Navigating UK healthcare
The National Health Service prioritises treatments of clear clinical benefit. A defined list of medicines and treatments is not routinely funded on NHS prescription, for reasons set out in national guidance. Here is what it includes, why, and how to access these items privately when you need them.
Dr Seth Rankin
MBChB MRCGP. Founder of LoveMyLife. Former NHS Commissioner and Managing Partner of Wandsworth Medical Centre.
23 April 2026
10 min read
The National Health Service (NHS) funds a very broad range of medication, but not all medication. National guidance sets out a list of items that should not be routinely prescribed on NHS prescription in primary care. The list covers treatments where the evidence of clinical benefit is limited, conditions that are minor and self-limiting, and products available over the counter (OTC) for less than the cost of a prescription item.
Knowing what is on this list is useful. It explains why your general practitioner (GP) may decline to prescribe something a friend was given years ago, why a treatment that is popular abroad is not available on an NHS script here, and what you can expect to pay for privately when the NHS decision goes the other way.
This article sets out the categories, with the items most commonly asked about in general practice. It also explains how the decisions are made and where to access items privately when you need them. Sources for every category are at the end.
Three bodies set the framework.
The [National Institute for Health and Care Excellence (NICE)](https://www.nice.org.uk/about) issues technology appraisals and clinical guidelines that NHS England is required to follow. NICE considers both clinical effectiveness and cost-effectiveness. A treatment that is effective but too expensive for the benefit it gives may not be recommended.
NHS England publishes guidance on medicines that should not be routinely prescribed in primary care. The 2017 and 2018 guidance lists treatments of "limited clinical value" and conditions for which over-the-counter items should not be routinely prescribed.
[Integrated Care Boards (ICBs)](https://www.england.nhs.uk/integratedcare/integrated-care-in-your-area/) apply the national guidance locally and add their own formulary decisions. A specific item may be on the local formulary in one ICB and not in the next. When in doubt, your GP's prescribing pharmacist can check the local position.
Every GP retains clinical discretion for individual cases. National guidance is the default, not an absolute rule. If your circumstances put you clearly outside the reasoning for the restriction, your GP can prescribe.
Diazepam for fear of flying is specifically advised against on current NHS guidance. The reasoning is both clinical (reduced reaction time in an emergency, paradoxical agitation in some patients, risk of deep vein thrombosis from enforced immobility) and regulatory (diazepam is a controlled drug in the UK and an unlicensed use). It is not prescribed on the NHS and, in practice, most private GP clinics will also decline.
Zopiclone and zolpidem for sleep on long-haul flights are not routinely prescribed on the NHS. Short-acting "z-drugs" are licensed for short-term insomnia per NICE TA77 guidance, not for managing travel, and carry their own safety considerations around driving and alcohol.
Propranolol for flight anxiety is sometimes prescribed in primary care and sometimes declined. It depends on the clinician, the history, and the circumstances.
The route most patients follow when a GP has declined is a structured fear-of-flying programme (several airlines run one-day courses), cognitive behavioural therapy (CBT) for flight phobia, or a pre-flight appointment with a private GP who can assess the case fresh.
Melatonin is licensed in the UK as Circadin for short-term treatment of primary insomnia in adults aged 55 and over. Outside that licence (younger adults, jet lag, long-haul travel, non-primary insomnia) it is not routinely NHS-prescribed and is generally accessed privately.
Z-drugs (zopiclone, zolpidem) beyond short-term use are restricted by NICE TA77 and by most local formularies to short courses (typically up to four weeks) for severe insomnia, not for ongoing sleep support.
For longer-term sleep issues, NICE recommends cognitive behavioural therapy for insomnia (CBT-I) as first line. CBT-I is available through NHS Talking Therapies (self-referral in England) and privately.
Kenalog (triamcinolone acetonide) depot injection for hay fever is listed by NHS England as a treatment that should not be routinely prescribed. NICE does not recommend it, and the risks of intramuscular steroid (localised atrophy, systemic absorption) outweigh the benefits compared with oral antihistamines and nasal steroid sprays.
Sublingual immunotherapy for hay fever has limited NHS availability and is provided through specialist allergy services rather than primary care, per the BSACI allergy guidelines. It is accessed privately in most cases.
The NHS-funded hay fever pathway is non-sedating antihistamines (most of which are now available over the counter), nasal steroid sprays (many also over the counter), and, for severe cases, referral to an allergy specialist.
Antimalarials. Atovaquone-proguanil (Malarone), doxycycline for malaria prevention, and mefloquine are paid for privately in almost all cases. Chloroquine and proguanil, still used for a narrow range of destinations, are available over the counter at pharmacies. See NaTHNaC malaria prevention guidance.
Non-NHS travel vaccines. Yellow fever, Japanese encephalitis, rabies pre-exposure, tick-borne encephalitis, hepatitis B for travel, meningitis ACWY for travel, and cholera (outside NHS criteria) are private. The NHS-funded list (hepatitis A, typhoid, combined diphtheria-tetanus-polio, and cholera under specific criteria) can be given through your NHS practice if it offers travel services.
Country-by-country travel-health advice is at NaTHNaC / travelhealthpro.org.uk.
NHS England guidance restricts routine NHS prescribing for a long list of minor self-limiting conditions. The full list, published by NHS England, covers acute sore throat, coughs, colds and nasal congestion, mild-to-moderate hay fever, mild cystitis, conjunctivitis, earwax and ear congestion, excessive sweating (hyperhidrosis), head lice, infant colic, infrequent cold sores of the lip, infrequent migraine, mild dry skin, dandruff, mild acne, mild-to-moderate athlete's foot, mouth ulcers, nappy rash, warts and verrucae, ringworm, oral thrush, prevention of dental caries, minor burns and sunburn, minor conditions associated with pain and discomfort (aches, sprains, headache, period pain, back pain), sun protection for most situations, teething and mild toothache, threadworm, and travel sickness.
The default route for these is the community pharmacy. Pharmacists can advise, supply an over-the-counter product, and, under the Pharmacy First scheme in England, prescribe for a defined list of seven common conditions including sore throat, earache in children, infected insect bites, impetigo, shingles, sinusitis, and uncomplicated urinary tract infections in women. Pharmacy First is free at the point of use.
Erectile dysfunction (ED) medication is NHS-funded within specific criteria, including defined medical conditions (diabetes, prostate disease, spinal injury, some others) and some psychological indications. Outside those criteria it is paid for privately.
Weight-management medication. Glucagon-like peptide-1 (GLP-1) medications (Wegovy, Mounjaro) are NHS-funded within strict NICE criteria and are generally accessed through specialist weight-management services rather than through general practice. NICE criteria, ICB commissioning, and service availability all change; the national position is updated regularly. Outside the criteria, GLP-1 medication is available privately through General Medical Council (GMC) registered prescribing services.
Cosmetic procedures, including cosmetic dermatology, tattoo removal, cosmetic varicose vein surgery, and aesthetic treatments, are not NHS-funded. Specific exceptions exist where there is a functional clinical indication, but the default is private.
Hair loss treatment. Finasteride and minoxidil for male pattern hair loss are not NHS-funded.
Gluten-free food prescribing has been reduced across NHS England. Some ICBs still prescribe a limited range (typically bread and bread mix) for patients with coeliac disease; many do not.
Specialised infant formula is NHS-funded only within narrow clinical indications, usually initiated by a paediatrician or specialist dietitian.
Nutritional supplements outside specific medical indications are paid for privately.
NHS England's 2017 guidance lists treatments of "limited clinical value" that should not be routinely prescribed on the NHS. The list includes homeopathic medicines, herbal medicines, glucosamine and chondroitin for osteoarthritis, co-proxamol (withdrawn), combination paracetamol and tramadol preparations in place of the separate drugs, prolonged-release doxazosin in place of immediate-release, immediate-release fentanyl for chronic pain, liothyronine (restricted to specialist initiation), lidocaine plasters for indications outside post-herpetic neuralgia, lutein and antioxidants for age-related macular degeneration, omega-3 supplements as non-specific therapy, oxycodone-naloxone combination preparations in place of oxycodone, perindopril arginine in place of perindopril erbumine, rubefacients for musculoskeletal pain, tadalafil once-daily for erectile dysfunction (where standard dosing is equally effective), and trimipramine.
The reasoning is published alongside the list and is consistent: each item either has limited evidence of benefit, a lower-cost equivalent available, or both.
The picture is not uniform across the country. ICBs apply national guidance to their local formulary and sometimes make their own decisions on specific items. A medication that is available in one area may not be in the next. Your GP's prescribing pharmacist holds the local formulary and can check quickly.
Individual patients can also be prescribed items from the restricted list where the clinical reasoning for the restriction does not apply to them. The national guidance is explicit that clinical discretion remains. Ask your GP, explain the specific reason you believe the standard advice does not fit your case, and the conversation can be had.
The three main routes are the same as for any private care.
Private GP consultation, where a GP assesses the request, prescribes if clinically appropriate, and issues a private prescription that a pharmacy dispenses on payment.
Regulated online pharmacies with GMC-registered prescribers, for items that can be prescribed after an online assessment. Regulated UK online pharmacies are on the General Pharmaceutical Council (GPhC) register.
Specialist private services for items that need specialist oversight, for example weight-management services for GLP-1 medication outside NHS criteria.
Private prescription costs vary widely. For many common generic medications, the private cost is comparable to the NHS prescription charge (£9.90 per item in England) or only modestly above it, with dispensing fees varying from pharmacy to pharmacy. For expensive or specialist medication, private cost can run to hundreds or thousands of pounds per month and can be prohibitive for anyone outside comprehensive insurance cover. It is worth asking the pharmacy what the private price will be before the prescription is dispensed.
The NHS funds a broad range of medication for conditions that need medical treatment. It does not fund medication and products where the evidence of benefit is limited, where a condition is minor and self-limiting, where an over-the-counter alternative exists, or where a treatment falls outside NICE and NHS England recommendations. The decisions are made nationally, applied locally, and supplemented by clinical discretion for individual cases.
For items on the not-routinely-prescribed list, private routes exist. Knowing which list an item sits on, and why, is the starting point.
NICE, About NICE. The guidance-setting body for clinical and cost effectiveness.
NHS England, Items which should not routinely be prescribed in primary care. The 2017/2018 "limited clinical value" list.
NHS England, Conditions for which OTC items should not routinely be prescribed. The minor-self-limiting-conditions list.
NHS England, Integrated Care Boards. Local NHS commissioners that apply national guidance to a local formulary.
NICE TA77, Z-drugs for insomnia. Guidance on short-acting hypnotics.
NICE NG240, Insomnia: non-pharmacological management. CBT-I as first-line treatment for chronic insomnia.
NHS, NHS Talking Therapies. Self-referral service for CBT and other psychological therapies.
Electronic Medicines Compendium, Circadin SmPC. UK licensing for melatonin prolonged-release.
NHS England, Pharmacy First. Pharmacist-led NHS service for seven common conditions.
NICE CG28, Erectile dysfunction. NHS prescribing criteria for ED medication.
NICE TA875, Tirzepatide for managing overweight and obesity. Weight-management medication criteria.
NaTHNaC, travelhealthpro.org.uk. UK travel-health advice and country-specific guidance.
NaTHNaC, Malaria prevention. Antimalarial guidance for travellers.
NHS, Travel vaccinations. NHS-funded vs private travel vaccines.
BSACI, bsaci.org. British Society for Allergy and Clinical Immunology guidelines.
GMC, gmc-uk.org. Regulator for UK doctors; register search for prescribers.
GPhC, pharmacyregulation.org. Regulator for UK pharmacies and pharmacists; includes online-pharmacy register.
NHS England, Gluten-free food prescribing. Policy update on gluten-free prescribing in England.
Clinically reviewed
Dr Seth Rankin · MBChB MRCGP - Founder and Medical Director, LoveMyLife
Dr Seth Rankin qualified in medicine at Auckland School of Medicine in New Zealand in 1990 and worked as a junior doctor across New Zealand, Australia, and the UK before qualifying as a Member of the Royal College of General Practitioners (MRCGP) through the London Deanery in 2004. He was Managing Partner of Wandsworth Medical Centre from 2006 to 2016 and served as a Board Member of Wandsworth Clinical Commissioning Group for nine years. He is the founder of London Travel Clinic, London Doctors Clinic, London Medical Laboratory, and LoveMyLife.
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