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GP: I hope pharmacists can amend all prescriptions after COVID-19

“In 2019, there seemed to be a rare outbreak of common sense within government”

The impact of COVID-19 could encourage permanent legislative change to allow pharmacists to make minor prescription changes, says Dr Toni Hazell

How is everyone doing now that we’ve had a few months of lockdown? Are you svelte from doing your online exercises with Joe Wicks or flush with your success at having mastered a new language?

No, me neither. My clothes seem to have shrunk in the cupboard. The combination of working a few days a week from the surgery with some days from home, while supervising home schooling, plus feeling guilty that when I send the kids to school I may be exposing them to COVID-19, is causing a constant low-level anxiety that I’m not enjoying.

But, as much as I hate the ‘won’t we all learn so much from COVID-19 and become better people’ memes on social media, the huge black cloud of lockdown does have the odd silver lining. One of them is the speed of change of systems within the NHS.

A healthcare consultant friend of mine sees patients with chronic diseases. Most of them are young and working, yet they have to take half a day off work every six months to visit her clinic. She had been trying for 10 years to arrange follow-up phone calls where appropriate and had been rebuffed by management at every turn. Then COVID-19 happened and boom – phone consultations became the norm for secondary care.

In primary care we all suddenly have laptops to allow us to log in from home, patients can easily text me a photo of their rash and video calls have become a la mode, and are fantastically useful when you just need to eyeball a patient rather than doing a proper examination.

So, what changes do we need in pharmacy? I’m sure there are loads that I don’t know about, but it has always seemed crazy to me that legislation prevents pharmacists from doing things that are well within their level of competence and training.

I’ve written before about the nonsensical situation, in which if I write a script for 56 tablets of naproxen 500mg and the packs are out of stock, the pharmacist isn’t officially allowed to dispense 112 tablets of naproxen 250mg without checking with me first.

In 2019, there seemed to be a rare outbreak of common sense within government when a shortage protocol was activated to allow pharmacists to dispense fluoxetine in strengths or forms different to those on the prescription without contacting the patient’s GP. But this replacement is only allowed while the shortage protocol is active.

The Royal Pharmaceutical Society (RPS) has called for a change in legislation so that pharmacists can make these sorts of changes all the time. This is part of their submission published in May to a Health Select Committee report on COVID-19.

The RPS simply requests that “medicines legislation should…be amended to allow pharmacists to use their professional judgement to make minor amendments to prescriptions in the event of a medicine being out of stock, such as: different quantities, strengths, formulations or generic versions of the same medicine”.

It is, of course, completely sensible for this to be allowed, and I hope that this succeeds. Maybe allowing pharmacists to use their common sense will be one more good thing that arises from this pandemic.

Look after yourselves everyone, and stay safe.

Toni Hazell is a GP based in a practice in London


Leon The Apothecary, Student

I agree with a change like this. The barrier is reimbursement for the most part in my opinion and modernising that I feel would be the first step.

Ex Pharmacist, Community pharmacist

Wow...I'm so glad I was sitting down to read this. What amazing and exciting progression for pharmacy......not. what a load of tut

Michael Mustoe, Community pharmacist

Hoorah! We can use AND exercise our common sense!! 

Well, if you're not doing that already you probably shouldn't be a Community Pharmacist - or any other healthcare professional come to think of it!

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

I hate to say this but I genuinely believe that Toni Hazell is the exception rather than the rule in GP-land. In my experience, there is rather a lot of looking down the nose at us from the average general practitioner because they see us as too thick to be a GP. I never wanted to be one thankyou very much. Being cooped up in a small room with weird, smelly, oozy people is not my cup of tea at all. I never want to see the bumhole of another human being EVER!!!!

Kevin Western, Community pharmacist

Certainly gets my vote

On Break, Community pharmacist

This is completely right that we should be allowed to use common sense and professional judgment to make this sort of change. I hate having to contact the surgery to ask for changes. 

The problem is no one is interested in changing the law/regulations/anything. We have all talked about it endlessly. Maybe we just need a new Chief Pharmaceutical Officer to push for reform.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

There is plenty of interest in changing laws relating to pharmacy. Trouble is, none of it is for the benefit of pharmacy.

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