The chief executive of the pharmacy regulator has met with the Department of Health and Social Care (DHSC) to discuss whether pharmacists could be allowed to make substitutions or minor amendments to prescriptions in the case of medicines shortages.
Speaking at a council meeting this week, Duncan Rudkin said that medicines shortages ‘often feature’ in the discussions the General Pharmaceutical Council (GPhC) has with other organisations, such as the Royal Pharmaceutical Society (RPS).
And he said that the GPhC wanted to ‘push’ itself to explore whether the regulator had any role in discussions with the pharmaceutical industry relating to medicines shortages.
He wondered whether more could be done to make ‘good’ and ‘appropriate’ use of pharmacists’ expertise to make amendments or substitutions to prescriptions ‘where that can be done quite safely’, without needing the skillset of a prescriber.
Mr Rudkin said that he had met with the DHSC on the issue.
Last month, health secretary Victoria Atkins said that the DHSC had ‘not made a decision’ on whether it would allow pharmacists to supply alternative medicines in the case of a shortage.
But Sir Chris Wormald, permanent secretary at DHSC, queried whether pharmacists have the ‘skill sets’ and adequate access to a patient’s medical history to make the ‘carefully balanced clinical judgment’ needed to safely supply an alternative medicine.
And in February, pharmacy minister Dame Andrea Leadsom said the DHSC has ‘no plans’ to allow community pharmacists to amend prescriptions.
Also at the GPhC council meeting this week, Mr Rudkin said the regulator was meeting with members of the parliamentary Health and Social Care Committee (HSCC) to follow up on points raised within its pharmacy inquiry.
Was Sir Chris Wormald deliberately setting out to antagonise with his comment about "skill sets" and adequate access to patient records? Or is the reporting inaccurate?
In making a decision to amend medication in the case of shortage, any change would primarily be to avoid a therapeutic opportunity cost to the patient, and the patient themselves would be fully involved in the decision. It is also more resource-intense for an already overstretched community pharmacy workforce. Currently, where there is a medicines shortage the pharmacist is obliged to refer back to the GP, which is highly inefficient. That the GPhC is addressing the matter demonstrates how unsatisfactory this situation is.
Community pharmacists have been delivering NMS since 2011 and consent mechanisms to access the SCR was established in 2016, the same year Sir Chris moved to the DHSC. The question of competence limitations is already covered by the fifth of the nine standards every pharmacy professional is accountable for meeting.
It is this core infrastructure and set of skills that can be extended to manage what is a serious pharmaceutical supply problem that is unlikely to be resolved in the near future. That the DHSC hasn't yet made a decision reflects upon the civil service and not the pharmacy profession.