Johnathan Laird
THE pharmacy supply chain is both complicated and convoluted. Deals and reciprocal arrangements vary from company to company and have effects at all stages of the chain.
An adverse effect of this complexity is that significant shortages or sporadic supply of essential medicines is now commonplace. The impact on patients can be profound. As pharmacists we try our best, and spend a lot of time each day trying to source medicines in a timely fashion. The hoops we have to jump through to get some stock is absolutely ludicrous, and sometimes it’s completely impossible to get certain medicines.
Shortages are not good for prescribers or pharmacists, and most importantly they are not good for patients.
There is however another way.
“Community pharmacist independent prescribers can prescribe any medicine within their competency and for which they are prepared to accept legal responsibility, including ‘off-label’ medicines and unlicensed medicines, but currently excluding controlled drugs.”
Community pharmacist independent prescribers should, with all the required caveats, be prescribing alternative medicines when there is a known supply problem.
Of course, this practice lends itself better to certain drugs and the risk will vary accordingly. One of the fundamental aspects of practising as a pharmacist independent prescriber (PIP) is to work within your area of competence and take responsibility for the management of that patient.
I defy any GP to have an issue with a PIP prescribing clotrimazole and hydrocortisone in separate tubes instead of the notoriously illusive Canesten HC.
No phone call to the surgery. No extra GP workload that day. The patient receives the medication in a timely fashion.
Faxing the IP script in a similar fashion to how we fax CPUS forms will update the patient record in a timely fashion; until of course we get read write access to patient records, and that can’t come soon enough.
If community pharmacists could provide a solution to the supply problem right at the end of the chain this would be a positive for patients. I, like my GP colleagues, are weary of the frequent phone-calls to arrange alternatives (even for minor changes), so we have set up a system as above to tackle the issue.
I cannot tackle every supply issue in this way, but we are making a significant dent in the problem. This is an ideal role for community pharmacist independent prescribers.
Is this the good news story that community pharmacy needs at such a tough time? Perhaps.
References
Good prescribing guidance by NHS Education for Scotland
Community Pharmacy Scotland branded out of stocks
NHS standards for managing medicine shortages in secondary care
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