Reasoning Tool · Exemptions · FP10 · what not to prescribe · RAG

Prescribing guide — eligibility, the FP10, and what not to prescribe

The prescribing admin that surrounds the clinical decision: who gets free prescriptions, how to write a legally valid FP10, the items the NHS asks GPs not to prescribe (OTC and low-value), and the red/amber/green (RAG) traffic-light rules for who should be prescribing what.

Last reviewed June 2026 · NHSBSA · NHS England · GMMMG · BNF

Who gets free NHS prescriptions (England)

Prescriptions are free for everyone in Wales, Scotland and Northern Ireland. In England a charge applies (around £9.90 per item, 2025/26 — verify current) unless the patient falls into an exemption below, or holds a prepayment certificate.

🎂 Age

Under 16
16–18 and in full-time education
60 or over

🤰 Maternity (MatEx)

Pregnant, or have had a baby in the last 12 months, with a valid maternity exemption certificate (MatEx).

🏥 Medical exemption (MedEx — apply via FP92A)

A defined, fixed list of conditions. Valid 5 years. The qualifying conditions are:

A permanent fistula needing dressing/appliance
Hypoadrenalism (e.g. Addison's) and other conditions needing specific replacement therapy — hypoparathyroidism, hypopituitarism, diabetes insipidus
Diabetes mellitus — except where treated by diet alone
Myxoedema (hypothyroidism needing thyroid hormone replacement)
Myasthenia gravis
Epilepsy needing continuous anticonvulsant therapy
A continuing physical disability that prevents leaving home without help
Cancer — treatment of cancer, the effects of cancer, or the effects of cancer treatment

💷 Low income & benefits

Income Support, income-based JSA, income-related ESA, Pension Credit Guarantee Credit
Universal Credit — if earnings are below the set threshold in the relevant assessment period
NHS Tax Credit Exemption Certificate, or an HC2 certificate (NHS Low Income Scheme — HC3 gives partial help)
Named on a valid war pension exemption certificate (for the accepted disability)

Not exempt but on regular meds? A Prescription Prepayment Certificate (PPC) caps the cost — a 3-month or 12-month PPC pays for itself after roughly 4+ items in 3 months or 12+ a year. There is also a separate, cheaper HRT PPC covering most HRT items for 12 months.

Check, don't assume. Patients self-declare exemption on the back of the FP10 — the NHSBSA runs checks and issues penalty charges for wrongful claims. If unsure, advise the patient to confirm eligibility before ticking the box.

Writing a legally valid FP10

The FP10 is the NHS prescription form (now mostly issued electronically via EPS). Whether printed or electronic, a valid prescription must carry all of the following — a missing element means the pharmacist cannot legally dispense it.

✅ Every prescription must have

✓Patient details — full name and address; age/date of birth is a legal requirement for children under 12 (best practice for all).
✓Date the prescription was signed.
✓Drug — name (use the generic/approved name unless brand is needed, e.g. modified-release, biologics, lithium), form, strength, dose and directions.
✓Quantity or duration to supply (e.g. "28 tablets" or "28 days").
✓Prescriber's signature (in ink, or a valid digital signature for EPS) plus name and practice address.

⚠️ Controlled drugs (Sch 2 & 3) — extra legal rules

Total quantity in both words and figures.
Form and strength stated; a clearly specified dose ("as directed" is not enough).
Prescriber's details and signature; computer-generated is acceptable but the signature must be valid.
Valid for 28 days from the appropriate date.
Good practice: limit to 30 days' supply (not a strict legal limit, but expected).

🎨 Common FP10 variants

Form	Use
FP10NC / FP10SS	Standard GP prescription (green).
FP10MDA	Instalment ("blue") — supervised opioid substitution (e.g. methadone).
FP10D	Dental prescriptions.
FP10PN / FP10CN	Nurse / non-medical prescriber forms.

EPS is the norm. Most prescriptions are signed digitally and sent to the patient's nominated pharmacy. The same legal elements apply — the smartcard digital signature replaces the ink one.

Items GPs are asked not to prescribe

NHS England guidance asks prescribers to stop routinely prescribing two groups: cheap over-the-counter (OTC) items for self-limiting conditions, and a list of low clinical-value medicines. Plus a clinical group: drugs that should be started and managed by secondary care.

🛒 The 35 conditions — OTC items not to routinely prescribe

NHS England (March 2018) lists 35 minor, short-term conditions that are either self-limiting (clear on their own) or suitable for self-care (treatable with items bought over the counter), plus probiotics, vitamins & minerals as items of limited clinical effectiveness. Each shows the related OTC item(s) a patient should normally buy rather than be prescribed.

Self-limiting conditions (8)

Acute sore throat lozenges, anaesthetic/analgesic throat sprays, paracetamol/ibuprofen
Infrequent cold sores of the lip aciclovir 5% cream
Conjunctivitis chloramphenicol eye drops/ointment, lubricants
Coughs, colds & nasal congestion cough linctus/expectorants, decongestants, paracetamol, vapour rubs
Cradle cap (seborrhoeic dermatitis — infants) emollients, soft brushing, baby shampoo
Haemorrhoids topical soothing/anaesthetic creams & suppositories (e.g. Anusol)
Infant colic simeticone drops, lactase drops, gripe water
Mild cystitis potassium/sodium citrate sachets, paracetamol/ibuprofen

Conditions suitable for self-care (27)

Mild irritant dermatitis emollients, mild hydrocortisone 1% cream
Dandruff antifungal/ketoconazole or coal-tar shampoos
Diarrhoea (adults) oral rehydration salts, loperamide
Dry / sore tired eyes ocular lubricants / artificial tears
Earwax olive oil, sodium bicarbonate or urea-hydrogen-peroxide drops
Excessive sweating (hyperhidrosis) aluminium chloride antiperspirants (e.g. Driclor)
Head lice dimeticone 4% lotion, wet-combing, malathion
Indigestion & heartburn antacids, alginates (Gaviscon), low-dose H2/PPI
Infrequent constipation bulk-forming, osmotic or stimulant laxatives
Infrequent migraine paracetamol, ibuprofen/aspirin, sumatriptan OTC
Insect bites & stings antihistamines, mild hydrocortisone, crotamiton
Mild acne benzoyl peroxide, topical washes
Mild dry skin emollients / moisturisers
Sunburn (excessive sun exposure) after-sun, emollients, paracetamol/ibuprofen
Sun protection sunscreens (except ACBS photodermatoses)
Mild–moderate hayfever / seasonal rhinitis oral antihistamines, intranasal steroids, sodium cromoglicate eye drops
Minor burns & scalds dressings, paracetamol/ibuprofen
Minor pain, discomfort &/or fever (aches, sprains, headache, period pain, back pain) paracetamol, ibuprofen (oral/topical), aspirin
Mouth ulcers antiseptic/anaesthetic gels & mouthwashes (e.g. Bonjela, chlorhexidine)
Nappy rash barrier creams, mild antifungal where needed
Oral thrush miconazole oral gel, nystatin
Prevention of dental caries fluoride toothpaste / mouthwash
Ringworm / athlete's foot topical antifungals (clotrimazole, terbinafine, miconazole)
Teething / mild toothache teething gels, paracetamol/ibuprofen
Threadworms mebendazole (+ household hygiene)
Travel sickness hyoscine, cinnarizine, antihistamines
Warts & verrucae salicylic acid preparations, cryotherapy

Plus — limited clinical effectiveness

Probiotics
Vitamins & minerals (not as dietary supplements or a "pick-me-up")

📉 Low clinical-value medicines

Liothyronine; lidocaine 5% plasters (outside licensed use)
Glucosamine & chondroitin; omega-3 fatty acids; rubefacients
Homeopathy; herbal treatments; lutein & antioxidants
Co-proxamol; immediate-release fentanyl (non-cancer); dosulepin; trimipramine
Perindopril arginine, prolonged-release doxazosin, once-daily tadalafil, paracetamol+tramadol combination, oxycodone+naloxone, aliskiren — prescribe the cheaper equivalent or alternative

✅ When OTC prescribing IS still appropriate

Treating a long-term condition (e.g. regular paracetamol for persistent pain)
Patient can't self-manage / buy (safeguarding, severe social vulnerability)
Symptom of a more serious condition, or where OTC isn't clinically suitable
Prescriber's clinical judgement always overrides the default.

Secondary-care / "red" drugs: some medicines should never be initiated in primary care (see the Traffic-light tab). Don't take on prescribing of a hospital-initiated drug without a clear shared-care agreement and the monitoring it specifies.

The traffic-light (RAG) system — who prescribes what

Area Prescribing Committees classify drugs by where prescribing responsibility sits. The list below uses the Greater Manchester (GMMMG) RAG classification as the worked example, grouped by system. The full GMMMG list runs to many hundreds of items — this is the GP-relevant subset.

📍

Not in Greater Manchester? Follow your local list

RAG status varies between areas — a drug that's green in one ICB may be amber (shared care) in another. This GMMMG list is illustrative. Always check your own Area Prescribing Committee / ICB formulary RAG classification and shared-care agreements before prescribing.

Your area: Not set — showing GMMMG as the example.

GREEN

Suitable for GP prescribing and initiation in primary care, within competence.

AMBER

Specialist initiates; GP continues under a shared-care agreement with defined monitoring.

RED

Hospital / specialist only. Not for GP prescribing or routine repeat in primary care.

GREY / not recommended

Insufficient evidence or value — do not routinely prescribe.

Shared care is a two-way agreement. For amber drugs, only take on prescribing once you have the specialist's shared-care request, are competent to monitor, and have capacity to do so safely — you can decline if those aren't met.