I am both disappointed and saddened by the response of Dr Andrew Green, the British Medical Association's (BMA) GP committee clinical and prescribing lead, to the government’s planned “serious shortages protocol”.
If you’re not familiar with this new legislation – due to come into force tomorrow (February 9) – it will provide the government with the legal ability to announce a “protocol” when faced with a serious, national shortage of a particular medicine. This would essentially give pharmacists permission to dispense an alternative strength/version/drug with a similar therapeutic effect – depending on the particular protocol – without first having to contact a GP to change the prescription.
It sounds like a practical solution to a growing problem, right? Not according to Dr Green’s BMA, which “does not believe it is appropriate for pharmacists to change patients from one drug to a different one without authorisation from an independent prescriber”.
Dr Green seems to suggest that pharmacists should simply call the surgery and speak to a prescriber to agree on the alternative drug before it could be dispensed, claiming this would “result in no delay to the patient in receiving the equivalent medicine”.
Sounds straightforward, right? Well I can only speak from my own experience as a locum, but trying to call a surgery to speak to a prescriber is often an arduous process. Our healthcare comrades in general practice are – like those in community pharmacy – overworked, understaffed and working with fewer resources than they would like.
Even if you have a good relationship with your local surgery, they do not have a caller switchboard and their phone lines are miraculously never busy, it is easy to imagine the following scenario taking place:
Receptionist: “Hello, this is NE surgery, how can I help?”
Pharmacist: “Hi, it’s Kristoffer the pharmacist, calling from C+D pharmacy. Can I speak to Dr Ink about a prescription?”
Receptionist: “She is with a patient at moment. Can she call you back?”
Pharmacist: “That would be great, thanks.”
Half an hour later…
Technician: “C+D pharmacy, how can I help?”
Prescriber: “Hi, it’s Dr Ink. I have a missed call from Kristoffer about a patient’s prescription. Can I speak to him please?”
Technician: “Do you mind holding for 10 minutes? He's in the consultation room with a patient at the moment.”
Prescriber: “I have another appointment, but could you get Kristoffer to call me back?”
Repeat cycle ad infinitum.
Going back and forth with the surgery can be a taxing process for all involved. If shortages are frequent, then this extra step could further bog down an already busy team and potentially result in further supply delays to the patient.
I want to emphasise that pharmacists are the experts in medicine, and we can take on responsibility to match our skillset. In the case of shortages, we won’t be choosing medicine for the sake of it. Pharmacy minister Steve Brine confirmed only last week that the government would only announce a protocol for a medicine in short supply “if clinicians think it is appropriate”, and explained 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.
If there’s one issue that does need to be addressed, it’s improving records transfer between community pharmacy and general practice. Contrary to Dr Green’s assertion that pharmacists will not know a patient’s medication history, we do have the ability to access patient records. However, we can’t edit these, to quickly and efficiently share information with the prescriber. To ensure that the supply of an alternative is safe and effective, the long called-for read-write access must be made available in every pharmacy. Now.
What I know for certain is that when shortages do occur, pharmacists and their teams will work hard to ensure the best alternative is supplied in a timely manner to patients – regardless of what the BMA thinks.