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‘No published assessment’ on pharmacist drug substitution, DH reveals

The DH has revealed that the pharmacy minister relied on an “internal” assessment when dismissing proposals to allow pharmacists to substitute medicines that are in short supply.

The Department of Health and Social Care (DH) has revealed that it has produced “no published…assessment” on proposals to allow pharmacists to substitute an out-of-stock medicine without a serious shortage protocol (SSP) in place.

In recent months, pharmacy minister Dame Andrea Leadsom has rebuffed questions from MPs about proposals to allow pharmacists to alter prescriptions when there is a shortage and an SSP is not yet in place without returning to a GP.

Read more: UPDATED: Pharmacy technicians to supply medicines under PGDs

In January, Dame Andrea said that the government’s “assessment” of a proposal to let pharmacists prescribe alternative medications when faced with a shortage was that it could “exacerbate” supply issues.

And last month, she said that the government had “no plans to introduce legislative proposals to allow pharmacists to amend prescriptions”.

 

"Internal” assessment

 

But when asked by C+D via a freedom of information (FOI) request for the “assessment” referred to by the minister in January, the DH said that there was “no published DH assessment on allowing pharmacists to substitute medicines without returning to the prescriber and without an SSP being in place”.

Instead, it said that it had produced an “internal” assessment that informed the minister’s position on the matter.

This assessment outlined that SSPs are only introduced where “sufficient supplies of the alternative product” stated in the SSP are “available to support the market”.

Read more: Pharmacists altering prescriptions could ‘exacerbate’ shortages, says minister

It said that permitting pharmacists to “take local action” to dispense an alternative medicine “could have” effects like:

  • “Creating a ‘knock-on’ shortage of the alternative” and therefore “exacerbate” the problem
  • “Creating uncertainty among prescribers” regarding the medicine received by their patients

It added that “flexibility” could:

  • Disrupt “market dynamics” and “obscure” demand predictions made by suppliers
  • Have “patient safety implications” if pharmacists did not know why “a specific product” had been prescribed

 

“Strategic opportunity”

 

But pharmacy bodies have argued that substitution without an SSP is a reasonable use of pharmacists’ hard-earned skills. 

In January, Pharmacists’ Defence Association (PDA) chair Mark Koziol told the health and social care committee (HSCC) that as the profession moved towards independent prescribing qualifications being the norm, such powers would be “a successful way forward” for the profession and a way to focus on pharmacists’ “unique skills”.

At the time, PDA director of policy Alison Jones told C+D 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”.

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.

But the matter may not be a settled issue. On Monday (March 25), health secretary Victoria Atkins told the HSCC that the government has “not made a decision” on whether to “expand the services of pharmacists to be able to cover…alternative medicines”.

Meanwhile, the DH today revealed that pharmacy technicians will be permitted to administer and supply medicines under patient group directions (PGDs), although it remains unclear when the change will come into force.

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