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GP bodies call for law change to mitigate impact of medicines shortages

by Rachel Carter
16 September 2020

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GP and pharmacy bodies have called on the Government to give pharmacists the power to make minor changes to a prescription when a medicine is out of stock.

In a letter to health secretary Matt Hancock, the Royal College of GPs, British Medical Association, and others asked the Government to amend medicines legislation to allow pharmacists to make changes such as a different quantity, strength, formulation, or a generic substitution.

The bodies said the change should be made ahead of the end of the Brexit transition period on 31 December, which the Government has already warned could cause disruption to medicines supply.

‘We are concerned about the impact that medicines shortages are having on patient care and urge you to work with GPs, pharmacists and patient groups to reduce bureaucracy and speed up access to appropriate treatment,’ the letter said.

It added that GPs and pharmacists are having to spend extra time dealing with medicines shortages, with community pharmacists currently legally obliged to contact prescribers or refer patients back to their GP to amend original prescriptions, even for minor adjustments.

‘This is frustrating for the patient, pharmacist and prescriber’ and causes ‘delays in access to medicines’, as well as taking up time that could be better spent elsewhere, the bodies said.

Shortage protocols ‘rarely used’

The letter also said that feedback from health professionals has suggested that Serious Shortage Protocols (SSPs) are ‘rarely used’ and a ‘more pragmatic approach’ is needed.

SSPs were introduced in 2019 as a way to help pharmacies manage any serious shortages of medicines, without needing to refer patients back to prescribers – but can only be used if the secretary of state is ‘of the opinion’ that there is a serious shortage of a specific medicine.

The letter added that generic substitutions are already ‘routine’ for pharmacists in secondary care and are used in Scotland for medicines on a recognised shortages list.

Meanwhile in Wales, the All Wales Pharmacist Enabling and Therapeutic Switch policy enables pharmacists to make certain changes without contacting the prescriber, it added.

The bodies said their proposals would not extend to therapeutic substitution, which should ‘instead be referred back to the prescriber, potentially notifying them of available alternatives to help them make appropriate changes to medicines’.

 ‘We recognise there are particularly considerations for certain medicines, such as for epilepsy or transplants, and this change in policy should be supported with guidance on when substitutions may or may not be suitable,’ the letter said.

‘Greater flexibility’

The letter was co-signed by the Royal Pharmaceutical Society, Pharmaceutical Services Negotiating Committee, Community Pharmacy Wales, Community Pharmacy Scotland, and patient charity National Voices.

Dr Richard Vautrey, chair of the British Medical Association’s GP committee, said: ‘At a time of significant increase to GP workload and the problems with supply of medications, allowing pharmacists to make these changes so that patients can obtain their medicines in a timely manner can only be a good thing for both doctors and patients.

‘GP practices have to deal with a significant amount of bureaucracy which takes precious time away from seeing patients and changes like this will go some way in addressing that, especially as we head into winter and at a time when we are seeing the number of Covid cases increase again.’

Professor Martin Marshall, RCGP chair, said: ‘It can be frustrating for GPs, pharmacists and patients when prescriptions can’t be dispensed due to shortages – and that minor adjustments to prescriptions which could be dispensed can’t be made by an experienced pharmacist without being reviewed by a GP.

‘Unfortunately, not only does this step increase GP workload, but often it slows down patient access to medication. Pharmacists are highly skilled in their area of expertise – medicines – so trusting them to make appropriate and sensible decisions regarding medicines, depending on supplies, will in turn allow GPs to focus on patients who need our care the most.’

A Department of Health and Social Care spokesperson said: ‘We have well-established processes to deal with medicine shortages and work closely with the MHRA, NHS England and others operating in the supply chain to help prevent shortages and minimise any risks when they do arise.

‘We will carefully consider the joint letter and the recommendations made.’

A version of this story first appeared in our sister title The Pharmacist.