Doctors are increasingly defying NHS rules to prescribe over-the-counter items like baby formula, shampoo, toothpaste and multivitamins for patients struggling to afford basic goods.
Prescriptions issued by GPs in England for these everyday products have soared by up to 80 per cent in two years, analysis of official NHS data by The Independent reveals.
This is a reversal of a trend that had seen levels gradually declining since 2018, when GPs were warned not to “waste” NHS resources on everyday items sold in high street stores and supermarkets.
Now, GPs say they are having to act to protect their “most vulnerable” patients from the impact of the cost of living crisis.
Although official NHS guidance clearly states over-the-counter products like standard multivitamin tablets, non-medicated anti-dandruff shampoo and regular infant formula should not be prescribed, doctors can use their discretion to overrule this when they think it is necessary.
Professor Kamila Hawthorne, chair of the Royal College of GPs, said that GPs would not prescribe items without “a good reason” and that doctors took into account all aspects of a patient’s health, including “physical, psychological and social factors”.
Between 2021/22 and 2023/24, there was a 16 per cent rise in GP prescriptions for everyday adult multivitamin tablets from over-the-counter brands, including Boots, Superdrug and Tesco. The number of prescriptions issued rose from around 151,600 in 2021/22 to 175,000 in 2023/24.
The figures are only for standard multivitamins which can be bought in stores and do not include special formulations for children or people with specific medical conditions, like renal failure.
Health chiefs have warned GPs not to prescribe vitamins except in specific cases of deficiency or malnourishment. NHS England states most supplements can be bought cheaply over the counter and “most people can and should get [vitamins] from eating a healthy, varied and balanced diet”.
But the number of people struggling to afford food is on the rise, with food bank charity the Trussell Trust reporting a 94 per cent increase in the use of its emergency food parcels over the past five years.
There was also a 4 per cent increase in GP-issued prescriptions for over-the-counter toiletries over the two-year period, rising from around 270,600 in 2021/22 to nearly 282,000 in 2023/24.
These prescriptions were for everyday “household and over-the-counter” items, including Colgate Total toothpaste, Ambre Solaire after-sun lotion and Neutrogena and Aveeno shampoos – not special medicated prescription products, which are recorded separately.
Our analysis also found the number of prescriptions for standard brands of baby formula, including SMA Little Steps and Aptamil 1, jumped by 80 per cent in two years and by a third in the last year alone – despite clear guidelines that NHS chiefs do not “approve” these prescriptions.
The figures do not include special formulas for specific conditions or dietary needs, which are allowed to be prescribed.
In 2021/22, doctors issued 201 prescriptions for standard formula – a small number that reflects how rare it was for normal infant formula to be prescribed as a medicine.
But by 2023/34, the number of annual prescriptions had risen to 362, amid the soaring cost of baby formula. Prices climbed by 25 per cent in the two years to late 2023, according to the Competition and Markets Authority (CMA) watchdog.
In February, the CMA is expected to publish its report on whether there has been profiteering by the formula industry.
“The most vulnerable in society are of course affected the most [by the cost of living crisis], and GPs witness how higher prices are affecting the health of our patients every day in our surgeries,” Prof Hawthorne said. “We recognise that prescription costs are significant for the NHS, and GPs will always encourage patients to buy over-the-counter items where appropriate and safe to do so. But … Some patients need them for medical reasons, and some, particularly during this cost- of living crisis, are struggling to – or can’t – afford them.”
Although the prescription data does not capture whether or not patients pay for them, it is likely that GPs would only issue one for an over-the-counter item when the patient does not pay, or if the item would cost significantly more than the standard £9.65 prescription charge.
Nine out of 10 prescriptions dispensed in England are issued free of charge – although 40 per cent of the population are liable to pay for their prescriptions – government figures show.
Those who are exempt from paying include children under 16 (or under 18 in full-time education), adults over 60, and people receiving some benefits or tax credits, including those on Universal Credit whose incomes are below a certain threshold.
NHS chiefs updated their prescribing guidance in November to reiterate that vitamins and toiletries should not be prescribed, except in circumstances where doctors felt “the patient’s ability to self-care is compromised because of medical, mental health or significant social vulnerability to the extent that their health and/or wellbeing could be adversely affected”.
An NHS spokesperson said: “GPs are expert medical professionals and use their knowledge to prescribe treatments that keep patients healthy and prevent further ill health.
“The NHS is one of the most efficient health services in the world and GPs are acutely aware of how much prescriptions cost the NHS, and will always encourage patients to buy ‘over-the-counter’ products.”
