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GP view: Are the fluoxetine powers a victory for common sense?

“Hallelujah! A victory for common sense – or so it seems”

The fluoxetine shortage powers are a step in the right direction for pharmacists, but GPs’ time is still being wasted unnecessarily, says Dr Toni Hazell

Apologies in advance, you’re probably sick of me wittering on about drug shortages.

In May, I wrote about how frustrating it is that pharmacists, highly trained professionals, aren’t allowed to dispense two 250mg packets of naproxen if the 500mg one isn't available. It’s an insulting waste of their time and mine to force a pharmacist to ring me for permission to make this change. So, I was interested to see that a 'shortage protocol' dealing with exactly this issue was launched this month.

There is an issue with the supply of fluoxetine 10mg, 30mg and 40mg strengths, but plenty of the 20mg tablets and liquid form are in stock. Pharmacists are now officially allowed to swap the different strength tablets (or change to a liquid) without the permission of a GP, and with the patient’s consent.  

Hallelujah! A victory for common sense – or so it seems. Maybe, just maybe, the Department of Health and Social Care (DH) has actually worked out what is going on at the grassroots level of the NHS. Maybe it has realised that with European doctors living in the UK increasingly considering leaving due to their treatment over Brexit, practices closing temporarily because of a lack of doctors, and GPs officially being labelled an occupation with a shortage, our time is too valuable to waste on unnecessary phone calls when we should be seeing patients.

Sorry, a moment of madness there. Of course the DH hasn’t realised – that would require it to face up to its own failings and impossible promises, to acknowledge that GP numbers are falling even as it promises us 5,000 more.

Clearly, the DH has been working hard to find another way to waste our time. It has suggested that GPs pro-actively contact patients taking fluoxetine to find out what supplies they have at home. A large practice might have several hundred patients taking it. Even at just a minute or two per call we would be looking at one or two days spent solidly calling patients, while the work that we should be doing piles up.

Oh well. Let’s look on the bright side – activation of the first shortage protocol is a milestone. If it works well and leads to a situation where pharmacists can make these common-sense swaps under their own authority on a long-term basis, then at least something good will have come out of all the hassle of recent medicines shortages.

Toni Hazell is a GP based in a practice in London


Tired Manager, Community pharmacist

As most of us are mere employees these days I doubt any of us really give a monkeys about price difference between capsules/tablets/doubling up strengths when required etc... as long as the patient gets what is needed!

ABC DEF, Primary care pharmacist

Prior to this whatever protocol I bet most pharmacists are already doing simple substitutions on daily basis without any of these unnecessary protocols . If naproxen 500mg is out just double it up with 250mg, if omeprazole 40mg is out just use 20mg, if prednisone tabs are out then use the e/c ones, if furosemide 4mg/5ml is out then use the 5mg/5ml and change the directions, if pamsvax is out just give other brands of tamsulosin, if there is no laxido then just give cosmocol/movicol, and if there isn't sugar free fluclox then just do sugared version etc etc. These are all common senses and pharmacists are perfectly capable of making such judgements as long as the substitution is communicated with the patients and patients accepting it. These protocols are nothing but a complete insult to pharmacists' expertise and abilities. 

Leon The Apothecary, Student

I have to agree, common sense switches tend to happen on a regular basis. SSP is the result of the protocol and the actuality not aligning or being considered in whole. Perhaps suggests a lack of insight? 

Caroline Jones, Community pharmacist

I suppose the difference here is that this SSP will allow Pharmacists to get paid for whatever combination they supply?

ABC DEF, Primary care pharmacist

Then why not just pay pharmacists according to what is endorsed on scripts, which in this case, will be the alternative brand +/- addon service fees? The whole point of SSP is to undermine pharmacists' judgement, knowledge and even status that we are not competent in making own clinical judgements and can only follow written protocols like SOPs, as we are branded as 'not skilled enough' and 'cannot be trusted' by the ignorant government.

When I saw the above article I couldn't help but laughed my head off. Do these people really think GPs know more about prescribing and medicines than Pharmacists do? But again what do I expect from these incompetent MPs?

What a joke.

Caroline Jones, Community pharmacist

This would have helped immensely with the Nifedipine issue.....although, technically not ideal to switch branded - if the choice is to switch to another drug; switching brands would always be the first option a GP would make!

Leon The Apothecary, Student

I've always considering Dr Hazell as a lady of common sense and of plenty of respect for the Pharmacist professional, so reaching this point must have been a frustrating journey.

It's total common sense for a pharmacist to have a front and centre role in the management of a condition's treatment, being the optimal professional to establish availability and viability of medicine.

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