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The government has opened its long-awaited consultation on giving pharmacists greater flexibilities to supply a different strength or formulation of medicine than prescribed in certain circumstances.
In a consultation document published on 18 September 2025, the Department of Health and Social Care (DHSC) has proposed flexibility “when the pharmacy does not have the medicine in stock and the pharmacist has assessed that there is an ‘urgent need’ to supply an alternative and it would be impracticable to obtain the product without undue delay”.
“An ‘urgent need’ includes urgent clinical need — for example, where a patient requires an acute medicine, such as an antibiotic straight away or where a delay would cause serious inconvenience to the patient,” the document said.
However, it added that flexibilities would not apply when there is a known serious shortage of the medicine prescribed or the alternative to be supplied, unless a serious shortage protocol, a medicine supply notification or central alerting system alert has specifically allowed the use of pharmacist flexibilities to manage a particular shortage.
Proposed flexibilities would not enable community pharmacists to supply an entirely different medicine from that which was originally prescribed; would not cover unlicensed medicines; and would only cover controlled drugs in schedule 5 and not controlled drugs in schedule 2 to 4 at this stage, the document added.
To enable the proposed changes, “there should be a provision for a pharmacist to make a record in a similar way to the current ‘emergency supply’ provisions”, the DHSC said.
“We are not expecting this measure to resolve all the issues surrounding medicine supply difficulties, but it is another tool for pharmacists to improve patient access to their medicines.”
The DHSC is seeking evidence on factors including how often pharmacists, GP practices and other relevant stakeholders are dealing with minor amendments, in particular referring patients or prescriptions to prescribers to have strength and formulation changes; delays to treatment that could have been avoided by allowing supply of a different formulation or strength to achieve the same dosage, so long as the same dosage regimen can be achieved; and whether there should be a separate requirement to notify the prescriber if an alternative is supplied or whether it should be left to the professional judgement of the pharmacist.
Organisations across the community pharmacy sector, including the Royal Pharmaceutical Society (RPS), as well as the Royal College of General Practitioners, have long called for pharmacists to be given greater dispensing flexibilities.
Commenting on the consultation launch, Claire Anderson, president of the RPS, said: “Empowering pharmacists to amend prescriptions using their professional judgement will help ensure more patients get the medicines they need, quickly and safely.
“We know from our engagement with patient groups and professional bodies that this change could significantly improve the experience for patients, particularly during times of medicine shortages. It’s vital that any changes are designed to support pharmacists in putting patients first, without adding unnecessary complexity.
“The RPS will respond to the consultation in due course,” she added.
For changes to take place, the Human Medicines Regulations 2012 would need to be amended — which could take several months — and both Houses of Parliament and the Northern Ireland Assembly would need to debate and approve the legislation via an ‘affirmative procedure’.
Each of the four UK countries would then have to decide how the new flexibilities would work within each country’s NHS terms of service.
The consultation follows a commitment in January 2025 from the government to “learning lessons” from a case of a child who died after stock shortages led to a delay in receiving antibiotics.
A coroner’s report raised concerns that pharmacists could not substitute alternate strengths of medicines and warned that “future deaths could occur unless action is taken”.
On 16 September 2025, the National Pharmacy Association (NPA) released the results of a survey that suggested patients were being forced to wait up to three weeks for medicines, owing to pharmacists being unable to substitute alternative formulations.
Olivier Picard, chair of the NPA, commented: “The current status quo is not only frustrating for patients, it is also dangerous.
“It is madness to send someone back to their GP to get a prescription changed when a safe alternative is in stock. It risks a patient either delaying taking vital medication or forgoing it altogether, which poses a clear risk to patient safety.
“However, any changes introduced must be simple and provide genuine flexibility to pharmacists. They should not just be an extension of existing out of date systems that do not help pharmacists adequately manage systemic and sporadic medicine shortages.
“We look forward to receiving more details and would urge pharmacies to respond to this consultation.”
The consultation will run until 11 December 2025.
