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Changing the law to allow pharmacists to amend prescriptions to a different strength could have the unintended consequence of making drug shortages worse, a senior civil servant has said. 

Earlier this week Gila Sacks, director of medicines in the Department of Health and Social Care, told a meeting of MPs and industry stakeholders that her department is “looking very closely at the moment” into whether community pharmacists should be permitted to make minor amendments to prescriptions to help patients access alternative formulations when a prescribed line is out of stock.

This is an issue the Royal Pharmaceutical Society has campaigned on, presenting written evidence to the All Party Pharmacy Group (APPG) whose meeting Sacks was speaking at on Monday. 

Describing the issue as “complex” and “nuanced,” Sacks said her team is “trying to define the circumstances in which it would be appropriate [for pharmacists to have] this kind of flexibility” and considering the question from several angles.

“Partly it’s about safety,” she said, explaining that the law “assumes that the prescriber has primacy” and that there is “a very high bar” when deciding on any exceptions to this principle.

In addition to these safety concerns, Sacks said she is “very mindful” that changing the law could inadvertently create new supply problems, commenting that at present in cases of national shortages the DHSC has oversight of what’s being prescribed and the flow of product in the system. 

She gave the scenario of a patient presenting with a prescription for an antibiotic and said that if a pharmacist could supply a lower strength of the medicine without a prescription, it could create shortages of that alternative “even though the pharmacist is doing absolutely the right thing for their patients”. 

“And if you then have particular patients, for example children, who can only tolerate the lower strength then you might run into trouble,” she said. 

“At the moment, serious shortage protocols define exactly the switch that can happen… where the alternative is clinically deemed to be safe.

“That’s not to say you don’t think there is a case, but you need to look very carefully at how to really understand and manage some of those risks.”