When a general practitioner or community pharmacist prescribes a medicine through the NHS electronic prescription service, it is typically a trusted but controlled medicine that when taken as directed can help treat a diagnosed medical condition.
Not every prescription has historically worked like this, with some non-medical interventions such as exercise offered on prescription, whilst in other cases certain medicines that are widely available over the counter were also available on prescription.
This changed in 2018 when medicines for many medical conditions were no longer available for prescription, even for people who qualified for free prescriptions.
As of 2024, there are 35 conditions, as well as one extra common prescription that are no longer prescribed on the NHS.
Here is the list, why these particular conditions are no longer covered, and if there are any general exceptions.
What Treatments Are Not Covered
According to both NHS and British Medical Association guidance, here are the conditions that should not be prescribed medication:
- Minor, short-term sore throats,
- Small lip cold sores,
- Conjunctivitis, whether caused by an eye infection or allergies,
- Colds, coughs, nasal congestion,
- Colic,
- Cradle cap,
- Piles/Haemorrhoids,
- Mild cases of cystitis,
- Mild dermatitis, redness and irritation,
- Dandruff,
- Mild diarrhoea, without another underlying cause,
- Tiredness/soreness/dryness in the eyes,
- Mild earwax buildup that does not need syringing,
- Hyperhidrosis, or excessive sweating,
- Head lice,
- Heartburn caused by indigestion,
- Constipation without a major underlying cause,
- Migraines which are not constant and do not have an underlying cause,
- Insect stings and bites without a poison or allergic attack,
- Minor cases of acne,
- Minor cases of dry skin,
- Minor cases of sunburn,
- Minor sun sensitivity,
- Minor cases of hayfever,
- First-degree burns and scalds,
- Fever, mild pain, discomfort and other associated conditions,
- Mouth ulcers,
- Nappy rash,
- Thrush of the mouth,
- Dental health and hygiene,
- Athlete’s foot/ringworm,
- Mild toothache/teething,
- Threadworms/pinworms,
- Motion/travel sickness,
- Verrucas/warts,
As well as this, there were times when GPs would prescribe vitamins, minerals and probiotic supplements for relatively nonspecific reasons.
This means that some treatments such as over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), ear drops and cough syrup are available to buy at a pharmacy but are not available to be prescribed, even for people who qualify for free prescriptions, with some exceptions.
The reasons for this are both extremely simple and surprisingly complex.
Why Are They Not Covered?
The simple reason is cost; buying certain medicines on prescription is more expensive not only for the NHS themselves but also for individual patients without a pre-payment certificate or who qualify for free prescriptions.
In the past, there was a somewhat weird situation where if a person went to a pharmacy complaining about a headache, they could buy a packet of painkillers for less than a pound if they chose a generic packet.
If they went to a GP and received a prescription for the same painkillers, it would cost £9.90, because the pharmacy would be obligated to charge the standard prescription charge.
In practice, that would seldom happen for precisely this reason, but in 2018 it went from an expected convention to the rule and applied to other conditions such as fungal infections, where a variety of effective over-the-counter treatments are available to buy at the same pharmacy for less.
Ultimately, it saves people money and saves the NHS money to head to a local pharmacy first for mild conditions like the ones above, and get advice and affordable treatments right there and then.
Are There Any Exceptions To The Rule?
Whilst this tends to be how pharmacies and GP offices will operate when it comes to readily available over-the-counter medications, there are of course exceptions to this.
The biggest and most obvious caveat is that all of the conditions above are mild, minor, simple cases with causes that will largely clear up by themselves or with the help of medicines that almost anyone can safely take themselves.
There are complex versions of nearly every condition above. Cold symptoms can be severe enough to be the flu, migraines might be constant and not go away using standard medications and, whilst very uncommon, a persistent sore throat could be a symptom of cancer.
As well as this, certain treatments are needed for long-term conditions, which means that in some cases they are placed on prescription for people who qualify for free prescriptions as a way to ensure that they are always available.
Sometimes the treatment is needed to treat a side effect of a prescription medicine or more serious illness. In some cases, a prescription is used to provide medicines in cases where it cannot be sold over the counter, such as to babies or pregnant women.
Finally, if there is a concern that someone may not be able to commit to buying medicines over the counter or has other adherence issues, they may be prescribed certain over-the-counter medications.
Frequently Asked Questions
The NHS encourages people to buy certain medicines for minor, self-limiting conditions because they are widely available over the counter. This helps ensure NHS resources are focused on treating more serious or complex medical conditions.
Medicines for conditions such as mild hay fever, coughs and colds, sore throats, indigestion, constipation, dandruff and uncomplicated pain relief are often available over the counter and may not routinely be prescribed by your GP.
Yes. Pharmacists are trained to assess common illnesses and recommend suitable over-the-counter treatments. They can also advise when self-care is appropriate or when you should seek further medical assessment.
Yes. Your GP may prescribe these medicines if there is a clear clinical need, if your symptoms are more complex, or if you have a long-term medical condition that makes prescription treatment appropriate.