If the majority of medicines prescribed in the UK are written as generic – which I understand to be the case – then the potential for cost-savings by empowering the pharmacist to make generic substitution would appear to be very small. Correct?

So, what advantages does this change of legislation offer? I can not see much of an advantage either in cost savings or interruptions to the GP as most practices conform to a PCT formulary in any case. As Pauline has already pointed out, many GP’s employ (or work closely with) pharmacists to assist their prescribing and generic substitution is already well entrenched.

On those rare occasions when a prescription is written for a branded product I would imagine there is very good reason why a GP has specified that, as most computer systems default to the generic equivalent, so, it’s actually more hassle for a GP to try and prescribe the branded version. So, it appears to me that this new legislation is actually giving licence to pharmacists to change prescriptions that have been written as branded for specific reasons. I’m not sure that’s a good thing – and obviously up until now it’s been illegal to do so – which further reinforces the concern.

My youngest child suffers with asthma. He’s been on a branded product for several years. Recently his branded product was switched to the generic equivalent. He’s since developed mouth ulcers while on treatment. We’ve never had this problem before but it became so bad that he was refusing his inhaler, it is most certainly linked to his medication – and specifically, we think, to his change of medication.

So, if we now go back to our GP and demand the branded version, the GP will be powerless to prevent the pharmacist dispensing whatever generic he can get the best deal on? And some of you are saying this is a good thing?

Hmm!

The use of the words ‘retail pharmacist’ in the article does community pharmacists a disservice. Our pharmacists practice clinical pharmacy on the High Street and are not simply shopkeepers. Many of them are running clinics and prescribing in their own right.

The article infers that pharmacists would substitute in inappropriate circumstances e.g. lithium and modified release meds, also in a situation where the patient would become confused. Pharmacists are fully aware of these situations, are responsible clinicians and will not substitute if it will adversely affect the patient. Many times they will have suggested that a brand should be prescribed when a prescriber has inappropriately prescribed a generic.

Pharmacists have been practising generic substitution in UK hospitals for at least 30 years, possibly longer.

In primary care it is different and until now pharmacists have needed to contact the GP to arrange generic substitution. GPs will find the legislation change of great benefit as it will result in lower prescribing costs and fewer telephone interruptions. I would expect the pharmacists to discuss the principles of the proposed change in legislation with their local prescribers and come to some form of local understanding.

GPs already employ pharmacists to assist them to prescribe generically, and some have software installed on their prescribing systems that offer generic substitute suggestions for manual or automatic switching.

This merely increases the tools at their disposal

Will pharmacists be allowed to substitute in most cases, anyway? YES. This is a financial and not a clinical question, since medicine is a business.

Michael Joseph