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The BMA is wrong, pharmacists can be trusted to dispense alternatives

"Going back and forth with the surgery can be a taxing process for all involved"

C+D's clinical editor is unimpressed by the BMA’s attitude towards pharmacists’ shortages powers

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:

**ring ring**

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…

**ring ring**

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.

Kristoffer Stewart is clinical editor of C+D, as well as a locum community pharmacist. Email him at [email protected], or contact him on Twitter @CandDKristoffer


R A, Community pharmacist

I think it depends on the situation i.e. switching branded to generic, capsule to tablet or liquid shouldn't be an issue for a GP. However, if drugs have different equivalent dose as is the case with certain drugs then a discussion is warranted.

Although what might solve this issue is if the department of health gave a weekly update of what could be switched to as an alternative if a certain drug went out of stock that have a different equivalent dose.

I remember between 2012 to 2013 when Isosorbide Mononitrate went out of stock we had to give patients M/R preparation but told the patient to break the tablet as advised by the local health board. My GP who I am on good terms said personally he thinks its bad idea but given the situation, no other alternative could be implemented. 

Edward H Rowan, Locum pharmacist

Typical GPs. They want to control everything but when it comes to it, they haven't got the resources so just put it to the back of an ever-growing queue.

Benie I, Locum pharmacist

I think I've seen this somewhere before......more work for the same or less money. Beautiful.

Really? Wow, Superintendent Pharmacist

Still no idea on how this will be paid for.... without even going into all of the other aspects of the situation

Sarah Willis-Owen, Locum pharmacist

Frustratingly I've sometimes had to swap back to the original  product quite soon after having sent a memo to all GPs next door to start prescribing an alternative. It seems like less work to me if I could just substitute a direct clinical substitution - especially if the list is already agreed with the GPs in advance. In hospital Parmacy we automatically substitute calcium products for the cheaper equivalent if there is a recommended formulary substitution or take a verbal order to change a script. I think we have so many more important things to do for our pateints than spend time toing and froing like this. Just wonder what we should do if it were an out of hours emergency.

Graham Turner, Non Pharmacist Branch Manager

I'm sure pharmacists could be trusted and relied upon to provide many other services. They have a 4 years masters degree and one year pre-reg experience. However, when they don't have the time to do what they already have on their plate, and won't be getting paid for these extra services, I suspect they might not be happy about it.

Pharmacies are already "bogged down" as they are. Get rid of MURs and NMS before adding any further jobs, please, they are awfully considered services which patients hate, and GPs in my experience just bin the paperwork we send them aanyway.

Kevin Western, Community pharmacist

Dr Green suggested 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”.

Presumably Dr Green works as a GP somewhere. it should be easy to test his hypothesis, can one of his local Pharmacists ring him and ask to speak to him about a medicine shortage - there shouldnt be a problem finding one, there are plenty around... I will put good money on the response, and it wont be "certainly , ill put you through now"!

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