Legislative changes should be considered to make “pharmacists responsible for identifying appropriate and available alternatives” when medicines are affected by shortages, according to a motion by Shropshire and Telford local medical committee (LMC) debated on Friday (November 22) at the English LMC conference in London.

GPs voted to approve the motion and urged the British Medical Association’s (BMA) General Practitioners Committee (GPC) to “urgently” enter into “discussions with relevant bodies to enable pharmacists, when medications are not available, to dispense an equivalent preparation or dosing regimen without the need to return the prescription to the GP for amendment”.

Extend powers beyond SSPs

Currently, pharmacists can only supply an alternative in cases of “serious, national” medicine shortages, following a serious shortage protocol (SSP) issued by the Department of Health and Social Care (DH).

The DH has so far issued three SSPs – for fluoxetine 10mg, 30mg and 40mg capsules. It later withdrew its SSP for fluoxetine 10mg capsules and extended the SSP for 40mg capsules to November 20. Last week it extended the SSP for 30mg capsules to December 18.

Dr Ray McMurray, GP workforce lead for Shropshire LMC, told the conference that the protocols are “very limited and very restricted” and stressed that “with worsening shortages, the criteria should be relaxed and the list extended”.

In its response to the consultation on the SSPs, before they came into force, the BMA said it is “not appropriate for pharmacists to change patients from one drug to a different one without authorisation from an independent prescriber”.

“There must be systems to support pharmacists”

Following the passing of the motion, BMA GPC executive team member Dr Krishna Kasaraneni said GPs mostly become aware of drug shortages “once a patient returns from the pharmacy needing an alternative prescription”, which can increase GP workload and delay patient treatment.

“[We] acknowledge the benefits of giving pharmacists more control in prescribing safe and considered alternatives,” he added. “Going forward, there must be systems in place to support pharmacists to ensure they have the necessary patient information to make informed decisions.”

Mike Dent, Pharmaceutical Services Negotiating Committee (PSNC) director of funding, told C+D the negotiator is “pleased LMCs are confident in the expertise of pharmacists in facilitating the supply of equivalent preparations or dosing regimes when there are supply issues”.

“PSNC is in agreement with the LMC conference that medicine supply issues are having an adverse impact on health professionals and we would be keen to explore with GPs the tools needed to enable pharmacists to dispense appropriate alternative preparations or dosing when supply issues make that necessary,” he added.

An exclusive C+D investigation – the findings of which recently featured on BBC Radio 4’s File on 4 and You and Yours programmes – revealed in September that pharmacy staff experienced shortages across 36 categories of medicines from March-September this year.