A joint letter from the BMA, the RCGP, the Royal Pharmaceutical Society, the patient group National Voices, and others, urges health and social care secretary Matt Hancock to give pharmacists the right to amend prescriptions to supply a different quantity, strength, formulation or generic version of the same medicine, if it is unavailable.
At present, community pharmacists are legally obliged to contact prescribers, or refer patients back to prescribers, to make even a small change to a prescription such as supplying two packets of 20mg tablets if the 40mg packet prescribed is out of stock.
'This is frustrating for the patient, pharmacist and prescriber,' says the letter. 'The process can cause delays in access to medicines and takes up health professionals’ time, which could be used elsewhere to support patient care.'
The letter calls for a more pragmatic approach than Serious Shortage Protocols, which are currently in place for just two medicines: fluoxetine 10mg and 40mg capsules. Such protocols 'may be appropriate for certain nationwide shortages,' says the letter, but in practice are 'rarely used'.
The MIMS drug shortages tracker currently lists over 100 medicines unavailable in the UK, while a list of products the government has banned wholesalers from exporting has expanded to around 200 products.
Chair of the Royal College of GPs Professor Martin Marshall said: 'It can be frustrating for GPs, pharmacists and patients when prescriptions can’t be dispensed due to shortages – and that minor adjustments to prescriptions which could be dispensed can’t be made by an experienced pharmacist without being reviewed by a GP. Unfortunately, not only does this step increase GP workload, but often it slows down patient access to medication. Pharmacists are highly skilled in their area of expertise – medicines – so trusting them to make appropriate and sensible decisions regarding medicines, depending on supplies, will in turn allow GPs to focus on patients who need our care the most.'
The letter argues that substitutions are routinely undertaken by pharmacists in secondary care, and pharmacists in Scotland and Wales are also free to make certain substitutions. The signatories say their proposal does not extend to prescriptions requiring substitution of a different active ingredient, which should continue to be referred back to the prescriber.
The letter calls on the Government to work with stakeholders to implement the changes ahead of the end of the UK transition from the EU at the end of this year.