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
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