Leading pharmaceutical distributor AAH has called on the Department of Health to clarify certain aspects of the government’s proposals to allow automatic generic substitution.

The firm highlights two areas of the proposals which it feels needs further attention, the first of which is the plan to give a month’s notice to add or remove a product from the list of those which may be substituted.
AAH says the Department needs to begin a dialogue with wholesalers and the Pharmaceutical Services Negotiating Committee (PSNC) to determine if that notice period is sufficient to manage stocks at both wholesaler and pharmacy levels.

Second, says the company, if the Department intends to press ahead with its plans, it needs to start talking to patient medication record (PMR) providers about how much notice they will require in order to update systems, what new functionality will be required and when, how this will align with other competing demands from other pharmacy e-programmes and, critically, who will pay for this development work.

“The medicines supply chain in the UK is highly efficient and a critical part of the infrastructure of the NHS,” said Mark James, group managing director at AAH Pharmaceuticals. “It is therefore vital that, prior to any changes to that supply chain, such as generic substitution, the practical implications are fully addressed,” he added.

A number of industry and trade groups, including the Royal Pharmaceutical Society of Great Britain (RPSGB) and the Ethical Medicines Industry Group (EMIG), have already publicised the grave misgivings they have expressed to the Department during its consultation over official plans to allow automatic generic substitution which, according to official estimates, would increase national generic prescribing rates from 83% to 88%.

The National Pharmacy Association (NPA) shares the view of these bodies that automatic generic substitution should not be implemented, and warns that the consequences of doing so are likely to run counter to the Department’s Quality, Innovation, Productivity and Prevention (QIPP) agenda.

“We believe that changes to a generic from the brand must be instigated by the prescriber, and the patient must be involved in the decision,” says Margaret Peycke, external relations manager at the NPA.

Initiatives to reduce waste are far more likely to achieve the financial savings which the Department is seeking than generic substitution, the “inherent problems” of which are listed by the NPA in its response to the government consultation, she adds.

The NPA believes the Department and the NHS should support repeat dispensing and medicines use reviews (MURs), develop the First Prescription Service which was proposed in the Pharmacy White Paper and complete research into understanding why patients don’t take their medication as intended by the prescriber.

83% of prescriptions are prescribed generically with only another 5% having the potential to be prescribed generically, says the NPA, and it calls on the Department and the NHS to target prescribers with low levels of generic prescribing, “rather than asking the pharmacist to intervene, which could potentially damage patient or prescriber relationships.”