Self Care

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 SWL no longer support the routine prescribing of health supplements and medications that can be bought over the counter for minor conditions, self-limiting and short-term illnesses. Prescribing of over the counter medicines is changing. The NHS SWL position statement provides further information to clinicians and patients including exemptions to the guidance and medicines in schools and nurseries.

Please remember:

  • 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 you take other medications. You do not need to make an appointment to see the pharmacist, and many pharmacies are open late nights and at the weekend.
  • If your problem is more serious and needs the attention of another healthcare professional such as a GP, the pharmacist will advise on this.

If your problem is more serious and needs the attention of another healthcare professional such as a GP or optometrist the pharmacist will advise on this.

For further information, please visit: 

Changes to how the NHS prescribes over the counter medicines for minor health condition

This means that certain medicines may no longer be prescribed if you can buy them ‘over the counter’. This will explain the changes, why they are happening and where you can get more information and support. 

What conditions are included in this change? 

Medicines available to buy ‘over the counter’ will not be routinely prescribed for the following conditions (this list is not exhaustive):  In March 2018, NHS England published guidance about reducing the prescribing of medicines or treatments that are available to buy ‘over the counter’. 

  • Acute sore throat  
  • Conjunctivitis  
  • Coughs, colds and nasal congestion 
  • Cradle cap   
  • Dandruff  
  • Diarrhoea (adults) 
  • Dry eyes/sore tired eyes  
  • Earwax  
  • Excessive sweating 
  • Haemorrhoids  
  • Head lice  
  • Indigestion and heartburn 
  • Infant colic  
  • Infrequent cold sores of the lip  
  • Infrequent constipation 
  • Infrequent migraine  
  • Insect bites and stings  
  • Mild acne 
  • Minor burns and scalds  
  • Mild cystitis Mild dry skin 
  • Mild irritant dermatitis  
  • Mild to moderate hay fever  
  • Minor conditions associated with pain, discomfort and fever (e.g. aches and sprains, headache, period pain, back pain) 
  • Mouth ulcers  
  • Nappy rash  
  • Oral thrush 
  • Prevention of tooth decay  
  • Ringworm/athletes foot  
  • Sunburn 
  • Sun protection  
  • Teething/mild toothache  
  • Threadworms 
  • Travel sickness  
  • Warts and verrucae

Probiotics, and some vitamins and minerals will also no longer be routinely prescribed, because most people can, and should get these from eating a healthy, varied, and balanced diet.  

In some instances (e.g., due to certain product license restrictions) patients will still be able to get prescriptions for the conditions (or medicines used to treat them) in the list above.  

Why does the NHS want to reduce prescribing of these medicines? 

The NHS has to make difficult choices about what it spends taxpayer money on and how much value the taxpayer is getting for that money. Medicines to treat these conditions are available to buy ‘over the counter’. Pharmacists can advise patients on self-care and the lowest cost versions of medicines available.  

By reducing the amount the NHS spends on treating these minor health conditions, the NHS can give priority to treatments for patients with more serious conditions such as cancer and mental health problems.  

What are the benefits of going to the pharmacy instead of making an appointment to see your GP? 

Pharmacists have the knowledge and skills to help with many healthcare conditions, and you don’t need an appointment to speak to a pharmacist. Visiting a pharmacist first helps to make more GP appointments available for people with more complex healthcare needs. 

If you have something more serious, the pharmacist is trained to signpost you quickly to the right medical care. 

What can you do? 

By keeping certain useful ‘over the counter’ medicines at home, you can treat common conditions immediately and you won’t need to see a GP. The medicines you may want to keep at home could include: 

  • A painkiller to help treat minor conditions associated with pain, discomfort, and fever.  
  • Indigestion medicines, oral rehydration salts and treatments for constipation and diarrhoea.  
  • Treatments for seasonal conditions such as colds and hay fever.   
  • Sunblock and after sun. 
  • Some basic first aid items.  

If you have children, make sure you also have products suitable for children. 

Speak to your pharmacist for advice on what medicines to keep at home, where to store them safely and how to use your medicines.   

Ensuring you have a well-balanced, healthy diet will mean most people won’t need to take vitamin supplements or probiotics. If you do wish to take these products to avoid you becoming deficient, you can buy them from a pharmacy, a supermarket or from a trusted online site. 

What about patients who need to take medicines for these conditions regularly or in special situations? 

Some individual patients may still be prescribed a medicine for a condition on the list. The reasons vary for each condition and GPs, nurses or clinical pharmacists will speak to you individually if this affects you. The main reasons are: 

  • Treatment for a long-term condition, e.g., regular pain relief for chronic arthritis, treatments for inflammatory bowel disease.  
  • Treatment of more complex forms of minor illnesses, e.g., migraines that are very bad and where ‘over the counter’ medicines do not work.  
  • Patients prescribed ‘over the counter’ medicines 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 may vary by medicine, but could include babies, children or women who are pregnant or breast-feeding.  
  • The prescriber thinks that a patient cannot treat themself, for example because of mental health problems or severe social vulnerability (not just having a low income).  

What if my symptoms don’t improve? 

Your pharmacist can advise on how long you can expect to experience symptoms for the conditions listed. If your symptoms have not improved after this time or you start to feel a lot worse, contact your GP or call 111. Accident and emergency (A&E) and 999 should only be used for life threatening emergencies. There are lots of advices on the NHS UK website to help you choose the right service: 

Where can you find more information and support? 

  • You can speak to a pharmacist who can help with advice and treatments for the conditions listed. 
  • NHS UK website has lots of information and advice on treating minor health problems with self-care.
  • NHS England for more information about the conditions for which ‘over the counter’ medicines will no longer be prescribed.. 
  • See below for further information by condition.

Download the Self Care Information for Patients: Conjunctivitis document, which is also available below.

Summary

Conjunctivitis is often called ‘pink eye’. It is self-limiting and it will resolve within a week.

What can you do to help?

DO’s:

  • Clean your eyelids with cotton wool soaked in sterile saline or boiled and cooled water to remove any discharge.
  • Gently apply cool compresses to the eye area.
  • See a pharmacist or optometrist if your eyes don’t get better or get worse.
  • Wash hands regularly with warm soapy water.
  • Wash pillows and face cloths in hot water and detergent.

DON’T’s:

  • Do not rub your eyes, do not share towels and pillows to stop infectious conjunctivitis from spreading.
  • Do not wear contact lenses until symptoms improved.

When shall I see a General Practitioner (GP)?

  • If your symptoms last for longer than 10 days OR you have any of the following symptoms: pain in the eyes, sensitivity to light, changes in vision and intense redness in one or both eyes, contact the local Minor Eye Conditions Service or ask your pharmacist.
  • If you wear contact lenses and have conjunctivitis symptoms that are not improving or have any of the above features urgently contact your contact lens practitioner or the Minor Eye Conditions Service.
  • If your baby has red eyes. Get a same day GP appointment if baby is less than 28 days old.

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.

Constipation

Download the Self Care Information for Patients: Cough and Colds document, which is also available below.

Summary

A cold on its own can be treated without seeing a GP. You should begin to feel better in about 1 to 2 weeks. A cough will usually clear up on its own within 3 to 4 weeks. Cough and colds can be treated with over-the-counter preparations from a pharmacy or other retail outlets.

What can you do to help?

  • To reduce the risk of spreading a cold; wash your hands often with warm water and soap, use tissues when you cough or sneeze and bin them once used as quickly as possible.
  • Rest and drink plenty of fluids.
  • Gargle with salty water (do not swallow) and steam inhalation.
  • Coughs will usually resolve within 3 weeks and colds within 2 weeks.
  • A pharmacist can recommend over the counter treatments for cough and colds.
  • Ensure you have a flu vaccine if you are in an ‘at risk category’ as it prevents you from catching the flu but not colds.
  • Antibiotics are not routinely needed for coughs and colds because they won’t relieve your symptoms or speed up recovery. 
  • Antibiotics are only effective against bacterial infections, and colds are caused by viruses.

When shall I see a General Practitioner (GP)?

  • Cough or symptoms that last more than 3 weeks.
  • Bad cough that rapidly gets worse e.g., you have a hacking cough or cannot stop coughing.
  • Increased temperature or feeling hot and shivering.
  • Difficulty breathing or develop chest pain.
  • Unintentional weight loss.
  • Side of your neck feels swollen and painful (swollen glands).
  • A weakened immune system e.g. because of chemotherapy or diabetes.
  • Feeling unwell/worsening symptoms and that are concerning you.
  • If you have a long-term medical condition e.g COPD, heart failure.
  • See a GP urgently if you’re coughing up blood.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: November 2021

Review Date: 2 years from approval date or sooner where appropriate.

Download the Self Care Information for Patients: Cradle Cap document, which is also available below.

Summary

What is cradle cap?  It appears as greasy, yellow/brown, scaly patches on babies’ scalps in the first two months of their lives. It is a harmless skin condition that doesn’t usually itch or cause discomfort, and usually clear up within few months without any treatment. Speak to your pharmacist about how they can support you to look after your baby’s cradle cap.

What can you do to help?

  • Wash your baby’s hair regularly with baby shampoo and gently loosen flakes with a soft brush.
  • Gently rub on baby oil, vegetable oil or olive oil to soften the crusts.
  • Soak the crusts overnight with baby oil, white petroleum jelly or a slightly warmed vegetable or olive oil and wash with baby shampoo in the morning.
  • DO NOT pick at the scales as this can cause infection.

Notes: Do not worry that hair may come away with the flakes as your baby’s hair will soon grow back.

When shall I see a General Practitioner (GP)?

If your baby’s cradle cap:

  • Seems to be itchy and uncomfortable for your baby.
  • Looks red or swollen, or starts bleeding.
  • Spreads to other areas of her face or body.
  • There is no improvement after a few weeks of treatment.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: February 2022

Review Date: 2 years from approval date or sooner where appropriate.

Dry and sore/tired Eyes

Download the Self Care Information for Patients: Managing Your Mild Dry Skin document, which is also available below.

Summary

Do you have mild dry skin? If so, it can and should be treated without seeing a doctor. Speak to your pharmacist about how they can support you to look after your skin in line with new NHS England guidance.

What can you do to help?

Several products are available to purchase. By following the steps below, it can reduce the incidence of dry skin:

  • Apply moisturisers (creams, lotions & ointments) liberally 3 to 4 times a day.
  • Moisturisers are best applied after washing your hands, taking a bath or showering because this is when the skin most needs moisture.
  • Do not rub the moisturiser in – smooth it into the skin in the same direction body hair grows.
  • Limit bath time, use warm water and avoid harsh, drying soaps.

When shall I see a General Practitioner (GP)?

  • If dry skin is accompanied by redness and/or inflamed.
  • If dryness and itching interfere with sleeping.
  • If you have open sores or infection from scratching.
  • If you have large areas of scaling or peeling skin.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: November 2021

Review Date: 2 years from approval date or sooner where appropriate.

Download the Self Care Information for Patients: Managing Ear Wax Build-up document, which is also available below.

Summary

Do you have a build-up of ear wax? If so, it can and should be managed yourself without seeing a GP. Your pharmacist should be your first point of contact.

What could be the signs of ear wax build-up?​

  • Earache
  • Itchiness
  • High-pitched tones inside ear
  • Difficulty hearing
  • Dizziness

 How can you help yourself?

Ear wax usually falls out on its own.

  • Ear drops can be used to clear a plug of wax. Consult your pharmacist for the appropriate choice of treatment.
  • Do not use earbuds, fingers or other objects to remove wax.
  • There is no evidence that ear candles or vacuums remove wax.

When shall I see a General Practitioner (GP)?

  • If your earwax hasn’t cleared after 10-14 days of treatment.
  • If you have persistent vomiting or fever.
  • If the affected person is an infant or young child.
  • If your ear feels badly blocked and causing dulled hearing.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: November 2021

Review Date: 2 years from approval date or sooner where appropriate.

Download the Self Care Information for Patients: Haemorrhoids (Piles) document, which is also available below.

Summary

Do you have haemorrhoids? If so, it can and should be treated without seeing a doctor. They often get better on their own after a few days. Speak to your pharmacist about treatment for haemorrhoids.

What can you do to help?

  • Drink plenty of fluids and increase fibre intake to keep your poo soft.
  • Cut down on alcohol and caffeine, and exercise regularly helps to reduce constipation.
  • Use an ice pack wrapped in towel to ease discomfort.
  • Take paracetamol to relieve pain but not painkillers containing codeine e.g. co-codamol which can cause constipation. Do not take ibuprofen if your piles are bleeding.
  • Avoid delaying going to the toilet.
  • Not spending more time than you need to on the toilet.
  • Do not push too hard when pooing .
  • Wipe your bottom gently with damp toilet paper.

When shall I see a General Practitioner (GP)?

  • There is no improvement after 7 days treatment at home or you keep getting piles.
  • Your temperature is very high or you feel hot and shivery and generally unwell.
  • There is pus leaking from your piles.
  • The bleeding from your piles is non-stop, contains clots or you are in severe pain.

Document History

Version: V1.1

Author:  SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: November 2021

Review Date: 2 years from approval date or sooner where appropriate.

Download the Self Care Information for Patients: Hay Fever document, which is also available below.

Summary

Do you have hay fever? Speak to your pharmacist about how they can support you to self care in line with new NHS England guidance.

What can you do to help?

You can do things to ease your symptoms when the pollen count is high:

  • Put petroleum jelly (e.g. Vaseline®) around your nostrils to trap pollen.
  • Wear wraparound sunglasses to stop pollen getting into your eyes.
  • 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.

When shall I see a General Practitioner (GP)?

  • If you are experiencing wheezing, breathlessness or tightness in your chest.
  • If your condition is not improving after using an over-the-counter medicine as directed in combination with measures to reduce your exposure to pollen.
  • If you are breastfeeding or pregnant.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: November 2021

Review Date: 2 years from approval date or sooner where appropriate.

Download the Self Care Information for Patients: Heartburn and Indigestion document, which is also available below.

Summary

Heartburn is a burning feeling in the chest caused by stomach acid travelling up towards the throat (acid reflux). Heartburn and acid reflux are the same thing and are a symptom of indigestion (dyspepsia).

What can you do to help?

  • Coffee, alcohol, chocolate, and fatty or spicy foods can make symptoms worse, so consume these in moderation or try to reduce your current consumption.
  • Try to eat smaller, more frequent meals and do not eat within 3 to 4 hours before going to bed.
  • Reflux is more common in patients who are overweight, so losing weight can help.
  • If you smoke, the chemicals you inhale may contribute to indigestion. These chemicals can cause the muscle that separates your oesophagus from your stomach to relax, causing acid reflux, so consider getting help to quit.
  • Stress and anxiety can worsen symptoms, so try to find ways to relax.
  • Anti-inflammatory painkillers (like ibuprofen) can make indigestion worse, so speak to your pharmacist or doctor if these symptoms occur.
  • Propping your head and shoulders up in bed or raising one end of your bed by 10 to 20cm to make it so your chest and head are above the level of your waist, can stop stomach acid coming up while you sleep.
  • Pregnant women often get indigestion, your pharmacist can recommend the best medicines to use over-the-counter.
  • For further information visit this website: nhs.uk-Heartburn and Acid Reflux.

When shall I see a General Practitioner (GP)?

 If:

  • Lifestyle changes and pharmacy medicines aren’t helping.
  • You have heartburn most days for 3 weeks or more.
  • You have other symptoms, like food getting stuck in your throat or frequently being sick.
  • You feel like you have a lump in your stomach.
  • You are in bad pain.
  • You are feeling faint.
  • You are 55 years of age or older.
  • You have lost a lot of weight without meaning to.
  • You have difficulty swallowing (dysphagia).
  • You have iron deficiency anaemia.
  • You have bloody vomit.
  • You have blood in your poo.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: November 2021

Review Date: 2 years from approval date or sooner where appropriate.

Homeopathy

Mouth Ulcers

Download the Self Care Information for Patients: Nappy Rash document, which is also available below.

Summary

Nappy rash is a minor condition that can be treated without the need for a GP consultation or prescription. It can easily be treated with simple over-the-counter medication.

What can you do to help?

  • With good hygiene, nappy rash will clear in about 3 days.
  • Change wet or dirty nappies as soon as possible.
  • Clean the whole nappy area gently but thoroughly, wiping from front to back.
  • Use water and cotton wool, or fragrance-free and alcohol-free baby wipes.
  • Apply a thin layer of barrier cream as a regular preventative measure, you can discuss with a pharmacist which creams suit best.
  • Bathe the baby daily, but not more than once as this can dry out 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 the baby’s skin.

When shall I see a General Practitioner (GP)?

  • If the rash does not go away and gets worse.
  • If baby seems unwell e.g. fever, feeding less.
  • Development of a bright red, moist rash with white or red pimples that spreads into the folds of their skin – signs of infection.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: February 2022

Review Date: 2 years from approval date or sooner where appropriate.

Download the Self Care Information for Patients: Sore Throat document, which is also available below.

Summary

Sore throats are very common. They are self-limiting and will often resolve within a week without treatment. Sore throats are usually caused by viruses and so antibiotics will not improve your symptoms and can cause unpleasant side effects. Self care measures or a visit to your local pharmacist can help ease your sore throat. What can you do to help?

  • Over-the-counter medication. Try Paracetamol for pain and fever. You can also try Ibuprofen, if suitable. (Some people find medicated throat lozenges or antiseptic throat sprays help too, although there is no evidence to support this benefit).
  • Drink fluids. Drink plenty of warm or cool fluids. Avoid very hot drinks.
  • Rest. Sleep and rest your voice.
  • Try sucking ice cubes or hard sweets, but do not give to young children due to risk of choking.
  • Avoid smoking and smoky environments that may irritate your throat.
  • Gargle with warm salt water (adults only).
  • Eat cool, soft foods. These will soothe your throat.

When shall I see a General Practitioner (GP)?

  • If your symptoms have not improved after a week.
  • If you have frequently occurring sore throats.
  • If you have a weakened immune system or are taking medication that can cause a sore throat.
  • If you feel hot and shivery or have a high temperature (over 38°C).
  • If your symptoms are severe and not responding to pain killers.
  • If you are worried about your sore throat.

When shall I call 999?

  • If you have difficulty breathing or swallowing.
  • If you are drooling.
  • If your symptoms are severe or rapidly getting worse.
  • If you have stridor: a high-pitched sound as you breathe.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: November 2021

Review Date: 2 years from approval date or sooner where appropriate.

Download the Self Care Information for Patients: Sunburn document, which is also available below.

Summary

You can prevent sunburn symptoms by using sun protection products.

These can be bought in a pharmacy or supermarkets without a prescription.

What can you do to help?

  • Use sunscreens from spring to autumn.
  • Apply sunscreens thickly and frequently (approximately every two hours).
  • Use sunscreen preparations with the highest sun protection factor (SPF).
  • A Minimum of factor 30 provides 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 11 am and 3 pm from March to October.
  • Avoid burning by covering up with suitable clothing, a hat and sunglasses.
  • Make sure the sunscreen is not past its expiry date.
  • Ensure sunscreen is applied liberally and regularly throughout the day.

When shall I see a General Practitioner (GP)?

  • If a young child or baby has sunburn as their skin is particularly sensitive.
  • If you have signs of severe sunburn such as blistering or swelling of the skin, chills, high temperature of over 38ºC or dizziness, headaches and feeling sick which are all symptoms of heat exhaustion.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: August 2022

Review Date: 2 years from the approval date or sooner where appropriate.

Download the Self Care Information for Patients: Travel Sickness document, which is also available below.

Summary

Travel sickness is caused by repeated movements when travelling, like going over bumps in a car or moving up and down in a boat.

The inner ear sends different signals to your brain form those your eyes are seeing. These confusing messages cause you to feel unwell.

Medication for travel sickness can be bought in a pharmacy or supermarkets without a prescription.

What can you do to help?

  • Reduce motion. You can sit in the front of a car or in the middle of a boat.
  • It may help to look straight ahead at a fixed point, such as the horizon.
  • Do not read, watch films, or use electronic devices.
  • Breathe fresh air, if possible. You can open a car window and also close your eyes and breathe slowly.
  • Distract children by talking, listening to or singing songs.
  • Avoid eating heavy meals before travelling.
  • On long journeys, try breaking the journey to have some fresh air, drink some cold water and, if possible, take a short walk.
  • 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.

When shall I see a General Practitioner (GP)?

If the sickness regularly persists after the journey.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: August 2022

Review Date: 2 years from approval date or sooner where appropriate.

Download the Patient Information Sheet: Vitamin D document, which is also available below.

Summary

This leaflet explains the importance of vitamin D for maintaining good bone health, and the changes to the availability of vitamin D supplements for adults and children on NHS prescription.

Why do we need Vitamin D?

Vitamin D (also called Vitamin D3 or colecalciferol) is important for bone health. It is needed to absorb calcium, phosphate and other nutrients from our diet and helps to keep bones strong and healthy.

Where do we get Vitamin D from?

Sunlight

Around 90% of the vitamin D we require is made when our skin is exposed to direct ultraviolet B (UVB) rays from sunlight. Darker skin needs more sun to get the same amount of vitamin D than lighter skin.

  • The sunlight needed must fall directly on to bare skin (through a window is not enough).
  • 2-3 exposures of sunlight per week in the spring and summer months (April to September) is enough to achieve healthy vitamin D levels through the year.
  • Sunbeds are not a recommended source of vitamin D.
  • Each episode should be around 15 minutes to uncovered arms and face, without sunscreen (many moisturisers and cosmetics contain sunscreen). This is not the same as sun tanning; the skin simply needs to be exposed to sunlight. Remember it is important to cover up or protect the skin if it starts to turn red or burn. The sun’s rays can be damaging, and sunburn should be avoided at all costs, due to the increased risk of skin cancer.

Diet

A small amount of Vitamin D comes from the food we eat.

  • Between October and early March, there is generally not enough sunlight to maintain adequate vitamin D levels, and so we need to rely on dietary sources of vitamin D and supplements.
  • Foods that contain Vitamin D include oily fish (e.g., sardines, herring, salmon and mackerel), red meat, liver, egg yolk, tofu, mushrooms.
  • In the UK, some margarine, soya products, breakfast cereals, orange juice and infant formula milk are fortified with vitamin D. It is important to check the content of vitamin D in fortified foods to ensure recommended daily intake is being reached. Children who have more than 500ml of infant formula a day do not need any additional vitamin D as formula milk is already fortified.
  • Food sources alone may not provide sufficient Vitamin D during the winter months and so Vitamin D supplements are recommended for everyone, at least during autumn/ winter. Children under 5 years and other risk groups are advised to take supplements all year round.

Supplements

See section on How much Vitamin D should I take?

Vitamin D Deficiency Risk Groups  

Some people are at greater risk of vitamin D deficiency than others. This may be because their bodies need more vitamin D, they cannot produce enough through their skin, their diet is low in vitamin D, or a combination of all the above. High risk groups include:

  • Pregnant or breastfeeding women.
  • People under 5 years or 65 years and older.
  • Limited sun exposure e.g., the housebound or people in institutions such as a care home.
  • People whose clothing covers up most of their skin when outdoors.
  • Ethnic groups with dark skin.
  • People who follow a strict vegetarian or vegan diet.
  • People who are obese or significantly overweight.
  • Certain medicines may reduce your vitamin D levels (e.g. medicines for epilepsy or HIV, rifampicin or cholestyramine).

How will I know if my vitamin D levels are low?

Testing of vitamin D levels is not routinely offered. In the UK, without supplementation most people will have low Vitamin D levels during the winter months. Your GP may check your blood levels if you have symptoms of vitamin D deficiency or have risk factors that may affect the health of your bones.

What happens if you do not have enough vitamin D?

Low vitamin D may not cause any symptoms. However, some people may have symptoms such as tiredness, and general aches and pains. A severe lack of vitamin D, known as vitamin D deficiency, can cause bones to become soft and weak, which can lead to bone deformities. In adults, it can lead to osteomalacia, which causes bone pain and tenderness. In children, it can increase the risk of developing rickets. For further information refer to Patient Info: Vitamin D Deficiency.

How much Vitamin D should I take?

Public Health England recommends that in the autumn and winter months (October to March) EVERYONE should consider taking a daily supplement containing 10 micrograms (400 units) of vitamin D. These can be purchased; you do not need a prescription. For further NHS advice refer to NHS.uk – Vitamin D.

If you fall within a risk group for vitamin D deficiency (see section on Vitamin D Deficiency Groups), then it is recommended that you consider taking a Vitamin D supplement dose of 10micrograms (400units) once daily, all year round.

Adults who have previously received treatment for vitamin D deficiency or insufficiency will require more vitamin D, usually 20 to 50micrograms (800units to 2,000units) a day. If you have previously received prescriptions for 20micrograms (800 units) of Vitamin D, it is acceptable to buy a 25micrograms (1,000unit) vitamin D supplement instead, if this strength is more readily available.

Children who have previously received treatment for Vitamin D deficiency or insufficiency will require more Vitamin D, usually 10 to 15micrograms (400 to 600units) a day.

Where to get Vitamin D supplements

There are a wide range of Vitamin D supplements available to buy at low cost from pharmacies, most supermarkets and health food shops. For maintaining good teeth and bone health a product that contains 10 to 25micrograms i.e. (400units to 1,000units) of Vitamin D is generally advised.

Eligible women who are pregnant or breastfeeding and children under the age of 4 years may be able to get free Healthy Start vitamins tablets that contain 10micrograms (400 units) of vitamin D from some baby clinics and children’s centers. Speak to your midwife or health visitor for more information, or alternatively visit the healthy start website.

Can I get Vitamin D on prescription?

GP practices in South West London will no longer routinely prescribe maintenance vitamin D supplements. This is in line with NHS guidance.

If you require a treatment course of high dose vitamin D (usually 8 to 12weeks) to replenish your vitamin D levels, this will be given on prescription. Once the treatment course is completed, you will be advised to buy low dose vitamin D supplements long-term, to prevent future episodes of deficiency.

Are there any risks with Vitamin D?

Although the risk of having too much vitamin D is extremely rare, you are advised to check with a health professional such as a pharmacist, before you start taking vitamin D supplements. This is particularly important if you are already taking or have been advised to take other supplements (e.g., folic acid in pregnancy) as the pharmacist can help you select a product that meets all of your health needs. Do not take more than 4000 units daily unless under specialist advice.

References/resources

Document History

Version: V 1.0

Author: Rheumatology Clinical Network and Bone Health Subgroup

Approved by: Integrated medicines committee (IMOC) January 2023

Review Date: 2 years from approval date or sooner where appropriate.

Version: V 1.1 accessible version (March 2023)

Download the Self Care Information for Patients: Vitamins and Minerals document, which is also available below.

Summary

Vitamins and Minerals are readily available to buy at low cost, from community pharmacies (and other retail outlets) and so will not routinely be prescribed on the NHS unless for specific medical conditions.

What can you do to help?

  • Eat a varied, balanced diet to obtain your daily requirement of vitamins and minerals.
  • Seek advice from a community pharmacist if you are unsure whether you need Vitamin and Mineral supplements. In some instances, taking certain Vitamins and Minerals for a long time can sometimes be harmful.
  • If you are pregnant, breast feeding or have a child under 5 years of age and in receipt of benefits, you may be eligible to receive Health Start® Vitamin supplements for free.

When shall I see a General Practitioner (GP)?

There are some exceptions whereby a GP can prescribe these preparations:

  • Medically diagnosed deficiency.
  • Osteoporosis
  • Malnutrition
  • Surgery or chronic conditions that cause malabsorption.

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 Information for Patients: Warts and Verrucas document, which is also available below.

Summary

Warts and verrucas are small lumps on the skin that most people have at some point in their life. Most warts and verrucas will eventually clear up without treatment. They can easily be treated with simple over-the-counter medication.

  • Warts feel firm and rough. They can appear on palms, knuckles, knees and fingers.
  •  Verrucas appear on your feet. They have tiny black dots under the hard skin.

Speak to your pharmacist about how they can support you manage this and give you advice about the best treatment for you.

What can you do to help?

  • Wash your hands after touching a wart or verruca.
  • Change your socks daily if you have a verruca and do not walk barefoot in public places.
  • Cover warts and verrucas with a plaster or clear nail varnish when swimming.
  • Don’t share towels, flannels, socks or shoes if you have a wart or verruca.
  • Don’t bite your nails or suck fingers with warts on.
  • Don’t scratch or pick a wart and take care not to cut a wart when shaving.

When shall I see a General Practitioner (GP)?

  • If you’re worried about a growth on your skin.
  • If you have a wart or verruca that keeps coming back.
  • If you have a very large or painful wart or verruca.
  • For a wart that bleeds or has changes in how it looks.
  • If you have a wart on your face or genitals.
  • If you have a condition with poor circulation to the feet, e.g. diabetes.

Document History

Version: V1.1

Author: SWL DROP list working group

Approved by: Integrated medicines optimisation committee (IMOC)

Approval date: November 2021

Review Date: 2 years from approval date or sooner where appropriate.

If you have any questions about the items which are no longer going to be prescribed then please email them to [email protected]