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Patients are being put at risk of serious illness as pharmacists are unable to dispense vital medications due to drug shortages, industry leaders have warned.
At least once a day drug supply problems mean pharmacies are unable to dispense a prescription, according to a survey of 500 pharmacies by the National Pharmacy Association (NPA).
Currently if a prescription is out of stock, patients need to go back to their GP to get an alternative medication. But this can delay care and increase the risk of serious illness.
That’s because the pharmacist is not permitted to make a substitution even if they have a safe alternative in stock, this is except in very limited circumstances where a Serious Shortage Protocol has been issued by the NHS.
The NPA, which represents 6,000 independent community pharmacies, is calling on the government to grant greater flexibility for pharmacists to substitute medication or strength of a drug when it is safe to do so.
The NPA says it is “madness” to send someone back to the GP and warned the current situation poses a risk to patient safety. It said it could lead to patients potentially going without vital medication, such as some types of antibiotics, presenting a serious risk to their health.
In January, Lancashire coroner Christopher Long wrote to health secretary Wes Streeting on this issue following the death of two-year-old Ava Hodgkinson.
He said how she died of overwhelming sepsis from a strep A infection after delays in receiving antibiotics due to restrictions preventing a pharmacist from amending an out-of-stock prescription.
Mr Long wrote: “Ava had seen her GP who had prescribed amoxicillin with a dose of 250mg/5ml.
“The pharmacy did not have this strength in stock but did have amoxicillin 125mg/5ml in stock.
“(They) could not issue this as restrictions currently in place prevent a pharmacist issuing any different strength of medication without an amended prescription, even where the medication can be provided to enable the same dose to be administered (here Ava’s parents could have been instructed to provide 10ml enabling the same dose of antibiotics to be provided).
“This led to a delay in Ava receiving antibiotics.”
The NPA survey revealed 95 per cent of pharmacies at least once a day were visited by a patient that was unable to obtain their medicines elsewhere due to supply problems.
It also revealed 96 per cent of pharmacies were unable to dispense a prescription at least once a day despite having a safe alternative formulation in stock.
Nick Kaye, Chair of the National Pharmacy Association said: “These are deeply concerning statistics which show that patients are potentially having to forgo vital medication due to shortages. “Pharmacies are at the sharp end of medicines shortages and frequently have to turn away distressed, frustrated and sometimes angry patients.
“It is particularly frustrating for pharmacists to be unable to meet a clear need when they have a perfectly safe and effective solution in their pharmacy already.
“It is madness to send someone back to their GP and it risks a patient either delaying taking vital medication or forgoing it altogether, which poses a clear risk to patient safety.
“We’re pleased the government are taking steps to bring together manufacturers, wholesalers and pharmacies to try and tackle this issue.
“However, the government must look again at allowing pharmacists – who are highly trained health care practitioners – to use their professional judgment to supply an appropriate alternative when the prescribed version is unavailable.”
In January the government rejected recommendations from the cross-party Health and Care Select Committee for pharmacies to have more flexibility to substitute medication to tackle growing numbers of shortages.
Dr Leyla Hannbeck, pharmacist and CEO of Independent Pharmacies Association, is also urging the government to make the changes.
“The risk of not implementing this, considering the big issues regarding medicines shortages, impacts significantly on patient care and risks delays in treatment which in some cases can increase serious illness,” she told the Independent.
However, she explained the Department of Health and Social Care (DHSC) is “reluctant” to implement these changes.
“Their excuse is that there could be a conflict of interest,” she added.
Dr Hannbeck added: “They forget that pharmacy is a heavily regulated profession, and any professional mismanagement could lead to being stuck off and not being able to practice.
“Pharmacists are experts on medicines and very well placed to make minor amends to prescriptions where necessary in order to ensure timely care for patients.”
Thorrun Govind, a former chair of the English Pharmacy Board of the Royal Pharmaceutical Society, called the reluctancy to give pharmacists this power “illogical”.
“They should be able to supply capsules for example, rather than tablets of the same drug,” she said.
It comes as DHSC has made the move to shift the focus of healthcare out of hospitals and into the community.
A Department of Health and Social Care spokesperson said: “We will work with the sector, making better use of the skills of pharmacists and pharmacy technicians, to build a service fit for the future.
“The Government is currently considering enabling pharmacists to substitute to a different dose or formulation, under specified circumstances, where such a substitution might be both urgent and safe.”
