Let pharmacists make minor substitutions in event of drug shortages, say stakeholdersBMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3657 (Published 17 September 2020) Cite this as: BMJ 2020;370:m3657
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We would like to commend Dyer on their article and agree with many points raised with regards to pharmacists making minor pharmaceutical substitutions, particularly in a primary care setting. As someone who works in a primary care pharmacy, I would like to make some contributions.
One of the main ongoing goals of the expanding services provided by community pharmacies is to benefit the wider healthcare team by easing General Practitioner (GP) workloads. It therefore seems counterproductive for the pharmacists to be legally obliged to contact the prescriber to request a new prescription in order to make a basic substitution based on stock availability. As Dyer mentioned in this article, these shortages are likely to become more frequent as a consequence of the United Kingdom leaving the European Union.
Recently, the role of community pharmacists has expanded to increase engagement with the wider care team, with increasing numbers of pharmacists present in GP practices. This has had beneficial outcomes for patients, as it improves communication between healthcare professionals and reduces waiting times. (1) If pharmacists in other primary care settings such as retail pharmacies were able to make these minor substitutions to medications without having to refer back to the GP it would further reduce waiting times and patient frustrations with the system.
In my own experience working within pharmacy, community pharmacists are more than capable of making these substitutions, using their own professional judgement to ensure patient safety. It also seems inconsistent that hospital pharmacists are regularly expected to make these judgements, when community pharmacists undertake the same degree programme and registration exams.
If this proposal is accepted, then I feel it will be important to ensure GPs are properly educated on the services provided by local community pharmacies, as currently there is limited awareness of the full scope of services available. (2) There should also be clear guidance provided to pharmacists to ensure that they continue to act within their professional remit.
Nabhani-Gebara S, Fletcher S, Shamim A, May L, Butt N, Chagger S et al. General practice pharmacists in England: Integration, mediation and professional dynamics. Res Social Adm Pharm. 2020 Jan;16(1):17-24.
Hindi, AMK, Jacobs S, Schafheutle EI. Solidarity or dissonance? A systematic review of pharmacist and GP views on community pharmacy services in the UK. Health Soc Care Community. 2019 May;27(3):565-598.
Competing interests: No competing interests