unnecessary GP appointments which people say they often struggle to access in the first place.

The service is especially valued by those people who are on low incomes, parents of young children and older people. We asked people specifically what we need to consider when this guidance is applied in pharmacies and the feedback we received fell into the following themes:

• Clear guidance and criteria needs to be provided and in place across the borough.
• There is a need to improve health education and awareness of what is available and where.
• Privacy issues in terms of accessing confidential advice in a pharmacy.

Feedback report

Click here to read the engagement report in full

How your feedback has been used

The national guidance will be rolled out in Barnsley during Summer 2019.

The CCG medicines management team has been working with pharmacies and GPs and nursing teams over a number of months, providing them with the same training and additional guidance on what conditions this applies to and what self care medications are available for people to buy.

There are some clear exceptions to the new guidance. This has formed part of the training for prescribers. It is also in the information leaflet. You may still be prescribed a medicine for a condition on the list if:

• You need treatment for a long-term condition, e.g. regular pain relief for chronic arthritis or inflammatory bowel disease.
• You need treatment for a more complex form of minor illness, e.g. migraines that are very bad and where over the counter medicines don’t work.
• You need an over the counter medicine to treat a side effect of a prescription medicine or symptom of another illness, e.g. constipation when taking certain painkillers.
• The medicine has a licence which doesn’t allow the product to be sold over the counter to certain groups of patients. This could include babies, children or women who are pregnant or breast-feeding.
• The person prescribing thinks that a patient cannot treat themselves, for example because of mental health problems or severe social vulnerability.

The guidance is clear that the person prescribing make the decision to prescribe based on the individual person's needs. Included in that is the recognition that this should not widen inequalities.

We have adapted the national NHS leaflet and promotional material to update the ones used by our neighbouring CCG in Rotherham. The leaflet and information was designed using the feedback we received in Barnsley. Click here to read or download the information. Your GP practice and pharmacy will be advertising the changes and how you can self-care on these conditions. There will also be a local campaign in 2019 which advertises self care options for the full range of conditions.

If someone chooses to go to a pharmacy for the self-care items, they can receive additional, personalised advice on which medications may work best for them. This includes talking to people about how long they might expect their condition to last, what the symptoms are likely to be and what to do if things get worse than expected. 

The PharmacyFirst scheme has changed the range of conditions available to the following: 

• Allergies
• Earache
• Eczema
• Scabies
• Vaginal thrush
• Head lice - from August 2019 pharmacists will provide enhanced guidance and support and will only be able to supply the Nitty Gritty combs or Bug Buster Kits for treatment of head lice.

Your pharmacy team can also offer you additional advice, guidance and support personal to you for a whole range of common, minor health concerns for which can buy treatments over the counter. All the PharmacyFirst information is available here and in your local pharmacy.

Here's what we asked in 2018

New guidance for GPs on when not to prescribe medication that can be bought over the counter

There is new guidance from NHS England on a number of minor health conditions for which GPs, nurses and other healthcare professionals should no longer routinely give you a prescription for when the medication or treatments can be bought from a pharmacy or store.

These are minor conditions which will clear up quite quickly with self-care, or there are medicines available to buy over the counter at your pharmacy or store which will relieve symptoms.

These are minor conditions including coughs and colds, constipation, stomach upsets, dandruff, headaches, infant colic, heartburn, headlice, nappy rash.

The guidance also covers prescriptions for probiotics and vitamins and minerals.

This means you will no longer normally be able to get medication prescribed by your GP or practice nurse for these minor conditions. This applies if you get free prescriptions or not.

It will also apply to most of the conditions in the Barnsley PharmacyFirst scheme.

Will this apply to everybody?

No there are a number of exceptions.

It is important to say that GPs will still prescribe the sorts of medicines which you can by from a pharmacy or store (over the counter) for people with longer-term or more complex conditions, or where minor illnesses are a symptom or a side effect of something more serious.

The medicines can also be prescribed if someone isn't as able to self- manage a condition because of medical or mental health issues or ’significant social vulnerability’, the guidance says. We are clear that GPs, in conversation with the patient, will still be able to make the final clinical decision to prescribe these over the counter medicines.

Why is there new guidance?

As the local NHS in Barnsley, we spend around £2million a year on prescribing medications for conditions that:

• Are considered to be self-limiting and so do not need treatment as it will heal or be cured of its own accord;
• Which lends itself to self-care i.e. the person suffering does not normally need to seek GP medical advice and can manage the condition by medical advice from a pharmacist or purchasing over the counter items directly from them or a store.

As a clinical commissioning group we are responsible for making the most of the NHS money that is available to Barnsley.

The new guidance can be accessed here 

Paper copies are available by calling 01226 433773.

We want to hear your views

This national guidance has been developed after a full public consultation.  A copy of the report is available here

Before we put this guidance into place in Barnsley, we want to hear from local residents, people working in health and any other interested parties.

We want to understand what we need to consider before this guidance is put in place.

We will collect everyone's feedback and it will be used to help design how this is rolled out across Barnsley.

This is to make sure it is as easy and clear for all patients and healthcare teams as possible to know what the new guidance means for them.

How you can have your say 

You can provide your feedback in any of the following ways:

• Online Survey (please click on the link to access the survey)
• Email 
• Freepost
• Telephone

This information has also been sent out to local groups, organisations and anyone signed up to receive our OPEN newsletter.  Paper copies of the survey have also been sent out to all Barnsley GPs, Pharmacies, Libraries and Children's Centres.  

For further information, to request a paper copy of the survey or to get help with completing the survey over the phone, please call us on 01226 433773 or send us an email at barnccg.comms@nhs.net 

The deadline for feedback is Wednesday 5th September 2018.

Thank you for taking the time to share your views and suggestions.