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Pharmacists not skilled enough for medicine shortage powers, MPs argue

Health minister Jackie Doyle-Price: This isn't pharmacists getting prescribing rights by the back door
Health minister Jackie Doyle-Price: This isn't pharmacists getting prescribing rights by the back door

Pharmacists do not have the necessary skills to be trusted with new emergency medicines shortages powers, MPs have argued.

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

Having the power to dispense alternatives without contacting a GP puts pharmacists in an “invidious position”, Norman Lamb, Liberal Democrat MP for North Norfolk, argued in a parliamentary debate on revoking the powers yesterday (March 18).

“They may well be having to make decisions ​that may impact adversely on a patient’s health and wellbeing when they are not necessarily skilled to make those judgements,” he said.

Ivan Lewis, Independent MP for Bury South, agreed, stressing that “pharmacists are skilled professionals in medicines and medicines management, but they are not specialist prescribers”.

Helen Goodman, Labour MP for Bishop Auckland, questioned why doctors undergo “all this training if anybody without it is suddenly able to dole out prescriptions”.

She also questioned whether pharmacists would be appropriately insured if a patient suffers an adverse effect as a result of the pharmacist dispensing under a government protocol – a concern raised by pharmacy bodies during the Department of Health and Social Care’s (DH) informal consultation on the shortages powers.

“Contentious regulations”

Shadow health secretary Jonathan Ashworth – who tabled the parliamentary motion to revoke the shortages powers – said the regulatory changes are “perhaps one of the most far-reaching and contentious of the government’s changes to medicines regulation in recent times”, and “could cause real problems for people with long-term conditions”.

He argued that doctors know a patient’s medical history better than a pharmacist, and claimed that “many community pharmacists do not necessarily want [the] responsibility” of dispensing alternatives without contacting a GP.

The government should have consulted patients, patient groups and health stakeholders before “rushing through these changes”, Mr Ashworth stressed, and called for “extensive communication and training” to “manage expectations and any dissatisfaction”.

“Considerable misinformation”

Defending the shortages powers, health minister Jackie Doyle-Price stressed that a protocol would be implemented only in “exceptional circumstances”, to “allow highly trained pharmacists” to dispense within the “narrow confines” of government instructions.

There has been “considerable misinformation” around the shortages powers and it is “not about pharmacists acquiring prescribing rights by the back door”, she stressed.

“It is entirely about ensuring that patients have access to the medicine they need, by making the best possible use of highly qualified pharmacists and freeing up GP time for patients who need to see their GP.”

The parliamentary motion to revoke the shortages powers was defeated by 292 to 240.

Read yesterday’s debate in full.

Legal challenge

Not-for-profit organisation the Good Law Project launched legal proceedings against the DH last month for pushing through the regulatory changes “without proper consultation with patient and clinical groups”. Ms Doyle-Price said the High Court rejected the judicial review request last week.

Result

Would you be happy to dispense an alternative under a government 'serious shortage protocol'?
Not sure. It would depend on the specific protocol
41%
Yes, I would be confident dispensing an alternative (quantity/dose/form/therapeutic equivalent) as designated by the government
48%
No. I would never be comfortable dispensing an alternative (quantity/dose/form/therapeutic equivalent) without consulting the GP
11%
Total votes: 118
22 Comments
Question: 
Would you be happy to dispense an alternative under a government 'serious shortage protocol'?

Elaine Petriat, Community pharmacist

I haven't read the whole debate (I don't think my blood pressure could handle it) but the comments from MP's above demonstrates their sheer ignorance about the pharmacy profession not to mention they are  down right insulting. Some Pharmacist's already are 'specialist prescribers', the rest of us are prescribing from PGD's.  And as mentioned in the comments already,  we routinely give advice to GPs (who are happy to take it instead of searching for alternatives themselves, busy, busy , busy) on appropriate alternatives that we can actually source.

Tired Manager, Community pharmacist

Let's just carry on with the current charade then... GPs refusing to prescribe an alternative during shortages unless one is specifically suggested by the local pharmacy. Don't assume that if its on a prescription the prescriber has used their own brain....

Paul Summerfield, Community pharmacist

Having read the debate in full, it is good to see that MP’s do not have a clue about pharmacy or pharmacists. I can hear the gasps of breath when I am writing this. This debate just highlights that pharmacy and pharmacists are not valued by the political class. Have the MP’s even heard of UKMi or the countless meds info departments and how they assist with medicines queries every single day? I think I have found a couple of CPD entries and a topic for my reflective account.

CAPT FX, Locum pharmacist

In simple terms my understanding of this whole scenario is something we are already doing. Like doubling up doses where a 250mg strength is available and 500mg is not. Or a situation where one particular branded generic is unvailable and another is. We are wasting a lot of time phoning up the Doctors or Practice Pharmacists requesting replacement prescriptions so that we can give two boxes of naproxen 250mg instead of i box of 500mg. Its laughable but then the laws of this land and the cost implications dictate that we do just that. 

There is no professionalism in doing this. I spent two hours trying to explain to my local MP these basics, suffice to say his silence during this debate was deafening. This for me is what it is all about. We are providing the Doctor with details of available alternatives. Doctors are phoning us looking for this information. 

All we need is the authority and responsibility to effect these changes without talking to the Doctor. Communication channels to inform the Doctors are already available and developed sufficiently as evidenced by our interactions during the flu vaccination season and emergency supply arrangements.

My biggest worry and I mentioned this to my MP is how this will without doubt be hijacked by Multiples managemnet structures. My experience shows that almost all Branches owned by multiples are run by non-professional Pharmacy Managers and these are the people who will hijack these powers like we witness every day. Pharmacists in Community Pharmacies are not in control of any aspect of the Pharmacy. Its all lip service and until we make up our minds and sort this area out seriously we will never be taken seriously. In one article on this Platform, someone is arguing the wisdom of a 5 year MPharm. course. Why waste all that time and incur the accompanying debt, when a 23 year old without any GCEs can be allowed to Manage and perform the role of a Pharmacist. This would be the same question I will be asking myself as an MP and Policy maker on this issue. 

Seena R, Community pharmacist

MPs not competent enough for Dealing with brexit, Pharmacists argue

R A, Community pharmacist

"Pharmacists not skilled enough for medicine shortage powers, MPs argue"

More like pharmacist don't have the authority to execute this power because most pharmacists have commercial string attached to their duties. This is due to the insidious influence of the multiples and the commercial nature of the community sector! 

How many times have most of us been bullied by area manager who is not pharmacists or dispensers or head office staff for not giving "excellent customer" service when we were simply doing our duty as healthcare profession? Or how about not doing any MUR's when we couldn't find any suitable patient because they were not clinically appropriate?

The MP's are right to object to this power but not because the pharmacists don't have competence we just don't have a say how a pharmacy is run. Most of us are string puppets dancing to the tunes of both big and small contractors. The only people who can break the chain are the GPhC who sit idly in their ivory tower.

Adam Hall, Community pharmacist

Everyone works for somebody. Either dance along or leave the party!

 

 

Benie I, Locum pharmacist

Nice attitude. Do do you work at the RPS by any chance?

R A, Community pharmacist

I'm not talking about dancing along or leaving the party simply how can you give so much power to a sector which has a serious conflict of interest. Pharmacists have commercial incentives dictated by an intermediary who has no real understanding of clinical pharmacy but can seriously influence it!

Its true GP are private contractors BUT they set their own terms, therefore, can reach a balance between treating patient and ensuring they are rewarded financially for it. Pharmacy, on the other hand, is dictated by people who have little or no understanding of the world of pharmacy and the poor pharmacist has to satisfy the whim of these peoples. The situation is exacerbated by the fact that  remuneration is wafer thin and the parent company gobbles most of it up and fail to invest in the workforce to allow it to carry out its duty and take on more responsibility!

Just to clarify I'm not saying that pharmacist are incapable its just they don't get the support and are unlikely to get any. Therefore its a big question mark?

A.S. Singh, Community pharmacist

True - besides the point of the article

One shareholders have an influence on NHS funds the system becomes a joke. UK is trying to copy ultra capitalist US (boots is actually American now) where Pharmacy should have no need to please shareholders.

This is where the system has gone wrong. Setting limits in the 80's to ONE Pharmacist owner per pharmacy would have meant in 2019 we would be more united as a profession with decent funding.

Interleukin -2, Community pharmacist

The sheer ineptitude and ignorance evidenced by some these comments in the article above is worrying. How did the wider society end up knowing so little about pharmacy ? 

John Ellis, Community pharmacist

MPs are clearly erring on the side of caution here. Let us hope that they will again take this cautious view when faced with the disastrous remote supervision legislation.

Benie I, Locum pharmacist

That will depend on who stuffs their mouths with the most cash.

Reeyah H, Community pharmacist

I’m glad it’s not going through. Imagine trying to claim for an alternative medicine by EPS. The nightmare. 

Paul Dishman, Pharmaceutical Adviser

It is going through, the motion to revoke the powers was defeated.

Peter John Walker, Manager

Should not the NPA, the RPS, the PDA and other bodies that purport to support pharmacists and pharmacy be doing something to over come this total ignorance of pharmacy and the education that a pharmacist is required to undergo and continue to expand their knowledge, that our MPs are showing by these comments. Many of these MPs are obviously being primed by the doctors representatives.

Thomas Wilde, Community pharmacist

Looking forward to hearing the RPS come to the defense of pharmacy and explain to MPs what we actually do and what an MPharm is about. Bet they'll do it any second now. yep any minute now they'll do something........

SydBashford Sold&Retired&DeRegistered, Community pharmacist

“Pharmacists do not have the necessary skills to be trusted”.... might as well just leave it there.... that’s what they all think on everything!

 

Community Pharmacist, Community pharmacist

I wish, one day I get good enough, to switch from capsule to tablet.

Leon The Apothecary, Student

Easy as A, B, D - oh dang...maybe one day.

A.S. Singh, Community pharmacist

dont forget to double metro 200

N O, Pharmaceutical Adviser

1. Look who is talking. We trusted you with BREXIT and after nearly 3 years look where we are !!! 

2. Any of these MPs actually discussed these matters with a real community Pharmacist, before putting these views in the Parliament ??? i guess NNNNNOOOOOOOO

3. “pharmacists are skilled professionals in medicines and medicines management, but they are not specialist prescribers”. ---- Who is asking for Prescribing powers??? Helloooo ???

4. “They may well be having to make decisions ​that may impact adversely on a patient’s health and wellbeing when they are not necessarily skilled to make those judgements,” --- What extra skill do we need, just to dispense an alternative drug that is in stock and has been approved by CLINICIANS on the GOVT's panel beforehand ??? Duuhhhhhhhh

5. “many community pharmacists do not necessarily want [the] responsibility” of dispensing alternatives without contacting a GP. --- This is the only point which makes sense, because of the liablity inurance and the criminalisation of the dispensing error (error forced on by the Govt)

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