‘Inherent risk’ in not allowing pharmacists to supply alternative medicines, says RPS

Pharmacists are highly trained clinicians, and ‘unnecessary bureaucracy’ must not stand in the way of providing patients with access to vital medicines, the Royal Pharmaceutical Society (RPS) has said in their response to the government consultation on pharmacist flexibilities.

The consultation, which began in September 2025, proposes allowing pharmacists to use their professional judgement to supply an alternative strength or formulation of a medicine when the original item is unavailable – something pharmacy leaders have long called for.

Under current regulations, pharmacists must dispense the exact product - strength, formulation and quantity - set out in a prescription with a small number of exceptions.

‘There is an inherent risk of adding in too many barriers to this enabling legislation, in terms of adding to confusion, and frustration for both pharmacists and prescribers, with a risk that pharmacists may not fully engage with the proposals,’ the RPS said in its response.

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Pharmacists should be empowered to exercise flexibilities as the standard approach; any necessary restrictions, to prevent inadvertent exacerbation of medicine shortages, should be included in a Medicine Supply Notification (MSN) or Central Alerting System (CAS), the RPS suggested.

‘This consultation is a landmark moment for pharmacy and patient care,’ said RPS president, Professor Claire Anderson.

‘We’ve long campaigned for pharmacists to be empowered to use their professional judgement in the face of medicines shortages, and it’s great to see progress being made. The final proposals must be practical and truly enabling,’ she added.

The RPS said it supports the restrictions on ‘therapeutic substitution’ but also noted that ‘generic substitution’ is not being covered or enabled as part of this consultation.

It felt this was a ‘missed opportunity’ and said that, in the case of branded generics, community pharmacists should be able to exercise flexibilities after a consultation with a patient.

The response emphasised that pharmacist flexibilities could reduce avoidable workload for prescribers and pharmacists, support more efficient use of NHS resources, and improve patient care.

Particularly for patients who need time critical medicines, such as those receiving palliative care, where delays in access have a major impact on the patient and their loved ones.

In September, the National Pharmacy Association (NPA) said that preventing pharmacists from substituting medicines posed a ‘risk to patient safety’.

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According to a survey of over 400 pharmacies, 97% reported patients waiting at least a day for ‘highly trained’ pharmacists to request a new prescription from the prescriber.

Some pharmacies reported patients waiting over three weeks to get a new prescription for certain medicines.

The RPS also suggested that allowing pharmacists to make substitutions could save the NHS money by removing unnecessary steps for both practitioners and prescribers.

‘There is no evidence to suggest these proposals will lead to a significant increase in costs associated with the prescribing and supply of medicines. These flexibilities are currently enabled in community pharmacies in Scotland, and no comparative increase in prescribing costs has been reported,’ the response stated.

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For healthcare professionals and pharmacy teams in particular, the burden of dealing with medicines shortages is being felt across all settings.’

In an introduction to the consultation, the Government said: ‘We are not expecting this measure to resolve all the issues surrounding medicine supply difficulties, but it is another tool for pharmacists to improve patient access to their medicines.’

The rule changes do not cover pharmacist prescribing, generic substitution, pharmacists supplying an entirely different medicine and only apply to community settings.