A homely remedies policy lets trained staff give a small range of over-the-counter medicines for minor, short-term ailments without waiting for a prescription. It works when the list has been agreed in writing with the GP practice, each medicine has a stated dose, interval, maximum and reason, staff check for interactions and allergies before the first dose, nothing is given for more than 48 hours without the GP being involved, every dose is recorded on the MAR chart, and stock is controlled and audited like any other medicine.
The short answer
Homely remedies are a good idea done badly in a lot of homes. The idea is sound: a resident with a headache at 8pm should not have to wait until the surgery opens. The failure is in the detail. The list is out of date or was never agreed with the GP practice. Staff give paracetamol without checking whether the resident is already prescribed it. Doses are written in the daily notes rather than on the MAR chart, so nobody knows when the last one was. A laxative is given every day for three weeks under a policy that says 48 hours. The stock is a carrier bag in the office. The fix is a short policy with a GP-agreed list, a first-dose check, a 48-hour limit, MAR recording and a monthly stock check, and a manager who audits it.
What a homely remedy is and is not
A homely remedy is a medicine that can be bought without a prescription, that the home stocks for use by any resident, and that is given for a minor, self-limiting condition under a written policy agreed with the GP practice. Paracetamol for a headache, a simple antacid for indigestion, a bulk laxative for constipation, a simple linctus for a dry cough, an emollient for dry skin.
It is not a medicine prescribed for a named resident; that is a prescribed medicine and follows the normal MAR process. It is not a resident's own over-the-counter purchase; that is self-medication and needs a risk assessment. It is not a PRN medicine, although the two are often confused; a PRN is prescribed for a named person with a protocol, while a homely remedy is stock for anyone who meets the criteria. And it is not a way of treating an ongoing condition: if the symptom lasts, the GP decides what happens next.
Keep the definitions in the policy. Most inspection findings on homely remedies come from these categories being blurred, with a resident's prescribed paracetamol borrowed for someone else, or a stock item given daily for a month because nobody noticed it had become a regular medicine.
At a glance: homely remedies rules
| Question | Rule | Where it is recorded |
|---|---|---|
| Which medicines | Only those on the list agreed in writing with the GP practice | The homely remedies list, signed and dated |
| Who decides to give | Trained and competent staff, following the criteria on the list | Competency record in the staff file |
| Before the first dose | Check allergies, current medicines for interactions and duplicates, and relevant conditions | First-dose check noted on the MAR or in the care record |
| Dose and interval | As stated on the list; never exceed the maximum in 24 hours | Each dose on the MAR chart |
| Duration | No more than 48 hours; then GP contacted | MAR and daily note with GP contact recorded |
| Stock | Home stock, locked, in date, recorded in and out | Stock record and monthly audit |
| Review of the list | At least annually and whenever the GP practice or pharmacist advises | Signed, dated list with review date |
The GP-agreed list
The list is the foundation. It sets out each medicine, its strength and form, the symptom it is for, the dose, the minimum interval, the maximum in 24 hours, the maximum duration before the GP is contacted, and the residents or conditions it must not be used for. It is agreed in writing with the GP practice that looks after most of your residents, with input from the supplying pharmacist, and it is signed and dated with a review date.
Keep it short. A typical list has five to eight items. The more medicines on it, the more interactions there are to check and the more stock to control. A common set is paracetamol tablets or liquid, an antacid, a bulk-forming or osmotic laxative, a simple cough linctus, an emollient, and possibly an oral rehydration product. Homes with residents on many medicines often keep the list shorter still.
Some GP practices will not agree a list, or several practices cover your residents with different views. In that case record what each practice has said and either restrict homely remedies to the residents of the practices that agree or ask each practice to confirm the list for its own patients. Do not proceed without written agreement from someone.
What goes on the list for each medicine
The entry for each item should let a member of staff at 3am decide whether to give it without phoning anyone. It needs:
- Medicine, strength and form, for example paracetamol 500mg tablets.
- Indication: the symptom it is for, in plain words.
- Dose and the minimum interval between doses.
- Maximum in 24 hours, and for paracetamol a reminder to count any prescribed paracetamol or combination product towards it.
- Maximum duration, normally 48 hours, before the GP must be contacted.
- Exclusions: conditions, medicines and residents for whom it must not be given. Paracetamol with liver disease or low body weight; antacids with certain antibiotics; laxatives where there is a bowel obstruction risk or the person is already on a prescribed laxative.
- What to check first: allergy, current MAR for duplicates and interactions, and the care plan for any GP note about that resident.
- What to record: MAR entry with reason and outcome.
Attach the current product information for each item and update the list when a product changes.
Before the first dose: the checks
The first time any resident is given a particular homely remedy, the staff member checks four things and records that they did. Is the resident allergic to it or has a condition on the exclusion list. Are they already prescribed the same ingredient or a product containing it, which for paracetamol means checking for co-codamol and similar combinations. Are they on anything that interacts, which is where the pharmacist's input to the list matters. And has the GP said anything about this resident and this medicine.
Many homes ask the GP at admission, as part of the medication reconciliation, to confirm which homely remedies on the list are suitable for that resident, and record the answer in the care plan. That turns the first-dose check into a quick confirmation rather than a judgement call at night. Where the GP has excluded an item for a resident, the care plan says so and the MAR carries an alert.
If any check raises doubt, the medicine is not given and the GP, out-of-hours service or NHS 111 is contacted instead. Record the decision either way.
The 48-hour rule
A homely remedy treats a minor ailment that will resolve on its own. If it has not resolved in 48 hours, it may not be minor, and the resident needs the GP. That is the whole reason for the limit. It stops a headache that is actually a problem with blood pressure being treated with paracetamol for a fortnight, and it stops constipation that needs a proper bowel plan being managed with stock laxatives indefinitely.
The limit is counted from the first dose, not reset by a day without symptoms. When 48 hours is reached, or earlier if the symptom is getting worse, the senior contacts the GP and records the call. The GP may prescribe the same medicine, in which case it becomes a prescribed medicine on the MAR with its own supply, or may want to see the resident. Either way the homely remedy stops.
Some GP practices agree a longer period for specific items such as emollients. If so, the list says so for that item. Otherwise 48 hours is the default and the policy should say it plainly.
Recording each dose on the MAR chart
Every dose of a homely remedy is recorded on the resident's MAR chart with the medicine, strength, dose, time, reason, the initials of the person giving it and, where practical, the outcome. That is the same standard as a prescribed medicine, and there is no lighter version. The MAR is how the next shift knows the last dose time and how many doses have been given in 24 hours, and it is what an inspector will reconcile against the stock.
On a paper MAR, the homely remedy is written in a dedicated section or on a separate homely remedies MAR sheet kept with the resident's chart, with the entry checked and countersigned in line with your transcription rule. On an electronic MAR, the homely remedy is selected from the home's agreed list, the system shows the last dose and the 24-hour count, and the reason is recorded from a pick-list with a free text note. An eMAR with an OTC cupboard function does this without any handwriting.
Never record a homely remedy only in the daily notes. Notes are not searchable at the point of the next dose, and a paracetamol overdose has happened in more than one home for exactly that reason. See MAR chart codes explained for how the entry sits alongside prescribed medicines.
Homely remedies and PRN medicines
Where a resident regularly needs a medicine that is on the homely remedies list, the answer is not to keep giving it as a homely remedy. It is to ask the GP to prescribe it as a PRN with a protocol. The PRN protocol then says what it is for, the dose and interval, the maximum, the signs that mean it is needed, what to try first, and when to review. That is a better standard of care and it takes the medicine out of the 48-hour limit legitimately.
The reverse also matters. Where a resident already has a prescribed PRN paracetamol, staff must not give homely remedy paracetamol on top of it. The first-dose check is designed to catch this, and the MAR should make the prescribed PRN visible before the homely remedy can be selected. See PRN medication protocols.
A monthly look at homely remedy use by resident will show you who needs converting to a PRN. Anyone who has had a homely remedy on more than two separate occasions in a month is a candidate for a GP conversation.
Stock control
Homely remedies are home stock, bought by the home from a pharmacy or a reputable supplier, and they are stored, recorded and audited like any other medicine. They are kept locked in the medicines room or a dedicated locked cupboard, not in the office drawer, and not mixed with any resident's own supply.
Keep a stock record for each item: date received, quantity, batch and expiry, and a running balance reduced by each dose given. The balance on the record should match the MAR entries across all residents, and a monthly count should match both. Liquids are harder to reconcile exactly, so record the date opened and discard by the date on the label. Check expiry dates monthly and remove anything out of date.
Buy small quantities. A home rarely needs more than one or two packs of each item at a time, and large stock invites the informal use that the policy is there to prevent. Record what you buy and where from, and keep the receipts.
When the symptom is not on the list
The list will not cover everything. A resident with earache, a rash, a sore eye or diarrhoea at 10pm has a symptom the list does not address, and the temptation is to reach for something anyway. The policy needs a plain rule: if it is not on the list, it is not given, and the senior contacts the out-of-hours service or NHS 111 for advice instead. Record the symptom, the call, the advice and what was done.
The same applies where the resident has a symptom on the list but an exclusion applies, or where the staff member is simply unsure. Unsure means do not give and ask. A call to 111 that ends with reassurance is a good outcome and a good record. A dose of something not on the list given on a guess is an error, and it is recorded and reviewed as one.
If the same symptom keeps coming up across residents, raise it at the next review of the list with the GP practice. The list should grow from what the home actually needs, not from what the wholesaler offers.
Residents' own over-the-counter medicines
Residents and families buy over-the-counter medicines: vitamins, herbal products, cold remedies, pain relief. Some residents can manage these themselves; some cannot; and some products interact with prescribed medicines, particularly herbal products and anything containing paracetamol, ibuprofen or antihistamines.
The policy needs a section on this. A resident who wants to self-manage an over-the-counter medicine has a self-medication risk assessment, the medicine is recorded in the care plan, and the GP or pharmacist is asked to confirm it is safe alongside the prescribed medicines. A resident who cannot self-manage has the medicine held by the home and, if it is to be given by staff, it is treated as a prescribed medicine with GP agreement, or as a homely remedy if it is on the list, or it is not given.
Families need to know the rule. A polite note in the admission pack, and a reminder when something appears on the bedside table, prevents most problems. Record every conversation.
Staff training and competence
Only staff trained and assessed as competent to administer medicines give homely remedies. There is no lower tier of competence for over-the-counter medicines; paracetamol, laxatives and antihistamines all cause harm when given wrongly. The competency assessment should include the homely remedies procedure specifically: where the list is, the first-dose checks, the 48-hour rule, MAR recording and stock.
Test it at supervision. Ask a senior what they would check before giving paracetamol to a resident for the first time, what they would do if a resident had had a homely remedy laxative for three days, and where they would record it. Ask a night carer where the homely remedies are kept and who can give them. The answers tell you whether the policy is real.
Keep the competency record in the staff file with the date and the assessor. HR and training records that link the competency to the staff member make it easy to produce for the people on shift on any given night.
Learning disability and mental health services
Homely remedies in these services need extra care for three reasons. Residents are often on psychotropic medicines with a long interaction list, so the pharmacist's input to the list is essential and the exclusions are usually longer. Residents may not be able to describe symptoms, so the decision that a headache is minor is harder to make and the threshold for contacting the GP is lower. And some residents ask for medicines frequently for reasons connected to anxiety or habit, which needs a care plan approach rather than a repeat dose.
Constipation is a particular issue, because it is common with antipsychotics and because it can become serious in people who cannot report pain. A stock laxative given under the homely remedies policy is a short-term measure only; anyone with recurring constipation needs a bowel care plan and prescribed treatment.
Capacity and consent apply in the same way as for any medicine. A resident with capacity can decline; a resident without capacity for the decision needs a best interests approach recorded in the care plan.
Policy outline
A homely remedies policy should fit on three or four pages. It sits with your other residential care home policies and procedures for medicines and is reviewed annually. The sections are:
- Purpose and scope: what a homely remedy is, what it is not, which residents and staff the policy covers.
- The agreed list: attached as an appendix, signed by the GP practice, with the review date.
- Who can administer: trained and competent staff only, with the competency requirement.
- Before the first dose: the four checks and how they are recorded.
- Administration: dose, interval, maximum, and the 48-hour rule.
- Recording: MAR chart entry for every dose, with reason and outcome.
- Escalation: when to contact the GP, out-of-hours or 111, and what to record.
- Stock: purchase, storage, stock record, expiry checks, disposal.
- Residents' own over-the-counter medicines: self-medication assessment and GP confirmation.
- Audit: monthly stock reconciliation and quarterly review of use by resident.
- Review: annual review of the policy and the list, and who signs it off.
Introducing the policy in a home that has never had one
Many homes have either no homely remedies at all, so every headache means a GP call, or an informal arrangement that would not survive an inspection. Moving to a proper policy takes a few weeks and is worth planning.
Start with the GP practice and the supplying pharmacist. Send them a draft list with the doses and exclusions and ask for their comments and a signature. While that is in progress, write the policy, decide where the stock will live, set up the stock record and the MAR section, and brief the staff. Run the first-dose checks for existing residents as part of the next round of care plan reviews so the GP exclusions are in place before the cupboard opens. Then buy the first small order, record it, and go live on a stated date.
Review after a month. Which items were used, were the checks done, did the MAR entries reconcile, and did anyone hit the 48-hour rule. Fix what you find and record that you did.
Auditing homely remedies
Add homely remedies to the monthly medication audit. Check that the list is signed, dated and in date for review. Count the stock and reconcile it against the stock record and the MAR entries. Check expiry dates. Pull the MAR entries for the month and check that every homely remedy dose has a reason, that no resident exceeded the daily maximum, that nobody was given a homely remedy for more than 48 hours without a GP contact recorded, and that no resident received a homely remedy while prescribed the same ingredient.
Then look at use by resident. Who had homely remedies more than twice this month, and should they be converted to a PRN? Which item is used most, and does that tell you anything about the home, for example a lot of laxative use suggesting a hydration or diet problem? Record the findings and the actions in the audit. See the monthly medication audit checklist for where this sits.
Keep the completed audits in the governance file. They are the evidence that the policy is followed rather than filed, and they are part of the CQC compliance trail for medicines.
Common findings at inspection
Inspectors and pharmacist inspectors look at homely remedies almost every time they look at medicines, because it is a small area where the failures are easy to see. The findings repeat across homes.
- A list that was never agreed with a GP practice, or was agreed years ago with a practice that no longer covers the home.
- Paracetamol given as a homely remedy to a resident who was already prescribed it.
- Doses recorded in daily notes, or not recorded at all, so the stock does not reconcile.
- A laxative or an antacid given daily for weeks under a 48-hour policy.
- Stock stored in an unlocked drawer, out of date, or mixed with residents' own medicines.
- Staff unable to say where the list is or what the checks are.
- Residents' own over-the-counter medicines on bedside tables with nobody aware of them.
Each of these is avoidable with the process above. None of them needs new equipment.
Common mistakes
- Treating homely remedies as low-risk and skipping the competency requirement.
- A long list with a dozen items, most never used, all needing stock control.
- No first-dose check, so interactions and duplicate paracetamol are missed.
- Counting the 48 hours from the last dose rather than the first.
- Not converting frequent users to a prescribed PRN.
- Borrowing a resident's prescribed medicine as stock for someone else.
- No annual review, so the list refers to products that have changed.
What good looks like on inspection day
An inspector will ask to see the homely remedies list and check the GP signature and the review date. They will open the cupboard, count a couple of items and ask for the stock record and the MAR entries to reconcile them. They will pick a resident who had a homely remedy recently and check the MAR for the reason, the dose, the interval and the 48-hour rule, and check the care plan for any GP exclusion. They may ask a member of staff what they would check before a first dose.
The home that does this well can produce the list, the stock record and the MAR entries within a few minutes and can show a resident who was converted from homely remedy to PRN after repeated use. If your records are electronic, be ready to show the OTC cupboard, the last-dose check and the audit on screen. Kiwi's eMAR includes an OTC cupboard alongside the MAR, stock and PRN protocols, so the homely remedy entry, the 24-hour count and the reconciliation sit in the same place as everything else. If you want to see how that works for your home, book a demo.
Final conclusion
Homely remedies are a small part of medicines management, but they are a part inspectors examine every time because the failures are so visible. A short GP-agreed list, a first-dose check, a 48-hour limit, every dose on the MAR chart, locked and reconciled stock, and a monthly audit are all it takes. Write the policy in plain words, train staff on it, test them at supervision, and convert anyone who needs a medicine regularly to a proper PRN. Done that way, homely remedies are evidence that the home responds to residents promptly and safely rather than a finding in the next report.
Frequently asked
What is a homely remedy in a care home?
A homely remedy is a medicine that can be bought without a prescription and that the home keeps in stock to treat a minor, short-term ailment such as a headache, constipation, indigestion or a cough. It is given under a written policy agreed with the GP practice, for a limited period, and recorded on the MAR chart like any other medicine.
Does each resident need individual GP approval for homely remedies?
The list itself is agreed by the GP practice for the home. Individual checks are still needed: before a first dose, staff confirm the resident is not on a medicine that interacts, has no relevant condition or allergy, and is not already prescribed the same ingredient. Many homes also ask the GP to confirm at admission whether any homely remedy is unsuitable for that person.
How long can a homely remedy be given for?
Normally no more than 48 hours. If the symptom persists beyond that, the resident sees the GP or the GP is contacted for a prescription. The 48-hour limit exists so that a homely remedy never becomes a way of treating an undiagnosed problem for weeks.
Do homely remedies need to be recorded on the MAR chart?
Yes. Every dose is recorded on the MAR chart with the medicine, dose, time, reason and the initials of the person who gave it. The MAR is how staff on the next shift know the last dose time, and it is what an inspector will check against the stock.
Can care staff give paracetamol without a prescription?
Yes, where paracetamol is on the home's agreed homely remedies list, the checks before the first dose have been done, the resident is not already prescribed paracetamol or a product containing it, the dose and interval on the list are followed, and each dose is recorded on the MAR. Outside those conditions, no.
Can a resident keep their own over-the-counter medicines?
Yes, if a risk assessment shows they can manage them safely, and the home knows what they are so interactions can be checked. Record the medicine in the care plan, ask the GP whether it is suitable alongside prescribed medicines, and review the arrangement at each care plan review.
Who can administer homely remedies?
Only staff who have been trained and assessed as competent to administer medicines, in the same way as prescribed medicines. Homely remedies are not a lower-risk category for training purposes; paracetamol overdose and laxative misuse are both real harms.
Sources
- NICE SC1 Managing medicines in care homes
- CQC: Medicines in health and adult social care guidance, homely remedies and over-the-counter medicines
- Specialist Pharmacy Service: homely remedies guidance for care homes
- Royal Pharmaceutical Society: The Handling of Medicines in Social Care
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 Safe care and treatment
- Human Medicines Regulations 2012
