alternative penicillin to treat Strep A
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The Department of Health and Social Care (DHSC) has allowed pharmacists to supply alternative penicillin to treat Strep A. It has issued Serious Shortage Protocols (SSPs) for three penicillin medicines.

“The SSPs will help mitigate local supply issues of oral penicillin and allow pharmacists to supply alternative forms of the medicine if they do not have the specific formulation stated on the prescription,” said DHSC.

SSPs have been issued across the UK for 3 penicillin medicines on Thursday (December 15.

“Issuing an SSP allows pharmacists to legally supply a specified alternative medicine, removing the need for the patient to return to the prescriber – which saves time in GP practices and inconvenience for patients.”

“Demand for penicillin has risen recently as it is used to treat strep A and scarlet fever, and the increased demand means that some pharmacists are experiencing temporary and localised supply issues and may not have the specific formulation listed on the prescription.”

DHSC also said that there are 9 other SSPs currently active. They have been used to improve patients’ access to hormone replacement therapy drugs and were used extensively during the pandemic.

The SSPs apply to the following medicines:

  • phenoxymethylpenicillin 250mg/5ml oral solution sugar free
  • phenoxymethylpenicillin 250mg/5ml oral solution
  • phenoxymethylpenicillin 125mg/5ml oral solution sugar free

Gordon Hockey, the Pharmaceutical Services Negotiating Committee (PSNC)’s Director, Legal, said: “We asked DHSC to introduce Serious Shortage Protocols (SSPs) to help mitigate the ongoing supply disruption affecting the availability of phenoxymethylpenicillin (Pen V) and are pleased to see that some have now been introduced.

“However, PSNC was not involved in the development of these protocols and our team is urgently clarifying some points to provide contractors with additional guidance and to seek assurances around the reimbursement of any alternatives supplied. We will issue our additional guidance as soon as possible.

More widely, PSNC has also been pressing DHSC to think broadly about what other measures could help to manage the current situation and consider the introduction of greater flexibilities, such as allowing pharmacists more professional discretion to amend prescriptions separate to SSPs.”

Chair of the Royal Pharmaceutical Society (RPS) in England, Thorrun Govind, is worried stock issues could significantly increase the workload for already stretched pharmacy teams and hopes “to see a change in the law which makes the whole process of supply of medicines easier and quicker for both pharmacists and patients”.

She said: “We urge the Government to amend medicines legislation to allow pharmacists to make minor amendments to a prescription without any protocol being needed. At present a prescription can only be changed by the prescriber, which causes unnecessary workload for GPs and delays for patients.”

“We want to see all pharmacists across the UK enabled to change prescriptions and be able to supply a different quantity, strength or formulation of a medicine (for example changing capsules to tablets) on a daily basis, to avoid unnecessary bureaucracy and the need for an SSP to be developed, signed and authorised by a Minister. In effect it would mean that pharmacists can help patients straight away – it would future proof the problem to some degree.

“Such substitutions have been standard routine practice for pharmacists in hospitals for years and are already used in Scotland. Patients in England and Wales should be able to benefit in the same way. None of these proposed amends would involve therapeutic substitution, so pharmacists would not be involved in changing treatments.

“Patients need timely access to medicines and pharmacists want to be better able to help people manage the supply of their medicines with consistency across the UK. We call on the Government to resolve this issue as soon as possible.”

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