Pharmacy minister Dame Andrea Leadsom has faced criticism from the sector after she claimed that allowing community pharmacists to alter prescriptions and supply alternative medications could ‘exacerbate’ supply issues.

Individual pharmacists would be operating ‘without the full oversight of supply issues that the [Department of Health and Social Care] has’, she suggested.

And this ‘could have the effect of creating a knock-on shortage of the alternative and could thereby have the potential to exacerbate rather than mitigate supply problems’, Dame Andrea said.

‘Furthermore, pharmacies will not know the reasons why a medicine has been prescribed, and in what particular way.’

Dame Andrea added that Serious Shortage Protocols (SSPs) ‘have been used in recent years to manage and mitigate’ shortages, and ‘are not introduced unless sufficient supplies of the alternative product to be supplied in accordance with the SSP are available to support the market’.

Her comments came this week in a written response to Labour MP Rachael Maskell who asked if the minister would ‘make an assessment of the potential merits of allowing pharmacists to prescribe alternative medications if those prescribed by a GP are not available, without referring back to the GP’.

RPS: ‘No prescribers have “full oversight”’

James Davies, England director of the Royal Pharmaceutical Society (RPS), said in response that ‘no prescribers in the health service have “full oversight” of supply issues as described by the government’.

Forcing patients to go back to their GP for an alternative prescription when a medicine is out of stock is ‘frustrating for patients and adds further pressure on general practice and pharmacies’, he added.

‘Our members consistently tell us that SSPs are overly bureaucratic and the government should work with stakeholders on a more pragmatic approach,’ he told The Pharmacist.

As all newly qualified pharmacists will be prescribers from 2026, the government ‘will need to consider how best to use their skills to support patient care’, added Mr Davies.

Mr Davies also called for a wider review of the UK medicines supply chain.

The RPS has previously called for a change in the law that would allow pharmacists to make minor amendments to prescriptions.

CPE: Minister’s comments ‘disappointing’

Gordon Hockey, director of legal at Community Pharmacy England (CPE), told The Pharmacist that the pharmacy minister’s comments were ‘a little disappointing’.

‘Whilst it’s understandable that DHSC is cautious about creating unintended consequences in the fragile medicines market, there are many benefits to introducing great flexibilities in altering prescriptions for community pharmacists,’ he added.

He said that while the introduction of SSPs in 2019 was ‘welcomed’, ‘these are still restrictive and don’t make full use of community pharmacists’ expertise’.

‘We have long been pressing DHSC to think more broadly about what measures could help patients access medicines more quickly, as well as requesting that they issue more communications on supply issues to reassure patients and protect pharmacy staff from the abuse that they are reporting,’ he added.

And he suggested that beneficial measures could include ‘enabling pharmacists to follow advice on which products to substitute without the formality of an SSP’.

Pharmacists could also be enabled to dispense alternatives to support patient adherence without the need to contact the prescriber, such as ‘when one formulation is easier for the patient to manage than another, or to start urgent treatment more quickly if the prescribed item is not currently on the pharmacy’s shelves’, added Mr Hockey.

CCA: Alterations and SSPs a ‘sticking plaster’

Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA), told The Pharmacist that altering prescriptions and SSPs were ‘ultimately sticking plaster measures’.

Instead, he suggested that a review of medicines supply and retained margin was needed.

‘Growing medicine shortages are a huge concern and pharmacy teams are having to spend far too much time sourcing medicines when they could be advising and treating patients,’ he said.

‘This is why an end-to-end review of the medicines supply chain is required. We also need to address the value of the allowable retained margin available to pharmacies, which has remained static for a decade now,’ Mr Harrison said.