NHS SWL are committed to delivering best value by ensuring that we use our resources well. To help us to support the implementation of the NHS England guidance ‘Conditions for which over the counter items should not routinely be prescribed in primary care’ (March 2018), NHS South West London no longer support the routine prescribing of health supplements and medications that can be bought over the counter (OTC) for minor conditions, self-limiting and short-term illnesses. The NHS SWL position statement provides further information to clinicians and patients including exemptions to the guidance and medicines in schools and nurseries.
Why are we doing this?
- We want to help people lead longer, healthier lives and support them to take better care of their health. Self care is about avoiding becoming ill and seeking help when needed. By managing minor health needs through self care, it will help to ease the pressure on the NHS.
- NHS South West London have a set amount of money to pay for the health services that are needed and have a duty to spend that money wisely.
What treatment and preparations are included?
- Pharmacy Only (P) and General Sales Lists (GSL) treatments that can be purchased over the counter from a pharmacy with or without advice
- GSL treatments (including a patient information leaflet) that can be purchased from other retail outlets such as supermarkets, petrol stations, convenience or discount stores
- Treatments that are used to treat a condition that is considered to be self-limiting and so does not need treatment as it will heal/resolve by itself; and/or
- Treatments that are used to treat a condition which lends itself to self care, i.e. that the person suffering does not normally need to seek medical care and/or treatment for the condition.
- Treatments available OTC which should no longer be prescribed in NHS South West London are listed below.
Guidance for prescribers
The position statement will continue to rely on your clinical judgement for each individual patient as there are a number of exceptions that would need to be considered. For a full list of the exceptions, please see Appendix 1 of the position statement. To support this change in prescribing, self care briefings on each condition including information on licensing, alternative products and approximate over the counter prices can be found below.
- The Self Care Forum have produced fact sheets on 14 conditions that can be treated by over the counter medicines. You may find it helpful to use these to print out for your patients
- NHS England has published patient material to support implementation of this guidance, including:
- Patient leaflet
- Easy to read version of the leaflet
- A black and white handout for prescribers to hand directly to patients during a consultation
Patients should be advised that:
- The NHS recommends everyone keeps a well-stocked medicine cabinet with self care medicines.
- Community pharmacists can offer advice on how to manage short term illnesses and minor conditions, when to seek medical advice, and what to take if they take other medications. Patients do not need to make an appointment to see the pharmacist, and many pharmacies are open late nights and that the weekend.
- If their problem is more serious and needs the attention of another healthcare professional such as their GP, the pharmacist will advise them on this.
For further information, please visit:
- Healthier Together – Improving the health of pregnant women, babies, children and young people throughout South West London.
- NHS Choices
- PrescQIPP – Looking after you and your family – How ready are you?
- Self Care Forum
Download the Self Care Briefing for Clinicians: Cradle Cap (Seborrhoeic Dermatitis – Infants) document, which is also available below.
Summary
Cradle cap (greasy yellow scaly patches usually on babies’ scalps) is harmless and does not usually itch or cause discomfort. It usually appears in babies in the first two months of their lives and clears up without the need for treatment.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- Advise patients of safe and effective self care measures:
- Regular washing of the scalp with a baby shampoo, followed by gentle brushing with a soft brush to loosen scales and improve the condition of the skin.
- Softening the scales with baby oil first, followed by gentle brushing, then washing off with baby shampoo.
- Soaking the crusts overnight with white petroleum jelly or a slightly warmed vegetable or olive oil and shampooing in the morning.
- If these methods do not achieve softening, a greasy emollient or soap substitute, such as emulsifying ointment, can be used, which helps to remove the scales more easily. Cradle cap shampoos can be purchased over-the-counter.
- Advise patients to seek medical attention and consider treatment with a prescription in the following circumstances, if baby’s cradle cap:
- Itches, swells or bleeds.
- Spreads to the face or body.
Examples of over-the-counter products available to buy
- Topical Imidazole cream:
- Clotrimazole 1% cream: Licensed for children and adults (£5.59 for 20g).
- Econazole 1% cream: Licensed for children and adults (£5.75 for 30g).
- Miconazole 2% cream: Licensed for children and adults (£4.29 for 15g).
- Cradle cap shampoos:
- Dentinox® treatment shampoo (£2.15 for 125ml).
- White petroleum jelly:
- Vaseline ® (£1.50 for 50g)
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: February 2022
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Infrequent Cold Sores of the Lip document, which is also available below.
Summary
- Cold sores caused by the herpes simplex virus usually clear up without treatment within 7 to 10 days.
- Antiviral creams are available over-the-counter from pharmacies without a prescription and if used correctly, these can help ease symptoms and speed up the healing time.
- To be effective, these treatments should be applied as soon as the first signs of a cold sore appear. Using an antiviral cream after this initial period is unlikely to have much of an effect.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- Advise patients of safe and effective self care measures:
- Eat cool, soft foods and drink plenty of fluids to avoid dehydration.
- Use an antiseptic mouthwash if it hurts to brush your teeth.
- Avoid triggers and use lip balm (SPF 15 or above) if sunshine is a trigger.
- Avoid rubbing antiviral creams into cold sore, dab cream on instead. Wash hands before and after applying cream.
- Advise patients to seek medical attention and consider treatment with a prescription in the following circumstances:
- If the cold sore has not started to heal within 10 days.
- If pregnant – there’s an increased risk of neonatal herpes.
- Have a weakened immune system – for example, because of chemotherapy or diabetes.
- Swollen, painful gums and sores in the mouth (gingivostomatitis) – patient to seek dental advice.
Examples of over-the-counter products available to buy
- Aciclovir cream: Licensed for adults and children (£4.00-£6.00 for 2g).
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: February 2022
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Conjunctivitis document, which is also available below.
Summary
Conjunctivitis is usually self-limiting and will resolve within a week. Treatment is therefore not usually needed.
If treatment is needed, this should be selected in line with the cause of the infection:
- In severe bacterial cases, antibiotic eye drops and ointments can be used to clear the infection.
- Irritant conjunctivitis will clear up as soon as the irritant causing it is removed.
- Allergic conjunctivitis can usually be treated with anti-allergy medications such as topical mast cell stabilizers (systemic antihistamines are not recommended for patients who do not have concurrent rhinitis or sinusitis). The substance that caused the allergy should be avoided.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about minor conditions suitable for self-care when appropriate.
- Advise patients of safe and effective self-care measures:
- Bathing/cleaning the eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove any discharge.
- Gently applying cool compresses to the eye area.
- Advise patients to seek medical attention and consider treatment with a prescription in the following circumstances:
- When they have any of the following symptoms: pain in the eyes, sensitivity to light, changes in vision and intense redness in one or both eyes.
- Symptoms have not cleared up after 2 weeks.
- Same day appointments are required for babies under 28 days old with red eyes.
Examples of over-the-counter products available to buy
Please advise patients that suggested prices are, a guide, correct at the time of writing and are subject to change.
- Chloramphenicol (0.5% eye drops): (£6.00 for 10ml) Not licensed for children under 2 years old.
- Chloramphenicol (1% eye ointment): (£5.00 for 4g) Not licensed for children under 2 years old.
- Sodium Cromoglicate (2% eye drops): (£5.00-£6.00 for 10ml).
Further information
Document History
Version: V1.1
Author: SWL DROP list working group
Approved by: Integrated medicines optimisation committee (IMOC)
Approval date: December 2021
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Cough, Colds and Nasal Congestion document, which is also available below.
Summary
Coughs, colds and nasal congestion are minor conditions that can be treated without the need for a GP consultation or prescription in the first instance. They can easily be treated with simple over-the-counter preparations like paracetamol and/or decongestants.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about minor conditions suitable for self care when appropriate.
- Advise patients of safe and effective self care measures:
- Rest and drink plenty of fluid.
- Gargle with salt water and steam inhalation.
- Coughs will usually resolve within 21 days and colds within 14 days.
- Advise patients to seek medical attention and consider treatment with a prescription in the following circumstances:
- Symptoms last for more than 3 weeks or suddenly worsen.
- Cough up blood stained phlegm.
- Difficulty in breathing.
- Sharp pain in chest.
- Side of neck feels swollen and painful (swollen glands).
- Losing weight without reason.
- Temperature is very high or feeling hot and shivery.
- Concerned about a child’s cold symptoms.
- Have a weakened immune system e.g. on chemotherapy.
Examples of over-the-counter products available to buy
Please advise patients that suggested prices are, a guide, correct at the time of writing and are subject to change.
- Paracetamol, Ibuprofen: Not licensed for children under 3 months old (£0.25-£4.00 for 16 tablets/capsules, £4.00 for 100 ml oral liquid).
- Aspirin: Not licensed for children under 16 years old (£0.40-£3.00 for 16 tablets).
- Saline nose drops (£2.40-£5.00 for 10ml).
- Saline sprays (£7.99 for 100ml) (£3.50-£5.00 for 15ml).
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: November 2021
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Mild Dry Skin document, which is also available below.
Summary
Dry skin is a minor condition that can be treated without the need for a GP consultation or prescription in the first instance. It can easily be treated with simple over-the-counter moisturisers.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- Advise patients of safe and effective self care measures.
- Emollients are best applied after washing your hands, taking a bath or showering because this is when the skin most needs moisture. Apply emollients liberally (see nhs.uk emollients).
- Moisturise three to four times a day.
- Use warm water and limit bath time.
- Avoid harsh, drying soaps.
- Advise patients to seek medical attention and consider treatment with a prescription in the following circumstances:
- Dry skin is accompanied by redness.
- Dryness and itching interfere with sleeping.
- Open sores or infection from scratching.
- Large areas of scaling or peeling skin.
Examples of over-the-counter products available to buy
Please advise patients that suggested prices are, a guide, correct at the time of writing and are subject to change.
- QV® Skin Lotion: £3.19 for 250ml.
- Diprobase® Lotion: £3.49 for 300ml.
- E45®: £2.35 for 50g: Not licensed for children under 1 month old.
- ZeroAQS® Emollient Cream: £3.29 for 500g.
- Zerobase® Cream: £1.04 for 50g.
- AproDerm® Emollient Cream: £1.70 for 50g.
- Zeroguent® Emollient Cream: £2.33 for 100g.
- Epimax® Cream: £0.75 for 100g.
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: November 2021
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Earwax document, which is also available below.
Summary
Blocked ears due to the accumulation of ear wax can be treated without the need for a GP consultation or prescription in the first instance. This can easily be treated with simple over-the-counter preparations such as ear drops.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate. See: NHS.uk-Earwax build-up
- Advise patients of safe and effective self care measures:
- Ear wax usually falls out on its own.
- If wax doesn’t fall out or blocks the ear, ear drops can be used to loosen wax. Consult a pharmacist.
- Do not use fingers or objects such as cotton buds to remove wax.
- No evidence that ear candles or ear vacuums remove ear wax.
- Advise patients to seek medical attention if:
- Earwax hasn’t cleared after 10 -14 days of using treatment.
- Hole in ear drum – perforated eardrum.
- Persistent vomiting or fever.
- Ear is badly blocked and they have hearing loss.
- Patient is an infant or young child.
Examples of over-the-counter products available to buy
Please advise patients that suggested prices are, a guide, correct at the time of writing and are subject to change.
- Olive oil ear drops (BP): (£1.00 to £1.42 for 10ml). Do not use if: swelling, pain or discharge.
- Sodium bicarbonate ear drops (BP): (£1.00-£1.25 for 10ml). Discard 28 days after opening.
- Olive oil spray: Adults and children 12 years OLD and above (£6.00 for 10ml).
- Audiclean® cleansing wash: Adults and children above 6 months old (£11.00 for 115ml). Do not use if history of ear problems or pain or discharge from ears.
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: December 2021
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Haemorrhoids document, which is also available below.
Summary
Haemorrhoids do not always cause symptoms, and some people do not even realise they have them. Haemorrhoids often clear up by themselves after a few days. Making simple dietary changes and not straining on the toilet are often recommended first. There are many over-the-counter treatments (creams, ointments and suppositories) that can reduce itching and discomfort.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- Advise patients of safe and effective self care measures:
- Drinking plenty of fluids.
- Avoiding medication that causes constipation e.g. painkillers that contain codeine.
- Not delaying going to the toilet.
- Gradually increasing fibre intake.
- Exercising regularly and losing weight if patient is overweight.
- Advise patients to seek medical attention and consider treatment with a prescription in the following circumstances to relieve symptoms:
- Persistent or severe symptoms.
- Rectal bleeding.
Examples of over-the-counter products available to buy
- Anusol® Cream: Licensed for adults and the elderly (£3.99 for 23g).
- Preparation H® cream/ointment: Not licensed for children under 12 years old (£4.30 for 25g).
- Germoloids®: Not licensed for children under 12 years old (£4 for 25g).
- Paracetamol (tablets): Not licensed for children under 10 years old (£0.50-£3.00 for 16 tablets/capsules).
- Paracetamol (suspension): Not licensed for children under 2 months old (£2.65-£4.50 for 100ml).
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: March 2022
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Hay Fever document, which is also available below.
Summary
Mild to moderate hay fever and other allergic symptoms can be managed by avoiding triggers or taking medications. If treatment is needed, a wide range of medication can be purchased from community pharmacies and supermarkets. These medications are usually less expensive than a prescription and can be purchased without seeing a GP.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate. See: NHS.uk:Hay fever
- Advise patients of safe and effective self care measures:
- Consult a pharmacist for advice as to which treatment is most suitable.
- Wear wraparound sunglasses to stop pollen getting into your eyes and use petroleum jelly around the nostrils to trap pollen.
- Shower and change your clothes after you have been outside to wash off pollen.
- Stay indoors and keep windows and doors shut as much as possible.
- Vacuum regularly and dust with a damp cloth. Buy a pollen filter for the air vents in your car and a vacuum cleaner with a HEPA filter.
- Patients should seek medical attention if:
- Experiencing wheezing, breathlessness or tightness in their chest.
- Pregnant or breastfeeding.
- Hay fever symptoms are not relieved by over-the-counter treatment in combination with measures to reduce exposure to pollen.
- The pattern of symptoms seems unusual or diagnosis is uncertain.
- An over-the-counter corticosteroid nasal spray has been used for longer than 3 months.
Examples of over-the-counter products available to buy
Please advise patients that suggested prices are, a guide, correct at the time of writing and are subject to change.
- Loratadine: (£0.99-£5.50 for 14 tablets). Not suitable for children under 2 years old. Not available over-the-counter in pregnancy and breastfeeding.
- Cetirizine: (£0.99-£5.50 for 14 tablets). Not suitable for children under 2 years old. Not available over-the-counter in pregnancy and breastfeeding.
- Sodium cromoglicate 2% eye drops: (£5.00-£6.50 for 10ml). Discard 28 days after opening.
- Beclomethasone: (£4.50-£6.00 for 100 metered dose spray). Not for patients under the age of 18. Not available over-the-counter in pregnancy and breastfeeding.
- Fluticasone: (£6.60-£8.60 for 50-60 metered dose spray). Not suitable for patients under the age of 18. Not available over-the-counter in pregnancy and breastfeeding or if planning to become pregnant.
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: November 2021
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Heartburn and Indigestion document, which is also available below.
Summary
Heartburn and indigestion are minor conditions that can be treated without the need for a GP consultation or prescription in the first instance. They can easily be treated with simple over-the-counter medication like antacids.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- Advise patients of safe and effective self care measures:
- Reduce or stop smoking and reduce alcohol consumption.
- Avoid non-steroidal anti-flammatory drugs (NSAIDs) e.g., aspirin, ibuprofen and food that triggers symptoms.
- Try and lose weight if you’re overweight.
- Eat smaller, more frequent meals and avoid eating within 3 to 4 hours before bed.
- Rarely, more serious medical problems may cause indigestion – particularly aged 55 or over. Advise patients to seek medical advice if symptoms last for most days for 3 weeks or they do not respond to treatment or you notice the following circumstances:
- Pain and other chest/stomach symptoms.
- Vomiting blood.
- Swallowing problems.
- Dark stools.
- Unexplained weight loss.
- Feeling faint.
- Symptoms persist after recommended duration of over-the-counter treatment.
- Feeling like there’s a mass in the abdomen.
Examples of over-the-counter products available to buy
Please advise patients that suggested prices are, a guide, correct at the time of writing and are subject to change.
- Antacids: Not licensed for children under 12 years old (£2.50-£4.00 for up to 48 tablets).
- Bismuth subsalicylate e.g. Pepto-bismol® oral suspension: Not licensed for children under 16 years old (£3.00 for 120ml).
- Alginates (Gaviscon® Infant): Not licensed for children under 1 years old or children over 2 years old (£10.00 for 30 x 2g).
- Omeprazole (Pyrocalm Control® 20mg tablets): Not licensed for children under 18 years old (£10.00 for 14 tablets).
- Pantoprazole (Pantoloc Control® 20mg tablets): Not licensed for children under 18 years old (£13.00 for 14 tablets).
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: November 2021
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Insect Bites and Stings document, which is also available below.
Summary
Most insect bites and stings are not serious and will get better within a few hours or days. Over-the-counter treatments can help ease symptoms, such as painkillers, creams for itching and antihistamines.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- Advise patients of safe and effective self care measures:
- Remove the sting or tick if it is still in the skin.
- Wash the affected area with soap and water and apply a cold compress to any swelling for at least 10 minutes.
- Raise or elevate the affected area if possible to reduce swelling and avoid scratching the area.
- Avoid traditional home remedies, such as vinegar and bicarbonate of soda, as they are unlikely to help.
- Advise patients to seek medical attention and consider treatment with a prescription in the following circumstances:
- Symptoms do not start to improve within a few days or are getting worse.
- The sting or bite is in the mouth or throat, or near eyes.
- A large area (around 10cm or more) around the bite becomes red and swollen.
- Symptoms of a wound infection, such as pus or increasing pain, swelling or redness.
- Symptoms of a more widespread infection, such as a fever, swollen glands and other flu-like symptoms.
- Urgent medical assessment is required if any of the following are present:
- Wheezing or difficulty breathing.
- A swollen face, mouth or throat.
- A fast heart rate.
- Dizziness or feeling faint.
- Difficulty swallowing.
- Loss of consciousness.
Examples of over-the-counter products available to buy
Please advise patients that suggested prices are, a guide, correct at the time of writing and are subject to change.
- Paracetamol
- Tablets: Not licensed for children under 6 years old (£0.90-£3.00 for 16 tablets).
- Suspension: Not licensed for children under 2 months old (£2.50-£6.00 for 100ml).
- Ibuprofen
- Tablets: Not licensed for children under 12 years old (£0.35-£4.00 for 16 tablets).
- Suspension: Not licensed for children under 3 months old (£4.50 for 100ml).
- Chlorphenamine
- Tablets: Not licensed for under 6 years (£3.00-£4.00 for 30 tablets).
- Syrup: Not licensed for children under 1 year old (£5.00 for 150ml).
- Cetirizine
- Tablets: Not suitable for children under 6 years old (£0.99-£5.50 for 14 tablets).
- Solution: Not suitable for children under 2 years old (£5.00 for 100mls).
- Hydrocortisone 1% cream: Not licensed for children under 10 years old (£1.50 for 15g).
References/resources
Document History
Version: V1.1
Author: SWL drop list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: August 2022
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Acute Sore Throat document, which is also available below.
Summary
A sore throat due to a viral or bacterial cause is a self-limiting condition. Symptoms resolve within 3 days in 40% of people, and within 1 week in 85% of people, irrespective of whether the sore throat is due to streptococcal infection.
There is little evidence to suggest that treatments such as lozenges or throat sprays help to treat the cause of sore throat and patients should be advised to take simple painkillers and implement some self care measures such as gargling with warm salty water (adults only) instead.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- Advise patients of safe and effective self care measures:
- Drink plenty of fluids but avoid hot drinks.
- Gargle with warm salty water (adults only).
- Avoid smoking or smoky places.
- Suck on ice cubes/lollies.
- Sore throats will usually resolve without treatment within 7-8 days.
- Advise patients to seek medical attention and consider treatment with a prescription in the following circumstances:
- Symptoms do not improve after a week. When the patient is immunocompromised.
- When symptoms are reoccurring often.
- Patients who have a very high fever and sore throat.
Examples of over-the-counter products available to buy
Please advise patients that suggested prices are, a guide, correct at the time of writing and are subject to change.
- Paracetamol (tablets): Not licensed for children under 10 years old (£0.25-£3.00 for 16 tablets/capsules).
- Paracetamol (suspension): Not licensed for children under 2 months old (£2.50-£4.50 for 100ml).
- Ibuprofen (tablets): Not licensed for children under 12 years old (£0.35-£4.00 for 16 tablets/capsules).
- Ibuprofen (suspension) : Not licensed for children under 3 months old (£2.50-£4.00 for 100ml).
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: November 2021
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Nappy Rash document, which is also available below.
Summary
Up to a third of babies and toddlers in nappies have nappy rash at any one time. Nappy rash can usually be treated at home using barrier creams purchased over-the-counter.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- Advice parents to discuss concerns regarding nappy rash with their health visitor or local pharmacist
- Advise patients of safe and effective self care measures:
- Change wet or dirty nappies as soon as possible.
- Clean the whole nappy area gently but thoroughly, wiping from front to back. Use water or fragrance-free and alcohol-free baby wipes.
- Apply a thin layer of a barrier cream to protect the skin.
- Bath the baby daily: but avoid bathing them more than twice a day as that may dry out their skin.
- Dry baby gently after washing them: avoid vigorous rubbing.
- Do not use soap, bubble bath, lotions or talcum powder as it contains ingredients that could irritate baby’s skin.
- Advise patients to seek medical attention and consider treatment with a prescription in the following circumstances:
- If the rash does not go away and gets worse.
- The baby develops a persistent bright red, moist rash with white or red pimples that spreads into the folds of their skin – signs of infection.
Examples of over-the-counter products available to buy
- Metanium® Nappy Rash ointment: Not licensed for adults and the elderly (£2.65 for 30g).
- Bepanthen® Nappy care ointment (£3.30 for 30g).
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: Integrated medicines committee (IMOC)
Approval date: February 2022
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Sunburn document, which is also available below.
Summary
Most people manage sunburn symptoms themselves or prevent symptoms from developing by using sun protection. These products can easily be bought over-the-counter.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- patients of safe and effective self care measures. Self care advice includes cooling the skin with a bath or shower, drinking plenty of fluids to prevent dehydration, taking painkillers to ease pain and using emollients or gels containing aloe vera to moisturise and soothe the skin.
- Advise patients to seek medical attention and consider treatment with a prescription in the following circumstances:
- A baby or young child has sunburn as their skin is particularly sensitive.
- There is blistering or swelling of the skin.
- They have a high temperature of 38ºC or above or they feel very hot and shivery.
- They feel very tired, dizzy and sick.
- They are experiencing a headache and muscle cramps.
- Severe sunburn can lead to heat exhaustion and heatstroke which can be very serious.
Examples of over-the-counter products available to buy
Please advise patients that suggested prices are, a guide, correct at the time of writing and are subject to change.
- Calamine Lotion: Licensed for all ages (£1.70-£2.20 for 200ml).
- Paracetamol (tablets): Not licensed for children under 10 years old (£0.90-£3.00 for 16 tablets).
- Paracetamol (suspension): Not licensed for children under 2 months old (£2.50-£6.00 for 100ml).
- Ibuprofen (tablets): Not licensed for children under 12 years old (£0.35-£4.00 for 16 tablets).
- Ibuprofen (suspension): Not licensed for children under 3 months old (£4.50 for 100ml).
Further information
Document History
Version: V 1.1
Author: SWL DROP List Working Group
Approved by: SWL IMOC (Integrated Medicines Optimisation Committee)
Approval date: August 2022
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Sun Protection document, which is also available below.
Summary
Most people prevent sun burn symptoms by using sun protection products which can easily be bought in a pharmacy or supermarkets.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- For optimum photoprotection, patients must:
- Use sunscreens from spring to autumn.
- Apply sunscreens thickly and frequently (approximately two hourly).
- Advise patients to:
- Use sunscreen preparations with highest sun protection factor (SPF), a minimum of factor 30 to provide maximum protection (protects against UVB) and at least 4 Star UVA protection.
- Spend time in the shade when the sun is strongest. In the UK, this is between 11am and 3pm from March to October.
- Avoid burning.
- Cover up with suitable clothing, a hat and sunglasses.
- Take extra care with children.
- Make sure the sunscreen is not past its expiry date. Most sunscreens have a shelf life of two to three years.
- Ensure sunscreen is applied liberally and regularly throughout the day (see nhs.uk Sunscreen and sun safety).
Examples of over-the-counter products available to buy
Please advise patients that suggested prices are, a guide, correct at the time of writing and are subject to change.
- Anthelios® XL Melt-in cream (£12.50 for 50ml).
- Nivea protect and moisture SPF 30 sun spray (£6.00 for 200ml).
- Sunsense® Ultra Lotion (£13.00 for 125ml).
- Uvistat® Cream (£16.00 for 125ml).
- Uvistat® SPF50 Lipscreen (£5.50 for 5g).
Further information
Document History
Version: V 1.1
Author: SWL DROP List Working Group
Approved by: SWL IMOC (Integrated Medicines Optimisation Committee)
Approval date: August 2022
Review Date: 2 years from approval date or sooner where appropriate.
Download the Self Care Briefing for Clinicians: Travel Sickness document, which is also available below.
Summary
Mild motion sickness can be treated by various self-care measures (e.g. stare at a fixed object, fresh air, listen to music etc.) More severe motion sickness can be treated with over-the-counter medicines.
Recommendations for clinicians
- Provide the patient with a ‘non-prescription’ sheet or a patient information leaflet to promote education about self-limiting conditions suitable for self care when appropriate.
- Advise patients of safe and effective self care measures:
- Avoid eating heavy meals before travelling.
- It may help to look straight ahead at a fixed point, such as the horizon.
- Reduce motion, sit in the front of a car or in the middle of a boat.
- On long journeys, try breaking the journey to have some fresh air, drink some cold water and, if possible, take a short walk.
- Breathe fresh air, if possible, for example, open a car window. You should also try to breathe slowly.
- Avoid strong smells, particularly petrol and diesel fumes. This may mean closing the window and turning on the air conditioning or avoiding the engine area in a boat.
- Close your eyes (and keep them closed for the whole journey). This reduces ‘positional’ signals from your eyes to your brain and reduces the confusion.
- Do not try to read, watch films, or use electronic devices.
- Try listening to an audio book with your eyes closed.
- Distract children by talking, listening to or singing songs.
Examples of over-the-counter products available to buy
- Cinnarizine tablets: Not licensed for children under 5 years old (£4.00 for 15 tablets).
- Hyoscine tablets: Not licensed for children under 3 years old (£2.80 for 12 tablets).
- Hyoscine hydrobromide 150 micrograms (Kwells® Kids): Not licensed for children under 4 years old (£2.50 for 12 tablets).
If a patient is pregnant or breastfeeding, they should not purchase travel sickness medications over-the counter without discussing with their doctor or midwife first.
Further information
Document History
Version: V 1.1
Author: SWL DROP list working group
Approved by: IMOC (Integrated Medicines Optimisation Committee)
Approval date: August 2022
Review Date: 2 years from approval date or sooner where appropriate.