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Prescribing non-prescription (over the counter) medicines for children attending nurseries and schools

Medicines that are available over the counter (OTC) (i.e. those medicines that do not require a prescription) do not need a GP signature/authorisation/prescription in order for the school/nursery/childminder to give it.

The 'The Statutory Framework for the early years foundation stage', which governs the standards of institutions looking after and educating children, used to include a paragraph under specific legal requirements - medicines that stated:

'Medicines should only be taken to a setting when this is essential and settings should only accept medicines that have been prescribed by a doctor, dentist, nurse or pharmacist.' This has now been amended to read ‘Prescription medicines should only be taken’...

The previous wording resulted in some parents making unnecessary appointments to seek a prescription for an OTC medicine so that it can be taken in nurseries or schools.

The MHRA licenses medicines and classifies them when appropriate as OTC (P (Pharmacy Only) or GSL (General Sales List)), based on their safety profiles. This is to enable access to those medicines without recourse to a GP, and the classification applies to both inside and outside the educational environment.

Medicines (both prescription and OTC) should only be administered at school when it would be detrimental to a child’s health or school attendance not to do so.

Medicine (both prescription and OTC) should only be administered to a child under 16 by a member of staff in the nursery or school, or self-administered, where written permission for that particular medicine has been obtained from the child’s parent and/or carer, except in exceptional circumstances where the medicine has been prescribed to the child without the knowledge of the parents. Students aged 16 years or over may provide their own consent to all medical treatments. For medicine consent templates, refer to appendix 1 and 2.

It is a misuse of GP time to take up an appointment just to acquire a prescription for an OTC medicine wholly to satisfy the needs of a nursery/school. OTC medicines may be appropriately administered with parental consent only.

In 2015, the GPC wrote to the Department of Children, Schools and Families seeking an amendment to the original paragraph in the EYFS (Early Years Foundation Stage) Statutory Framework, who confirmed in a letter that a GP prescription is not required, and as a result they have now updated their guidance to clarify that this is only applicable for prescription drugs, whereby non-prescription medication can be administered where there is parents' prior written consent.

The Statutory Framework for the EYFS outlines the policy for administering medicines to children in nurseries/preschools 0-5 years:

The provider must promote the good health of children attending the setting. They must have a procedure, discussed with parents and/or carers, for responding to children who are ill or infectious, take necessary steps to prevent the spread of infection, and take appropriate action if children are ill.

Providers must have and implement a policy, and procedures, for administering medicines. It must include systems for obtaining information about a child’s needs for medicines, and for keeping this information up-to-date.

Providers must keep a written record each time a medicine is administered to a child, and inform the child’s parents and/or carers on the same day, or as soon as reasonably practicable".

Training must be provided for staff where the administration of medicine requires medical or technical knowledge. Prescription medicines must not usually be administered unless they have been prescribed for a child by a doctor, dentist, nurse or pharmacist (medicines containing aspirin should only be given if prescribed by a doctor).

Ref: British Medical Association. Prescribing non-prescription (over the counter) medication in nurseries and schools. July 2017 https://www.bma.org.uk/advice/employment/gp-practices/quality-first/manage-inappropriate-workload/prescribing-non-prescription-medication

Adopted from Telford CCG

Shropshire CCG Medicines Management Team December 2018

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