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BMA argues pharmacists’ new shortages powers are ‘inappropriate’

BMA: Pharmacists should not be allowed to change a patient's prescription without authorisation
BMA: Pharmacists should not be allowed to change a patient's prescription without authorisation

It is “not appropriate” to grant pharmacists power to deal with shortages by dispensing an alternative without contacting a prescriber, the BMA has argued.

The Human Medicines (Amendment) Regulations 2019 order – which comes into force on Saturday (February 9) – includes provisions to allow pharmacists to dispense an alternative in accordance with a “serious shortage protocol” announced by the government – rather than the prescription and without contacting the GP – in the event of a national medicines shortage.

But Dr Andrew Green, the British Medical Association's (BMA) GP committee clinical and prescribing lead, said it does “not believe that it is appropriate for pharmacists to change patients from one drug to a different one without authorisation from an independent prescriber”.

In its response to a government consultation on the powers, the BMA explained that it does not agree with dispensing a therapeutic equivalent as a “blanket approach” to dealing with shortages.

“Patients have idiosyncratic responses to drugs within the same class, and the pharmacist will not know what has already been used,” it added. “This would, effectively, be a new prescription.”

“However, in a crisis situation we would accept a pharmacist amending the prescription – only after discussion with the prescriber, including information about medicines availability.

“This should result in no delay to the patient in receiving the equivalent medicine,” it added.

Brexit could exacerbate shortages

Dr Green added: “GPs and their teams have to contend with medicine shortages on a daily basis, much to the frustration of staff and their patients, and there are obvious concerns that a no-deal Brexit could exacerbate existing issues.”

The association understands the new legislation “is intended to minimise disruption to patients, GPs and pharmacists in the event of a serious shortage, building on how GPs and pharmacists are already working together locally to deal with current issues”, he said.

However, this does not make it appropriate for pharmacists to change a patient’s prescription without authorisation, he stressed.

Develop rules with clinicians

It is “imperative that the specific details of the new rules and their practical application are developed by clinicians, and clearly communicated to doctors, patients and pharmacies”, Dr Green added.

Pharmacy minister Steve Brine told parliament last week that the government would only announce a protocol for a medicine in short supply “if clinicians think it is appropriate” and “when other mitigation measures have been exhausted”.

It is in the process of creating a “national, clinically chaired group” with “national oversight at senior doctor level” to advise ministers on when pharmacists should supply an alternative, he added.

34 Comments
Question: 
What do you make of the BMA's comments?

Leon The Apothecary, Student

At the very least I believe a simple change change such halving strength and giving double dose to sidestep a shortage could be done even by a technician, there's no clinical need need to work out 40mg = 2 x 20mg.

In my experience, there's a lot of pharmacies out there that make that change then request a Px alternative post factum.

It's an easy first step.

Interleukin -2, Community pharmacist

That my friend, is dispensing error. Gets you attention from the GPHC

 

Mr CAUSTIC, Community pharmacist

You follow the protocol for an anti-hypertensive and substitute . The following morning the patient takes your new drug . They have a severe idiosyncratic reaction and have a car accident as a result . Who gets the blame . The local press have a field day and patients will get their prescriptions dispensed elsewhere. Sorry it is too risky . It will probably  be OK  99.99 % of the time but I do not want to be the pharmacist who had the problem patient . At the moment we cannot even switch tablets for capsules or give double the quantity of a half strength product . Cannot give capsules out for a script where it states tablets and tablets do not exist !

 

How High?, Community pharmacist

1. GPs curreently know the situation with regard to many drugs such as naproxen and yet still slavishly "follow my formulary". 

2. I wonder how that would work with EPS which merely reimburses what was prescribed, irrespective of any endorsement?

3. BMA. What the heck are SCR then?

4. Actually lets not sign up to another "free" service putting all the onus on ourselves. Let the government issue a list of problem drugs to GPs along with reccomendations as to what they should prescribe. Why should it be up to us?

5. Who's going to tell the public that we're qualified to do this? They don't think I'm qualified to even question the trelegy ellipta prescribed with a trimbow inhaler.....

Locum Pharmacist, Locum pharmacist

The pharmacist is not paid enough to take on the added risk associated with providing an alternative.Let the gp take the risk they are paid to,I want no part in it.

Lucky Ex-Locum, Superintendent Pharmacist

Agreed.

Zafash Pharmacy, Community pharmacist

I usually do night shifts in the pharmacy I work in and the amount of phone calls I receive from out of hours doctors and the A&E  doctors to guide and advice them about a particular medicine and whether it can be prescribed for a particular patient is worrying. Here we go but BMA believes that "pharmacists, the medicine experts can not do what they are trained for".

Also, not a problem at all. this means less donkey work for me. my reply be like:

" we don't have this medicine in stock, go back to your doctor." 

Jay Badenhorst, Superintendent Pharmacist

Good thing the BMA response has the patient's best interest at heart... (before you say it, yes I am being sarcastic)

Dario Canada, Community pharmacist

So the medicine specialists cannot do what they trained years to do but when it comes to do prescreening diagnosis to patients to allow the GPs to arrive late at the practices is ok... Well get your arses out of bed earlier and do your jobs properly then...

Lucky Ex-Boots Slave, Primary care pharmacist

I find it ridiculous that doctors automatically get prescribing rights when they qualify without much pharmaceutical and pharmacology knowledge while pharmacists, as drug experts in these areas, need to study another 'top-up' course to be able to prescribe. The ideal situation should be - the doctors make diagnosis and code it, then pass the cases onto the pharmacists for decision on treatment regime, management, reviews and monitoring, while nurses can focus on managing patients with long-term conditions in specific areas e.g. diabetes, asthma/copd, hypertension, minor ailments, wound care and dressings incl. catheters, home visits for elderly/frail, care homes etc. and again passing all prescribing and treatment bits to pharmacists after reviewing. This is probably the best way to utilise skill mixes, expertise and time of all 3 professions for the best treatment outcome. 

And to be fair putting pharmacists in dispensary is literally a waste of skills as we are way more capable than simply churning out drugs as checking machines. These operational tasks can be done by ACT without problems. The only thing that really needs a pharamcist's input is the clinical checking bit, which can easily be done at the same time when pharmacists prescribe the meds. Sadly this ideal workload distribution will never happen!

Beta Blocker, Primary care pharmacist

As a prescriber working in surgery myself, I absolutely agree with everything you've said. I sometimes get GPs passing medication queries over to me because they don't understand the drug, formulation etc

Sharlene Faulds, Pharmacy technician

Excellent response couldn't agree more.

N O, Pharmaceutical Adviser

Forget about SSP, we need a complete overhaul of GP prescribing system. Yes I mean it, the IT SYSTEM and the GPs own knowledge about current medicines available.

Many don't have access to discontinued medicines and their system (as old as them) do not give them any options for currently available products. This is what happens when more and more is stress given on using software to suggest the cheapest available product in a therapeutic category rather than give a range of choice for the GP to select.

 

Angry Pharmacist, Locum pharmacist

..’and the pharmacist will not know what has already been used’...Ermm sorry, what the whole point of SCR again??

 

Paul Dishman, Pharmaceutical Adviser

Dear BMA,

Sorry haven't got time to waste phoning your overworked members so will be sending prescriptions back to them via their patients.

 

janet maynard, Community pharmacist

You've joined the ranks of advisors now then!

Paul Dishman, Pharmaceutical Adviser

Not really Jan. C&D don't have a category for 'retired', so it was advisor or student.

Keith McElrea, Pharmaceutical Adviser

It is not appropriate for Dispensing Doctors to prescribe and give out medicines with no pharmacist check in place.  However, it happens because it is deemed better than no medicines dispensing service at all.  Likewise, shortages powers, while perhaps undesirable, are designed to prevent the whole system being gridlocked with 20 pharmacists an hour trying to call GPs for alternative prescriptions, and pharmacists being tied up for hours they do not have trying to resolve simple issues they already know the answers to.  I’m sure with anything that does not lay within their competency they will still be using their initiative and picking up the phone to their GP, and getting through as 19 others aren’t trying to speak to them unnecessarily. 

Richard Judge, Manager

There are no "Powers" being granted in this proposal. Pharmacists will be told what to substitute. Individual pharmacists will not be making substitutions on the fly.

N O, Pharmaceutical Adviser

"" Pharmacists will be told what to substitute. ""

Then why such a cry from BMA ????

C A, Community pharmacist

They are just living up to the other meaning of BMA. "Pharmacists doing xyz" hey that's a Doctor's job - Bite My A**

Richard Judge, Manager

From the previous article: "The protocol would be developed with clinicians and would clearly indicate what alternative can be dispensed and to which patients it applies."

N O, Pharmaceutical Adviser

Agree.

I don't think the BMA have read that article. So once again, why such a cry from BMA ????

Daniel McNulty, Superintendent Pharmacist

“This should result in no delay to the patient in receiving the equivalent medicine,” 

Brilliant. Bet he said this with a straight face.

1. We're not paid for this service

2. We've no legal protection for this service

3. The GP trades union are bursting into tears about it

The words  "I'm sorry but this product is unavailable. I suggest you make an appointment with your named GP to discuss the alternative." spring to mind.

C A, Community pharmacist

Then the patients will complain they have to wait 2 weeks to see their GP.

Paul Dishman, Pharmaceutical Adviser

It doesn't take much to set the BMA off, they've had ridiculous hissy fits over the years at the thought of pharmacists making any sort of advance from the 1950s

Angry Pharmacist, Locum pharmacist

And this ladies and gentlemen is why Pharmacists are seen as nothing more than shopkeepers. 5 years of study as an expert in drugs and medicines and we’re not even allowed to prescribe....nope here’s your Masters in Pharmacy now go mind the shop please 

Adam Hall, Community pharmacist

BMA don't want us to do it? Not a problem!

Dear Patient - Your medication is in short supply. I cannot contact your GP. Tough Luck!

 

Graham Turner, Non Pharmacist Branch Manager

If you still have to go to the effort of contacting the prescriber, and making a clinical recommendation about a replacement medication, what is the problem with the prescriber just sending over a replacement rx?

The person saying that there will be no delay to the patient doesn't know what they are talking about. I have waited hours for doctors to call back, and many times you simply can't get hold of the prescriber at all, for example the rx was written the previous day and the prescriber is now on their day off.

N O, Pharmaceutical Adviser

Absolutely.

The whole idea of introducing SSP is to make sure the patient gets an alternative theraputically similar medication without having to go back to the GP or even wait longer in the Pharmacy while the matter of new drug is sorted out. 

Why would we need any protocol, if the GPs have to be involved ?? Whatever BMA's view is what is currently existing set up. No point spending loads of cash in ""creating a “national, clinically chaired group” with “national oversight at senior doctor level” to advise ministers "" if the final outcome is NOT different to existing practice.

Instead set aside that amount for funding the Pharmacies properly in handling the crisis.

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