Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Proprietary Association of Great Britain (PH 17)

  The Proprietary Association of Great Britain (PAGB) is the national trade association, which represents manufacturers of over-the-counter medicines and food supplements. We represent more than 98 per cent of the branded OTC medicines market in the UK and the vast majority of the branded food supplements sector. We regularly conduct attitudinal and behavioural research among consumers and doctors which has helped provide an understanding of the extent of ill-health, particularly of minor ailments, in the community and how people deal with them. The research also demonstrates the value of education in helping people manage chronic, recurring conditions within a long-term public health strategy.

  We have already stressed to Government the need to look at what people do about their minor ailments to get a clear picture of what they may be expected to do about improving their health and taking preventive measures. We appreciate the opportunity to give our views to the Health Select Committee on this topic.

  These views are based on our research (1), which suggests that:

    —  96 million GP consultations a year are for minor ailments (which people could manage for themselves);

    —  these result in 63 million prescriptions a year (14 per cent of total NHS prescriptions in 1997);

    —  half the prescriptions written are for ailments suffered by people who pay the prescription charge, which is often three times the cost of an OTC product;

    —  if just 25 per cent of these consultations were translated into self-care/medication activities it would free up 135 hours for every GP and £380 million a year. (Although we do acknowledge that not all these consultations are just about the treatment of minor ailments, it is an illustration of the potential);

    —  while our research shows that people's first response often is self-care or self-medication, 10 per cent of ailments are referred to the GP;

    —  the research also shows that 65 per cent of these consultations result in a prescription and 17 per cent with advice to wait and return if the symptoms worsen. These data suggest that the patient might be seeking reassurance rather than treatment;

    —  further research (2) shows that most of these consultations are indeed for reassurance that the symptoms are simple and not masking serious disease. The doctor's reassurance rather than a prescription would have been sufficient;

    —  a qualitative survey among GPs (3) however, reveals that they feel the unique doctor-patient relationship must be preserved and a prescription is a tangible manifestation of this; and

    —  further research among GPs and their patients (4) shows that while GPs are cautious, almost reticent, to make OTC recommendations, the majority of their patients said GPs should ask about prior OTC use. The study also revealed patients saying that GPs should make OTC recommendations and if they did the patients said they would act on this advice and very few said they would be upset by this behaviour.

  These data show that there is a culture of dependency upon the GP, which is being fuelled by the profession, as there is little to help them break the cycle and encourage greater self-reliance by their patients.

  The reason we believe a consideration of these factors is fundamental to public health strategies is that it shows the degree to which we need to move the population towards independent action before they can truly embrace the actions needed for the promotion of public health. These would include understanding the need for and application of prevention strategies, improving health in general and changing environmental factors, which lead to poor health.


  Working with Tyne and Wear Health Action Zone, we have been trying to construct a study involving PCG/Ts, pharmacies, NHS Direct and a walk in centre with the objective of testing the hypothesis that empowering patients to do more for themselves in the treatment of minor ailments will help to change the culture of dependency.

  The project was first discussed in January 1999 and a working group set up consisting of people from the three health authorities in Tyne and Wear and members of PAGB. Funding was approved for the project in the autumn of 1999 but the path of the project changed and an amended description had to be resubmitted to guarantee funding since the start of the project had passed the financial year from which funding had initially been secured. Additionally, the performance measures for HAZs had been changed, which contributed to the delay in implementation.

  The revised project plan was submitted in May 2000 and funding once more secured.

  We believe this project serves as a case study for the problems that can arise when timing cannot be controlled and monies must be pitched and re-pitched.

  The organisational arrangements are important to get right if real progress is to be made in testing ways in which public health programmes can be developed.


  Understanding what is meant by public health is the key to its communication, in the first instance, to the public. It is not a term understood by the majority of the population and has different definitions depending on which discipline of the health professions is consulted. The first objective of the Minister for Public Health and the Director of Public Health must be to engage in definitions and ensure consistency of understanding, which must then be communicated, to the public. Once achieved there needs to be a period of public consultation.

  The structure of PCG/Ts lends itself to tailoring this consultation at a very local level. PCG/Ts can identify vulnerable groups and those who would benefit from a change in health behaviour thereby allowing a direct communication with them around the benefits of introducing public health strategies. PCG/Ts can also do this by involving local authorities, social services and education services to look very specifically at the fundamental factors influencing the state of that population, namely environment, transport, care at home, employment and education.

  Education is a key factor in effecting a change in behaviour but it must be delivered in a way that allows for action. A problem solving approach works and our research suggests that the public want to be treated as adults, do not want to be patronised and want to be given information upon which they act.


  There needs to be strong leadership at the centre and this must firstly be provided by the Minister for Public Health and the Director, which can then serve to motivate activities on a local level.

  We believe that if the target is to improve public health in England (and we limit our comments to England) there needs to be a level of public communication, which is missing from the arena currently.

  There is also little evidence of cross-departmental working, whether at local or national levels.

  Budgets must be clarified and until this is done it will be difficult for cross-departmental working to be realised.

  Information, education and consultation lie at the heart of a strategy, which is by definition long term. As such, the education must begin in schools so that the skills needed to empower future generations towards independent action can be introduced.

  We believe that the research we have carried out provides a very important guide to what is necessary to bring about long term social change and would welcome being involved in the debate on how this can be achieved.

  We would like to make the research available to the Committee so that it can inform the enquiry and would be willing to talk to members of the Committee on our comments, views and thoughts. Please contact Ms Gopa Mitra, MBE, on 020 7421 9315 or e-mail:


  1.  BMRB Everyday Healthcare Study of Self-medication in Great Britain, October 1997.

  2.  The HPI Research Group OTC Medicines and Consumers, May 1994.

  3.  McMaster Cawte Associates OTC recommendation by GPs, April 1994.

  4.  Bradley C P, Riaz A, Tobias R S, Kenkre J E and Dassu D. Patient attitudes to over-the-counter drugs and possible professional responses to self-medication. Family Practice 1998; 15:44-50.

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