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Community pharmacists should be given powers to make dose and formulation substitutions for out-of-stock medicines within three months, according to the House of Commons Health and Social Care Committee.
In its final report published following its inquiry into pharmacy services, published on 29 May 2024, the committee said that witnesses at its inquiry had “repeatedly” argued that pharmacists should be able to dispense alternative items when a prescribed item was out of stock, at a time of widespread medicines shortages.
The committee highlighted evidence from the Royal Pharmaceutical Society (RPS) that called for pharmacists to be able to make prescription substitutions for a different quantity, strength or formulation, and for generic substitutions when medicines are unavailable.
It said that despite government opposition, these changes would be “compatible with the direction of travel towards community pharmacies delivering more clinical services”.
The report also called for a review of the effectiveness of serious shortage protocols, introduced to deal with medicines shortages, “with a focus on their timing and their administrative burden”.
The committee’s wide-ranging report also called for a complete overhaul of the community pharmacy contract model in England, stating that the current ‘Community pharmacy contractual framework’, published in July 2019, was “evidently not fit for purpose” and that it had contributed to financial pressures being faced by pharmacies.
The report said that the committee had been told of annual shortfalls of “at least £67,000 per pharmacy in England”, up to “around £100,000” by pharmacy representative organisations during evidence sessions held as part of the inquiry.
It added that any new framework must close the gap in funding that has appeared during the current five-year deal, reduce complexity and “de-risk” the purchasing price of medicines.
A new framework should also ensure funding is “explicitly available” for both dispensing and clinical services to avoid the current situation where one pays for another, the report said.
The committee made a number of additional recommendations, which included:
- Publication of a long-term vision for further development of clinical services in community pharmacy settings within one year;
- Commissioning community pharmacies to provide HIV pre-exposure prophylaxis;
- Free over-the-counter medication for people on low incomes to be provided as part of the Pharmacy First scheme;
- Pharmacists and technicians to have access to the Learning Support Fund;
- A review of the Additional Roles Reimbursement Scheme funding to be published within three months;
- The development of an integrated and funded workforce plan for pharmacy within 12 months.
Tase Oputu, chair of the Royal Pharmaceutical Society (RPS) English Pharmacy Board, said: “Our evidence to the committee [submitted in November 2023] highlighted RPS key campaign issues around workforce planning, wellbeing and protected learning time, investment in pharmacy students through the Learning Support Fund, and much-needed investment in IT and interoperable patient records.
“The committee has rightly recognised the growing impact of medicines shortages on patient care and the widespread support for reform.”
Janet Morrison, chief executive of Community Pharmacy England, commented: “We agree with the select committee that the pharmacy funding gap needs closing and that pharmacy owners need a transparent and fair funding system, including funding to support premises development, and that the medicines supply chain must be reviewed.
“We also support their calls for more promotion and an expansion of Pharmacy First, and for the NHS and government to set out a long-term vision for development of clinical services in the sector.”
Paul Rees, chief executive of the National Pharmacy Association, said: “The committee tells it as it is — pharmacies have huge potential to improve local healthcare and cut GP and hospital waiting times. Yet they have suffered a decade of cuts, hundreds upon hundreds have closed and those that remain open face a financial cliff edge.
“The next government must pay heed to the committee’s stark warning that pharmacies are creaking under the strain of funding pressures and staff shortages.”
Neeraj Shah, head of public affairs at the Company Chemists’ Association, also welcomed the wide range of recommendations: “We support the call to develop an integrated and funded workforce plan, including the provision of adequate support for independent prescribing graduates from 2026, especially given our concerns regarding the availability of designated prescribing practitioners,” he said.
