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Wholesalers: Give pharmacists emergency powers to amend prescriptions

HDA's Martin Sawer: I'm not pulling any punches with these suggestions
HDA's Martin Sawer: I'm not pulling any punches with these suggestions

Pharmacists need emergency powers to substitute drugs on prescriptions in the event of a no-deal Brexit, wholesalers and the RPS have said.

Discussing the likelihood that a potential no-deal scenario would exacerbate medicines shortages, Martin Sawer, executive director of wholesaler body the Healthcare Distribution Association (HDA), told MPs yesterday (October 23) that one solution would be “allowing pharmacists to substitute prescriptions to alternate medicines they have available”.

The government should also consider relaxing the law to “allow pharmacists to share and use other pharmacies’ medicines” to cope with shortages, he told the committee.

Speaking at a Health and Social Care Committee hearing at the Houses of Parliament, Mr Sawer suggested the government “remove and stop all wholesale licences for a limited time” in the event of a no-deal Brexit, to prevent the exporting of medicines that “we would want to keep in the country”.

“I’m not pulling any punches, we have to think of emergency powers,” he added. “We need politicians to understand that there could be consequences of a no-deal.”

RPS: Sensible to allow pharmacists to change medicines

Royal Pharmaceutical Society (RPS) president Ash Soni also said it would be “sensible” to allow pharmacists to switch medicines on prescriptions in the event of Brexit shortages, rather than “adding yet more pressure to general practices”.

“We’ve already got shortages in the market,” Mr Soni told The Times last week. “We worry that under the circumstances of a no-deal Brexit, there would be issues around a group of drugs that are more significant than they are normally.

“We need the ability to be able to deal with that rapidly.”

Do you agree pharmacists should be granted emergency powers in the event of a no-deal Brexit?

Richard MacLeavy, Dispenser Manager/ Dispensing Assistant

I think there would be unintended consequences, such as more branded generics being prescribed. At the moment a lot of branded generics are not prescribed because their avalibility is poor and it causes too much work for the GP when they have to write an alternative (which is inevitably for the generic). If you implemented the above, I recon far more branded generics would be prescribed in the hope that they would be avalible and therefore the surgery will save money but if not the pharmacist can just change it for a generic rx. We then would see a purchase profit reduction

Richard Binns, Primary care pharmacist

GP practices don't profit from the prescribing of branded generic medicines or any other medicines management activities (except specific prescribing incentive schemes, which only really offer a token payment which in the grand scheme of things is rarely significant). Switching medicines to save on prescribing budget often has a negative impact on surgery finances due to the extra work involved due to the extra resources required to carry out said activities (something I'm sure most community pharmacists can relate to)

The switching of meds for cost related reasons is normally instigated by the meds management team at the CCG, the reason GPs authorise this is generally to support a system which is finacially in crisis with a view to protecting the funding to existing services.

Leon The Apothecary, Student

I blew a doctor's mind this week when they found out Seretide has a generic.

C A, Community pharmacist

Weirdly now that there is competition the cost of Seretide 250 evohaler has dropped by £20ish... was £59.48 now £39.85... how odd ;)

Reeyah H, Community pharmacist

No thanks. So now we would have to do the Dr’s job too? For free again? We’ve already been forced to become nurses with flu vaccines! 

Ben Merriman, Community pharmacist

Can we also amend Rx when wholesalers (allegedly) cause shortages in the market?

Dave Downham, Manager

You've misspelt "cynically" .

John Urwin, Community pharmacist

Yet more Project Fear, this time (appropriately) on steroids.

I think it would have be useful to have some examples of the changes or substitutions that they are proposing. Do they mean simple dosage form changes like capsules to tablets? Switching brands where possible?

"allowing pharmacists to substitute prescriptions to alternate medicines they have available" is the kind of thing organisations like the HDA come out with but don't appreciate how hard this would be to implement in a community pharmacy. I'd have no problem substituting capsules for tablets or other minor changes but I'm not going to change the active ingredient a patient is taking. Like Caroline Jones said in a previous comment, it could work if there is a robust cascade system, but that would take some joined up thinking which is unlikely.

Caroline Jones, Community pharmacist

Pharmacists would also need access to patient records, to a greater degree than they have now as there would have to be a robust process in place to ensure there were no contraindications to switching to a different medicine....renal function etc

Smith, Locum pharmacist

Summary Care Records training from CPPE.

C A, Community pharmacist

A large number of SCRs that I have seen just have repeat and acute medication information and little else, and not everyone has them!

Caroline Jones, Community pharmacist

The DOH could be brave and bring in compulsory to prescribe genetically, no branded products unless boavailability issues. 

Regarding switching drugs, this would need to be a cascade system managed by CCG and in accordance with local formularies. 


Dave Downham, Manager

Brave? Surely sensible?

Leon The Apothecary, Student

Giving pharmacists emergency powers to amend prescriptions is another example of trying to kill a fly with an atom bomb. Just enforce generic prescribing, or create guidelines to always read prescriptions generically unless a specific clinical need is identified.

Adam Hall, Community pharmacist

In principle, this sounds like a good idea but I would be wary of unintended consequences 

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