The general relationship between doctors and pharmacists is that doctors prescribe and pharmacists dispense, and that separation is central to how the medical system has historically worked.
There are exceptions to this, most notably with the Pharmacy First service that allows trained community pharmacists to write prescriptions for seven relatively common and uncomplicated conditions without needing to consult a GP first, which can help patients get relief quicker.
As well as this, there are some rural areas where there are dispensing doctors who both prescribe and dispense at the same time, but they are typically only able to as a last resort to avoid a pharmacy desert.
However, whilst pharmacists cannot prescribe outside of certain exceptions, they can offer over-the-counter medications and advice. In some very specific cases, they can even amend a doctor’s prescription.
How Can A Pharmacist Change A Prescription?
There are very strict conditions where pharmacists can amend a prescription, with each NHS trust having a published policy for exploring the scenarios where a pharmacist can amend a
prescription without talking to the prescriber first.
There are a lot of different examples, but they can typically be grouped into a few common amendments.
Generic Substitution
Probably the most common reason for a change in prescription is a like-for-like swap from one version of a drug to another. Often this is a switch from a brand-name drug to a generic version once it becomes available.
This is a common and highly publicised practice, which often explains why a prescription might look different, as some manufacturers prefer certain types of manufacturing techniques, so the type of pill, colour or size might be different.
However, the dosage will be the same and generic medications are legally required to have precise tolerances.
With that said, there are certain types of medications which cannot be substituted in this way due to a lack of a like-for-like substitute.
Form, Type And Direction Alterations
A pharmacist cannot alter the dosage without consulting the prescribing doctor. However, what they can sometimes do is alter the way in which a medication is dispensed.
This can mean switching a liquid medication for capsules, or substituting two smaller tablets for one larger one when a dosage has stabilised.
This is done for a variety of reasons following consultation with a patient. For example, some people find it easier to remember to take just one pill rather than two or find it easier to take
capsules over other types of pills or liquid medication.
They can also, in some cases, change the rounding of doses for medications based on the weight of a patient in order to make it easier to measure and easier to take.
This is often known as compounding and works under the rule that anything that makes a prescription easier to follow is beneficial.
Therapeutic Substitution
A much rarer situation is where a pharmacist swaps one medication for a different drug that provides the same effect and is in the same drug class.
This is typically done in the case of shortages or where there are different formulations of the same medication, as is the case with statins.
This will rarely be done without consulting a prescriber first, however.