We should be spending time with patients rather than wasting it – and our money – sourcing branded generics, says Adeel Sarwar, committee member, Community Pharmacy West Yorkshire

I won’t forget February 25, 2022. It was a busy Friday afternoon and there hadn’t been a GP at the local surgery the previous day. Two days of repeat prescriptions landed just as lunch break had begun.

The dispenser who normally orders the stock told me we had received several complaints about outstanding Laxido prescriptions, but she couldn’t source any product, even though we had a stockroom full of the generic version.

I said I would try to get hold of some but 20 minutes later I was still on hold to the wholesaler.

An otherwise healthy patient in his 70s walked in and asked for me. I’d known him for 12 years as the main carer for his wife.

He came to the pharmacy once a month and always cracked jokes with the staff to cheer them up, myself included.

He wanted to talk; he wasn’t well. I was still on the phone to the wholesaler and dealing with another query, so I asked a pharmacy team member to speak to him. His blood pressure was low. We referred him to his GP.

He died three days later. When I went to the funeral I tried to comfort his sons and grandchildren, who were distraught at their sudden loss.

Every one of those conversations reminded me of the time I didn’t speak to him because I was trying to order Laxido.

I am sure my experience is repeated in pharmacies across the entire country – time that could be spent with patients being spent sourcing branded generics instead.

Tangible impact

Community Pharmacy West Yorkshire continues to work hard on behalf of local contractors to ensure that the various local NHS components always have strong community pharmacy representation.

Every CPWY committee meeting is attended by CCG medicines optimisation leads from across West Yorkshire.

Branded generics are discussed repeatedly at our meetings and we have been clear that they are having a tangible impact on community pharmacy and our patients.

At our March meeting, all West Yorkshire CCGs confirmed that they now avoid branded generic prescribing as much as possible.

However, they did acknowledge that legacy branded generic prescribing continues. So what can pharmacy do about branded generic prescribing?

Although on my patch CCGs no longer actively implement branded generics, their use in practice remains high.

I believe all pharmacies should report every issue with branded generic prescriptions to their CCG medicines optimisation team so it can be reviewed and managed. I would also like to see every pharmacy discuss the impact of branded generics with local GP practices.

Furthermore, every pharmacy should highlight to their CCG where branded generic prescribing takes place for Category M or Category C products.

Most CCG policy documents will state that these medicines shouldn’t be on a primary care prescribing rebate scheme (PCRS), nor should there be any impact on the pharmacy network or adverse effect on the local healthcare community. We know this is not the case.

Why is this important?

There are situations where brand prescribing should occur; for example with some inhalers, contraceptives, insulin, emollients or where there are differences in the licensed indications between branded and generic versions. My LPC certainly supports branded prescribing where there is a clinical reason.

However, branded generics too often cause inconvenience for patients and delays to treatment when the stock is unavailable.

They are often confusing for both GPs and patients, stressful for pharmacy teams trying to source product, and impact significantly on GP and pharmacy time if re-prescribing is necessary.

At a time of increasing operating costs in pharmacy, the financial impact of the cuts to the national contractual framework is only exacerbated by the loss of margin when branded generics are used.

These arrangements actually cost the Government more money, exacerbate financial stresses for community pharmacy, and create wider stresses for our teams and our patients. Enough is enough.