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Pharmacists can refuse to supply medicine under shortages protocol

"We can only hope that the feared shortages do not materialise"

Legal expert David Reissner explains how changes coming into force today allowing pharmacists to dispense alternative medicines in the event of shortages don’t compel them to do so

The NHS terms of service for pharmacies in England have been amended to enable medicines to be supplied under a serious shortage protocol (SSP).

Ordinarily, a pharmacy owner must supply a prescribed product with reasonable promptness. However, if the prescribed product is the subject of a SSP:

  • the pharmacy owner must consider whether it is reasonable and appropriate to supply in accordance with the SSP instead of in accordance with the prescription and may refuse to supply what is on the prescription
  • the pharmacy owner may provide a different product or different quantity to what is prescribed if:
  • this can be done with reasonable promptness;
  • it is in accordance with the SSP; and
  • the supply is by or under the direct supervision of a pharmacist who is of the opinion, in the exercise of his or her professional skill and judgement, that supplying a different product or quantity is reasonable and appropriate.

If a supply is made under an SSP:

  • prescriptions must be endorsed appropriately for remuneration purposes
  • pharmacy owners must notify prescribers of a supply under a SSP, if the Department of Health and Social Care has published a recommendation to do so
  • patients must be informed of the different supply by including information on the dispensing label.

If an SSP is in place, pharmacy owners do not have to use it. If a pharmacy owner is of the opinion, in the exercise of his or her professional skill and judgement, that supplying a different product or quantity is unreasonable or inappropriate and they are able to supply the prescribed product or quantity within a “reasonable timescale”, they are allowed to do this and no longer have to supply with “reasonable promptness”.

We can assume that “reasonable timescale” involves a longer period than “reasonable promptness”, but the actual period in either case would necessarily depend on the precise facts and circumstances.

Similarly, if a pharmacist is of the opinion that supplying a different product or quantity under a SSP is unreasonable or inappropriate, and is unable to provide a different product within a reasonable timescale, a supply under the SSP can still be refused. In this case, the patient must be referred back to the prescriber.

We can only hope that the feared shortages – whether resulting from a no-deal Brexit or not – do not materialise, and that despite all the effort in changing the law to allow SSPs, they are never needed.

David Reissner is chair of the Pharmacy Law and Ethics Association


Michael Mustoe, Community pharmacist

I'm afraid that if we as a group of practitioners continue to take 'Mr Caustic's' view of life i.e. take no risks, just pass everything back to the GP, then we will never gain the standing and respect we deserve, and we will, therefore, never make any significant progress. We must take on services which make a meaningful contribution to the healthcare of the nation, and we must treat more patients for more health issues with the best available medicines

Mr CAUSTIC, Community pharmacist

When a gp prescribes a drug and the patient has a side effect it is not newsworthy . When a pharmacist does a switch and there is a problem it will be newsworthy . Daily Mail or local paper headline " patient fell down escalator because pharmacist switched blood pressure medication causing it to drop too low . Hidden in the body of the story will be " the switch was done under new powers ...."

If it's a ppi or steroid cream I don't predict a newsworthy consequence .

Switching between different presentations and strengths should have been introduced 50 years ago !

Mr CAUSTIC, Community pharmacist

I have a patient on labetalol along with about 15 other medications . If there was a ssp i would not supply an alternative for fear of a side effect from the replacement. Say he took the new medication and it had an adverse effect that resulted in him falling down the stairs or an accident whilst driving his car .

The family,friends and the neighbours would all blame the pharmacist for giving him the different medication . I admit that this is a remote possibility but overnight ones reputation in the area would alter for ever .

What would the reporting of the inquest say . Headline Mr X died as a result of pharmacist switching his medication .  The fact the main body of the report would say that he was just following the new guidelines would not be read by most people . I will leave it to the GP to make the switch and then it probably would not even be reported .   No real story just another death of no real interest to the press .

ABC DEF, Primary care pharmacist

Pretty much the mentality of 'the less you do, the less mistakes you could make' which is true in reality.  And patients will always blame pharmacists (but not GPs) because we get no respect for being ''not skilled, qualified and clinical enough'' to make these decisions according to some MPs.

Pretty sure no pharmacist will use this power anyway to put their own career at risk.

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