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The GP Pharmacist: Trust pharmacists to solve the shortages crisis

"In order to maintain smooth supply in these unusual times radical action is required"

The GP Pharmacist is calling for a radical solution to the problem of drug shortages – which affect pharmacists in every sector

It seems to me that medicines shortages would not be such an increasingly burdensome problem if it wasn’t for the high level of mistrust that permeates pharmacy and the supply system.

Take the announcement from the Department of Health and Social Care that community pharmacists will be empowered to make switches under a ‘serious shortage protocol’.

Within a few weeks, pharmacy minister Steve Brine was having to provide reassurance to suspicious GPs by stressing that safeguards were to be put in place before the introduction of any protocols. He has also admitted that these protocols are likely to increase workload in pharmacies – an admission, I think, that the process of what should be relatively straightforward switches is likely to be arduous.

As such, wariness from doctors around the abilities of community pharmacists means these extra measures may end up being insufficient to address the shortages – and result in more work for pharmacies.

This is very unfortunate, because much of my time is spent managing prescription requests for alternatives. I am not ashamed to admit that I have a vested interest in the proposed protocol – in the hope that it will reduce the number of queries, and my workload.

However, what these protocols do not address is the inflated costs at which pharmacies are having to purchase some medicines – way above the reimbursement prices, even after concessions have been applied. Readers may question how this impacts on a GP pharmacist, so let me give you an example of what is becoming an increasingly regular request, and the resulting dilemma.

I am often asked to provide substitute prescriptions for premium-priced, branded versions of patients’ regular medication.

In the context of the funding cuts and the deluge of ‘bread and butter’ generics such as naproxen and furosemide – that have only been obtainable at costs above reimbursement prices – I have much sympathy for contractors. One independent pharmacist recently told me that having to supply one of our patients with an extremely expensive renal medication as the only (branded) product available against a generic prescription could push them over the financial edge.

However, terms of service dictate that this is exactly what they should do. If I produce a substituted prescription, am I not complicit in them breaching that contract?

If there wasn’t such uncertainty, and lack of faith in the price concessions system, I don’t believe I would be put in this awkward situation.

But the system is broken. In my opinion, in order to maintain smooth supply in these unusual times, radical action is required. I would suggest cultivating some renewed faith in contractors. Maybe even bring back the option to endorse prescriptions ‘NCSO’ (no cheaper stock obtainable). But this time, rather than the time consuming process of drawing up a monthly list, allow it for any product in short supply, and trust pharmacies to claim for the price they paid.

For those of you who hesitate at the possibility of this suggestion, ask yourselves: Why? Don’t you trust your pharmacist?

The GP Pharmacist is a former community pharmacist working in a general practice

Has your pharmacy collaborated with a GP or practice in the past year? There’s still time to enter the C+D Award for GP Partnership of the Year


Michael Mustoe, Community pharmacist

I know that my patients trust me.
They are often really disappointed that I cannot carry out more on their behalf without the need to refer to someone else.
At some point, hopefully sooner rather than later, the bodies that run, make political decisions about, our NHS, will wake up and realise that an amazing resource is being wasted - to the detriment of patients across the UK
When are grown up, intelligent and patient - centred decisions to, at last, make full use of Community Pharmacists professional expertise, going to be made and implemented?
Trust and empowerment are key to making progress

R A, Community pharmacist

I hate to admit it but our working practice does evoke suspicion due to the following issues:

1) GP's have a contract with the NHS directly, pharmacists work for large/small businesses which have a contract with NHS but pharmacists have commercial targets. Therefore pharmacists have a conflict of interest to get renumerated they need to satisfy the commercial targets set by the company compared to GP's who have to satisfy NHS criteria. This begs the question will pharmacists use this as a means to benefit commercially as they have with MUR? That is one suspicion. 

2) GP - Pharmacist relationship: In the past, you had a regular GP practitioner working in one practice (no locums) and a regular pharmacist (locums were a rarity) this allowed a relationship of trust to be built. These days both GP and Pharmacists are itinerant individuals due to that lack of continuity its difficult to establish trust and in the age of liability, I guess a GP doesn't wish to be held responsible. 

I do wish to stress the fact that I am not saying Pharmacists shouldn't be trusted but there are obstacles which need to be overcome. I think the best advocate will be the GP Pharmacists who can help the GP's overcome there concern of the pharmacist. 

Angry Pharmacist, Locum pharmacist

We need to ASK to be trusted now do we? Says it a really doesn’t it? 

Keith Sykes, Community pharmacist

Exactly that. NCSO , price paid. I'll even attach a copy of the invoice. Just don't apply clawback !


Andy Burrells, Community pharmacist

I'd love to know where GPs / the BMA get this idea that they can interfere in our professional advancement and obligations.

This is not 1972 and the laws that govern our sector are not fit for current practice.
We need the ability to be dynamic and reactive but can't when around every corner theres something or someone holding us back

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