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PAGB has long called on Government to raise awareness of self care and invest in a strong, prevention-led primary care sector – but how much progress is being made? By Saša Janković

PAGB’s 2024 Self-Care Census report, published in July, reveals the attitude of 4000 UK adults in the context of the current state of primary care services, aiming to highlight the challenges and opportunities for self-care.

Worryingly, at a time when GP services are stretched to their limits, it found that the number of GP appointments for self-treatable conditions – resulting in advice to use over-the-counter (OTC) medicines – is rising, climbing 17 percentage points from last year to 75 per cent this year. 

On the plus side, consumers demonstrated a widespread trust in OTC medicines, with 89 per cent of adults surveyed confirming they are confident using OTC products to manage their symptoms.

However, the report shows there is still more to be done to promote self-care, with confidence in self-care among younger adults appearing low. 

Around 23 per cent of those aged 25 to 34 admitted they would try to get a GP appointment for a self-treatable condition rather than self-care or visit a pharmacist, compared to just nine per cent of those aged 65 or older, and fewer than a third of 18-24-year-olds ‘strongly agree’ they would choose to treat themselves at home or seek advice from a pharmacy, compared with 44 per cent of those aged 65 and over. 

PAGB says these results support the “rapidly increasing need” to prioritise self-care education and awareness of the full range of primary care services outside General Practice and Accident & Emergency (A&E) departments, adding that the data corroborates last year’s Frontier Economics report which suggested at least 25 million GP appointments and five million A&E attendances each year are used for self-treatable illnesses.

Policy progress

These figures are not going to improve on their own, so what policy levers can be pulled to support the community pharmacy sector in delivering this agenda?

Over the years PAGB has made numerous calls for investment in a strong, prevention-led primary care sector and has already called for a government plan to prioritise self-care.

In 2021, the Self-Care Strategy Group (SCSG) – founded by PAGB in 2019 with representatives of leading pharmacy and healthcare organisations committed to self-care – published a blueprint for a national self-care action plan outlining nine recommendations to better support and encourage self-care in England. 

Actions called for included improving health literacy in the school curriculum and modernising the digital health infrastructure, the empowerment of pharmacists and the widening of patient access to self-care medicines through reclassification.

These recommendations provided a roadmap towards a future where all people have greater agency over their health and confidence to utilise the full range of primary and community care services, not just GP practices.

More recently, before the general election this year, PAGB argued for a re-evaluation of the criteria “restricting the potential for medicines reclassification”.

This was followed by a letter to the new health secretary Wes Streeting in which the SCSG welcomed the Labour government with calls for expanded prescribing rights; optimised digital health tools; the enablement of direct referrals between primary, diagnostic and specialist care services; the widening of access to self-care medicines in pharmacies; and the expansion of public awareness campaigns with the promotion of credible health information on self-care. 

This is by no means the first time government has been made aware of these requests, so what does the PABG hope the new administration will deliver?

“We have long argued in favour of measures to prioritise self-care, increase education and awareness and support people’s confidence to practice self-care for self-treatable conditions”, says Michelle Riddalls, CEO at PAGB. “In recent years, our work advocating for a national self-care strategy has seen good progress. 

“By working closely with our members, organisations across the healthcare sector and policy makers we successfully secured a national self-care policy in May 2023 with the government’s ‘Delivery plan for recovering access to primary care, which incorporates seven out of the nine recommendations made by the SCSG in our blueprint.

"This is a great step in the right direction, with the Government recognising the positive impact self-care can have for the public, the economy and cost savings to the NHS.”

What comes next, according to Riddalls, is the PAGB calling on the new government to prioritise self-care in their first 100 days.

“We recently wrote to the Secretary of State for Health and Social Care detailing the scale of the opportunity and highlighting the quick and cost-effective wins that prioritising self-care will deliver and how this can help reduce the burden on the NHS ahead of the winter illnesses season,” says Riddalls – which includes embedding self-care fully in primary care to realise its full potential in reducing the burden on the front door of the NHS; improving patient awareness of, and confidence in, self-care, to empower them to access the right care at the right place; and promoting an attractive environment for the OTC sector, to ensure its continued investment in, and prioritisation of, the UK market. 

Pharmacy self-care pilot

If Streeting’s department is looking for real-world evidence of the utility in promoting community pharmacy as the gateway to self-care, there is a great example up and running on its doorstep.

Community Pharmacy North East London (CP NEL) launched a self-care scheme funded by the local Integrated Care Board at the end of July, to allow eligible patients who cannot afford OTC medicines to access them for free – which is also expected to boost Pharmacy First consultations locally. 

“We know that the majority of our pharmacies have signed up to offer the scheme, and GPs are really welcoming the service, as are patients,” says CP NEL CEO Shilpa Shah.

Indeed, Streeting’s first visit to a community pharmacy since taking on the role of Secretary of State for Health and Social Care was with Shah at Hainault Station Pharmacy in Ilford. This gave Shah the opportunity to discuss with him how valuable the service is for patients and “how great it would be if it was added on to Pharmacy First nationally”. 

In the meantime, Shah says there are other things government should consider to support the community pharmacy sector in delivering the self-care agenda. “We need to make it easy for everyone everywhere, to be able to get the medication they need”, she says.

“We have deprived areas where people are struggling and using food banks and are simply not buying OTC remedies which will help symptoms of minor conditions.

"For example, children with headlice are not allowed to go to school but if their families can’t afford treatment they then are missing out on their education and, potentially, the chance of having a better life in the future.”

Healthcare spend and the OTC market

Recent consumer spending figures from the Office for National Statistics (ONS) reveal that UK households spent a record £32.3 billion on health products and services in 2023, up £2.5 billion (+8.3 per cent) on 2022’s £29.8 billion. This included £8.6 billion spent on products such as medicines, vaccines and vitamins – up from £7.9 billion in 2022 – and £4.2 billion on consultations with doctors and specialists (and £4 billion on dentists and hygienists).

“It is great that Brits are now spending more on preventative healthcare measures [but] it is concerning that a growing amount of our household spending is going on health issues that the NHS is increasingly unable to fund,” comments Dr Avinash Hari Narayanan (MBChB), clinical lead at London Medical Laboratory, “These record figures appear just as patients in England have endured another rise in prescription prices from £9.65 to £9.90 per item.”

The OTC medicines market was worth £3.19bn in 2023, and PAGB’s 2024 Self-Care Census report reveals there is an increasing desire from consumers for more medicines to be made available over the counter. Almost three in four adults (74 per cent) would like more medicines available from a pharmacy without a prescription, and Riddalls says there are other opportunities to further empower people to choose self-care for self-treatable conditions.

“Educating the public about comprehensive primary care services, which includes the role that pharmacies can play as well as the self-care resources available to all of us, is essential,” she says. “With over half of people agreeing that schools should be responsible for providing self-care education, integrating this into the school curriculum will also help to empower students with essential knowledge and skills to manage their health effectively.”

Digital tools are also an important resource to support education and awareness about self-treatable conditions and direct people to self-care information. “Written in consumer-friendly accessible language, brands’ websites and apps often hold a lot of education and information about self-treatable conditions.  They provide advice and direction on where to go for support and help, and how to self-care. 

“In fact, the data from this year’s census has revealed that 73 per cent of adults surveyed agree that they would trust health information from an OTC brand’s website,” says Riddalls. 

But with 40 per cent of people in the PAGB survey saying they feel “overwhelmed” by the sheer amount of information available digitally – and the same number saying they don’t know what online health information they can believe – there’s still a way to go to ensure confidence in digital self-care tools.

OTC impacts

There may also be more to consider when it comes to claims of the big economic impact of OTCs. 

A new economic impact study on OTC products from Frontier Economics, funded by PAGB, aims to help policymakers recognise the importance that self-care and OTCs play in the UK today and acknowledge the sizeable benefits that greater OTC usage could bring. 

According to the study, every £1 spent on OTCs – which amounts to some £3.3 billion a year – creates £8.40 in economic and social benefit, which includes contributions to the economy via wages and exports, savings from avoided workplace absence, and from prescriptions and appointments not needed in the NHS. Employers reap the biggest benefits from people buying OTCs, followed by the NHS and then the UK economy.

When it comes to increasing the uptake of OTCs by consumers, health economist Leela Barham says: “Those who are willing and able presumably already do use OTCs. For those that don’t, there could be good reasons – leaving aside the switch of POM to OTC.

"I think we already know that OTCs make a meaningful contribution to the bottom line for many community pharmacy contractors, but the question is: can it be grown sufficiently to help pharmacies offset cost pressures, now and into the future? Of that I am not so sure because cost pressures have been significant and there is little to believe that that will abate any time soon.” 

Changing behaviours

So what can be done in order for self- care to deliver on the promise of saving the NHS money and bring in more income for community pharmacy? “It’s got to be about the demand side because the supply side is ready and waiting,” adds Barham, “But changing behaviours of people is notoriously difficult. 

"Raising awareness hasn’t been enough through past efforts like the self-care campaign and efforts by the industry and others. And let’s not be too hasty about the promise of Pharmacy First because it’s so new. People need to gain more experience and share those experiences with others.

"That could really change perceptions of going to the community pharmacy.”