Community Pharmacy England (CPE) has said that giving pharmacists greater flexibility to make small substitutions when medicines are out of stock should become routine practice.
The view was expressed in its draft response to a Department of Health and Social Care (DHSC) consultation launched last month, in which changes were proposed that would allow community pharmacists to dispense a different strength or formulation of the same medicine when the prescribed version is unavailable.
Under the proposals, pharmacists would only be able to make such substitutions where the medicine is not in stock; there is an ‘urgent need’ to supply it; and obtaining the exact product would be impractical without undue delay.
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The alternative supplied must provide the same medicine at the same dose, dosage regimen and treatment cycle.
CPE said the proposed reforms on pharmacist flexibilities were a ‘positive step forward’ for the sector, particularly given continuing medicines supply challenges faced by pharmacy teams.
However, while CPE broadly supports the proposals, it warned that the government’s current plans do not go far enough. The negotiator said it wants to see wider substitution powers for pharmacists, including the ability to manage branded generic prescribing issues.
‘We believe that the ability to use flexibilities should be the norm unless specifically prohibited,’ CPE said, adding that it would like to see a system similar to that already operating successfully in Scotland.
James Davies, CPE’s director of research and insights, said: ‘CPE, in collaboration with other pharmacy bodies, has long been calling for more flexibility for pharmacists when dispensing medicines subject to supply issues, and we are pleased to see a positive step forward from the government on this issue.
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‘However, there is potential for government to take these flexibilities much further, allowing them to become the norm rather than placing so many restrictions on their use.’
Mr Davies added: ‘Community pharmacists are more than capable of handling such scenarios and using their expertise to determine when it is, and isn’t, appropriate to make a change.
‘This would further reduce the costs and workload burden associated with referring patients back to prescribers when a medicine is not available.’
Pharmacy owners are encouraged to submit their own responses to the DHSC consultation, which closes at 11.59pm on 11 December 2025.
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Earlier this year, the All-Party Parliamentary Group (APPG) on Pharmacy warned medicine shortages had become ‘a permanent and escalating’ threat to patient care, placing an unsustainable burden on pharmacy teams and disrupting the safe delivery of treatment across England.
In August, the House of Lords Public Services Committee launched an inquiry into England’s ability to ‘predict and prevent’ medicine supply issues.
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