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Pharmacists altering prescriptions could ‘exacerbate’ shortages, says minister

A government assessment has warned against allowing pharmacists to alter prescriptions if drugs are not available, pharmacy minister Andrea Leadsom has revealed.

Pharmacists could “exacerbate” medicine supply issues if prescribing rules were changed to let them alter a prescription to supply an alternative, pharmacy minister Andrea Leadsom claimed this week (January 29).

Dame Andrea was responding to a parliamentary question from Rachael Maskell, Labour MP for York Central, who asked whether the DH had made “an assessment” of the “potential merits” of allowing pharmacists to supply an alternative when the prescribed medicine is not available, “without referring back to the GP”.

Read more: GPhC reports 'growing caseload' over pharmacist prescribing

The pharmacy minister said that the Department of Health and Social Care’s (DH) assessment was that pharmacists could create a “knock-on shortage” of the replacement medicine if prescribing rules were changed.

“Our assessment is that allowing pharmacists to take local action to alter prescriptions and supply an alternative without the full oversight of supply issues that the DH has could have the effect of creating a knock-on shortage of the alternative and could thereby have the potential to exacerbate rather than mitigate supply problems,” she said.

Read more: Pharmacy bodies ‘press’ government for greater powers to amend prescriptions

She added that pharmacies would not know why a particular medicine was prescribed by a GP “and in what particular way”.

Dame Andrea drew Ms Maskell’s attention to the serious shortage protocol (SSP) system, which she said was developed to “manage and mitigate” shortages by allowing a pharmacist to supply “in accordance with a protocol rather than a prescription”.

She said that SSPs are only introduced by the DH if there are “sufficient supplies of the alternative” medicine available.

 

Make pharmacists “front and centre” of medicines 

 

 

Pharmacists’ Defence Association (PDA) director of policy Alison Jones told C+D today (January 31) that “as more pharmacist independent prescribers come on board, the strategic opportunity must be taken for their qualification to be fully utilised for pharmaceutical care”.

Ms Jones said that the PDA advocates for pharmacists “working as part of a multi-disciplinary team across primary care”, co-ordinated by a leading organisation such as the integrated care board (ICB) who has “oversight across all interfaces with patients” including GP practices, care homes and community pharmacy.

Read more: GP: Why we need pharmacists to suggest alternatives during shortages

This would put pharmacists “at the front and centre of helping to support patient’s medicines-related needs” such as adjusting their treatment based on test results or addressing polypharmacy, she added.

“The current focus needs to change to improve patient outcomes, address the significant number of patients who end up being admitted to hospital with an adverse drug reaction, and to make the best use of the public investment in medicines,” she said.     

 

Rule change requests

 

It follows repeated calls from the sector to update prescribing and dispensing rules to mitigate medicine supply issues.

Earlier this month, PDA chair Mark Koziol called on MPs to change legislation to allow prescribing pharmacists to resolve “medicines related needs” without returning to the doctor or using SSPs to “change doses”.

And in December 2022, C+D reported on calls to change prescribing rules from the Royal Pharmaceutical Society (RPS) and Community Pharmacy England (CPE) - then the Pharmaceutical Services Negotiating Committee (PSNC).

Read more: Give pharmacists power to change prescriptions, RPS demands

At the time, then-RPS chair Thorrun Govind urged the DH to “amend medicines legislation to allow pharmacists to make minor amendments to a prescription without any protocol being needed” as “soon as possible”.

The RPS had made a similar call in 2020, when it published a letter in The Times urging the government to allow community pharmacists to “make changes to prescriptions that would reduce unnecessary delays in providing medicines to patients in the event of a supply shortage”.

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