Open consultation

Enabling pharmacist flexibilities when dispensing medicines

Published 18 September 2025

Summary

This consultation is seeking views on enabling ‘pharmacist flexibilities’ when dispensing medicines. The flexibilities being proposed would allow pharmacists working in a community pharmacy to supply a different strength or formulation (which may mean a different quantity) of the same medicine originally prescribed. The aim is to improve patient access to medicines, reduce the burden on healthcare systems and improve person-centred care. We are not expecting this measure to resolve all the issues surrounding medicine supply difficulties, but it is another tool for pharmacists to improve patient access to their medicines.

The Human Medicines Regulations 2012 (HMRs) require that dispensing is to be “in accordance with a prescription”. This means that pharmacists must dispense the exact product (strength, formulation and quantity) set out in a prescription. There are a very small number of exceptions, such as ‘original pack dispensing’ where pharmacists are allowed to vary the quantity supplied compared with the quantity prescribed by plus or minus 10% in order to be able to dispense a medicine in its original pack. This proposal is an important new exception to that principle.

Many prescriptions dispensed in community pharmacies are not subject to supply issues. The pharmacy is able to dispense exactly what is ordered on the prescription, either straight away or obtain what the patient needs when (or before) the patient needs it. Unfortunately, there are situations where the pharmacist does not have exactly what is ordered on the prescription and is unable to obtain it in time for the patient. This can lead to any or all of the following:

• negative impact on the patient’s health
• poor patient experience
• an increased burden on healthcare services

However, there may be occasions when the pharmacy has an alternative product available in the pharmacy which offers the same treatment and regime to the one prescribed. The new ‘pharmacist flexibilities’ being proposed are a statutory discretion to enable the pharmacist to supply such an alternative to that prescribed for a prescription only medicine (POM) in certain circumstances.

Proposal for pharmacist flexibilities

The Department of Health and Social Care (DHSC) has considered various options on when pharmacist flexibilities could be enabled - from only enabling it in very restricted circumstances to enabling it in any circumstance.

We have considered the impact on patient safety, the medicine supply chain and conflict of interest. Balancing these with enabling pharmacists to provide improved person-centred care, the proposals are that pharmacist flexibilities are enabled when the pharmacy does not have the medicine in stock and the pharmacist has assessed that there is an ‘urgent need’ to supply an alternative and it would be impracticable to obtain the product without undue delay.

An ‘urgent need’ includes urgent clinical need - for example, where a patient requires an acute medicine, such as an antibiotic straight away or where a delay would cause serious inconvenience to the patient.

However, the flexibilities will not apply (except in limited exceptions) when there is a known serious shortage of the medicine prescribed or the alternative to be supplied. This is to avoid the risk of causing knock-on shortages and disruption to the medicine supply chain. We define a serious shortage as where a medicine’s supply is being actively managed through the issuing of any or all of the following (and, where these apply, the equivalent in the devolved governments):

• a serious shortage protocol (SSP)
• a medicine supply notification (MSN)
• an alert through the central alerting system (CAS)

However, we propose an exception where an MSN or CAS has specifically allowed the use of pharmacist flexibilities to manage a particular shortage.

What this consultation does not cover

This consultation is not about:

• ‘pharmacist prescribing’, where a pharmacist is qualified as an ‘independent’ or ‘supplementary’ prescriber and is able to prescribe treatment for patients. In these cases, as a prescriber, the pharmacist will typically have more time to consider the suitability of the medicine as part of a prescribing process and will have been commissioned separately by an NHS organisation to provide a prescribing service

• ‘generic substitution’ (flexibilities to allow pharmacists to provide an alternative generic medicine or a different brand when a specific brand has been prescribed. There is already a high generic prescribing rate (over 80%). Where prescriptions are prescribed by brand, it is often where there is only a brand available or where the prescriber has specifically prescribed a brand (for example, a patient can only tolerate a particular brand)

• ‘therapeutic substitution’ (pharmacists supplying an entirely different medicine from that which was originally prescribed)
• medicine supply in secondary care settings, such as hospitals

There are different patient safety considerations associated with generic substitution and therapeutic substitution, which require different mitigations and governance that are not discussed as part of this consultation.

Background

The HMRs require dispensing of prescriptions to be “in accordance with a prescription”. This means supply of medicines must be the exact product prescribed, with some exceptions, as follows:

• where it is practically impossible to dispense the quantity prescribed or very difficult to split the original pack - for example, an inhaler
• medicines containing valproate
• original pack dispensing - where the pharmacist can supply up to plus or minus 10% of the quantity prescribed if it means they can supply an original pack
• SSPs - where the pharmacist can supply in accordance with the SSP, issued by ministers, rather than the prescription. The SSP could allow a different formulation, strength, quantity or medicine

In general, the current system works well for:

• patient safety through a clinical check by the pharmacist after the prescriber has independently decided what to prescribe
• the medicine supply chain being able to predict with reasonable accuracy the volumes required for the market. This avoids potential knock-on shortages of alternatives (if pharmacists made individual decisions without guidance), which could exacerbate rather than mitigate supply problems
• avoiding potential for conflict of interest by separating prescribing and dispensing functions to support value for money for the NHS

Issues with the current dispensing arrangements

If a pharmacist is unable to supply a medicine to a patient when they present to collect the prescription, there is professional guidance as to what they should do. This is set out in the standards and codes published by the 2 regulatory bodies for pharmacists in Great Britain and Northern Ireland, namely:

• the General Pharmaceutical Council’s Standards for pharmacy professionals
• Pharmaceutical Society Northern Ireland’s ‘Professional standards of conduct, ethics and performance for pharmacists in Northern Ireland’ (available on their Code, standards and guidance page)

These require pharmacists to act in the patient’s best interest.

Pharmacists would be expected to jointly discuss with the patient what their alternative options are, including:

• the pharmacy ordering the patient’s medicine for the next day or trying to obtain it from another pharmacy
• the patient taking the prescription and finding another pharmacy that can supply the medication straight away
• the pharmacy or patient liaising with the prescriber to agree an alternative to be prescribed

However, despite following guidance, where a patient presents in a pharmacy with a prescription and the pharmacist does not have that exact product in stock, this can lead to:

• a negative impact on patient health where the patient goes without their medication for a short period leading to their symptoms or condition returning or exacerbating - for example:
  • the medicine is new to the patient for an acute condition such as pain or an infection
  • the patient has run out of a repeat medicine
• a poor patient experience, such as patients or their carers having increased journeys having to ’shop’ around different pharmacies or return to the pharmacy at a later stage when the pharmacy has been able to obtain the prescribed medicine
• increased administrative burden on healthcare professionals and GP practices - for example, pharmacies sending the patient back to the prescriber for an alternative prescription or the pharmacy having to obtain a new prescription

Currently, if the pharmacist has an alternative product on the shelf (even if it will provide the same medicine and dosage regimen to that prescribed), they are unable to supply it without getting a new prescription. This is because they are bound by the HMRs which require dispensing to be in “accordance with a prescription”.

Pharmacist flexibilities

Calls for increased pharmacist flexibilities

We have received several calls for pharmacists to be given further flexibilities, including:

• a Royal Pharmaceutical Society (RPS) report on medicines shortages, which recommended “flexibility in existing medicines regulations to speed up access”
• a House of Commons Health and Social Care Committee report on pharmacy, which recommends to “allow pharmacists in community settings to make dose and formulation substitutions for out-of-stock items”
• a ‘Prevention of future deaths’ report (Ava Hodgkinson: prevention of future deaths report - Courts and Tribunals Judiciary), issued to DHSC in January 2025, where the coroner expressed concern that pharmacists are not permitted to provide differing strengths of the same medicine without an amended prescription and a risk that “future deaths could occur unless action is taken”
• an All-Party Pharmacy Group report on the inquiry into medicines shortages in England, which recommends to “empower pharmacists to make dose and formulation substitutions during shortages”

We have spoken to various stakeholders informally and found broad support for pharmacists to be given further flexibilities when dispensing medicines but with varying considerations around the benefits versus risks.

What we mean by ‘pharmacist flexibilities’

Pharmacist flexibilities are about enabling pharmacists working in a community pharmacy to supply a different strength or formulation (which may mean a different quantity) of the same medicine originally prescribed for a POM. This measure is not expected to ‘resolve’ all the issues surrounding medicine supply difficulties, but it is a step towards improving patient access to their medicines by giving pharmacists a legislative basis to supply an alternative medicine to that prescribed, in certain circumstances.

Options for ‘pharmacist flexibilities’

While recognising the benefits that enabling pharmacist flexibilities could provide regarding person-centred care, DHSC has considered various options on when pharmacist flexibilities could be used appropriately - from enabling it in very restricted circumstances to enabling it in any circumstance.

For example, pharmacist flexibilities could be enabled:

• only when there is an urgent clinical need, such as where the patient would suffer clinical consequence by not having their treatment immediately
• only for certain medicines or medical conditions
• in any circumstances

We have considered the impact on patient safety, the medicine supply chain and conflict of interest. We want to ensure that the flexibilities are used when they are safe and in the patient’s best interest, but not used so often that they undermine the current arrangements of supplying a POM in accordance with a prescription. To ensure pharmacists flexibilities are only utilised when the benefits outweigh the risks, we propose that the flexibilities can only be used in certain circumstances.

Considerations

Patient safety

It is widely recognised that prescribing and dispensing should not routinely be done by the same person. Where it does occur:

• there should be a risk assessment in place
• it should be in the best interests of the patient

(See RPS guidance on Prescribing and dispensing by the same healthcare professional.)

In primary care, prescriptions are mainly prescribed by an appropriate practitioner (for example, a GP, dentist, nurse prescriber or pharmacist prescriber) and dispensed in a community pharmacy, under the supervision of a pharmacist [see note 1 below]. This allows for a clear separation between the roles of the prescriber and dispenser. The pharmacist can conduct an independent check, particularly around the dose prescribed - for example, checking the dose is appropriate for the patient, taking account of their age and drug interactions with other medications they are taking.

With pharmacist flexibilities, the pharmacist decides exactly which product to supply to the patient. This means there is no longer such a clear separation of roles between the person who chooses which product is to be supplied and the person who supplies the medicine, reducing the independence of the pharmacist’s check on the suitability of the product being supplied.

Further, a community pharmacist may not have access to all the patient information (such as past medical history and blood results) to know the reason why a patient may have been prescribed a specific product. This increases the risk that if the pharmacist switches supply to an alternative product, the patient may get something that is not suitable for them. Pharmacists could feel pressured into making substitutions that they do not feel are necessarily safe and in the patient’s best interest.

As the pharmacist supplies what is on the prescription, there is consistency in what the patient receives. Prescribers will have certainty as to what their patient is receiving - for example, if the patient queries dosing regimens with them. Consistency is important to reduce the risk of medication errors, which are more likely to occur in patients taking multiple medicines, or those that are easily confused or in care settings.

Switching to an alternative, particularly if switched back and forth between alternatives many times, could increase the likelihood of confusion and administration errors. This is of even more concern if the patient is taking several medicines, all of which may have an alternative supplied to what is prescribed at any one time.

Further, patients may have established arrangements to remind them how and when to take their medicines, which would need to be amended if they had to take a different strength or a different formulation. Care settings, such as nursing homes, might use medicine administration record (MAR) charts that list the prescribed medicines and dosing regimen. MAR charts are used by healthcare professionals or carers to ensure correct administration. If an alternative strength or formulation was supplied, this increases the risk of administration errors and increased administrative burden to amend these arrangements.

Note 1: there are new arrangements to allow pharmacy technicians to supervise medicines that were before parliament in July 2025.

Overall, changes that reduce the clear separation between prescribing and dispensing increase the risk of undermining important safeguards designed to protect patients. Where there is not a clear separation between prescribing and dispensing, the independence of the check could be reduced. This can increase the risk of the patient receiving a medicine that is not appropriate for them, particularly where the pharmacist may not have access to the full clinical picture.

A lack of consistency in the product supplied can also increase the likelihood of confusion and administration errors, particularly for patients taking multiple medicines or in care settings where dosing regimens are closely managed. Changes to prescribed products may require updates to established routines or formal records, such as MAR charts, increasing both the risk of error and the administrative burden on healthcare staff.

Impact on the medicine supply chain

Suppliers use historic ordering to reasonably predict future demand, which helps to maintain continuity of supply. If there are no restrictions as to when pharmacist flexibilities can be used, there is a risk that there is a significant increase in alternatives being supplied to what has been prescribed. This makes the supply of each product difficult to monitor by the supply chain and predict future demand. Hence there is a risk over time to the continuity of supply.

A particular concern is that pharmacists might frequently use higher quantities of lower strengths of a product as an alternative to a higher strength product. In general, there are lower volumes of lower strength products, which could mean that quite quickly the stock of lower strengths is depleted. Lower strengths are often required for dose titration (gradually increasing the dose of a medicine using lower strengths) or reserved for children - if their stocks are depleted due to pharmacist flexibilities being used when there is no patient need, there may unnecessarily be no alternatives to use for dose titration or children.

Enabling pharmacists to supply an alternative if the product prescribed is in shortage would, on the face of it, benefit patients in that moment but there is a risk to supply if this creates ‘knock on’ shortages without the oversight of the overall supply situation and thereby may exacerbate rather than mitigate supply problems. Currently, the use of SSPs resolves this predicament for the pharmacist as they are developed with central oversight to ensure that suppliers of the alternative medicine proposed can meet any increase in demand created by supplying the alternative. However, where an MSN or an alert through the CAS (or, where these apply, the equivalent arrangements in the devolved governments) recommends that an alternative strength or formulation can be used, an exception is proposed that allows for pharmacist flexibilities to continue to be used for this circumstance. This will mean that when there is a national shortage that can be managed by supplying a different strength or formulation (with a corresponding change in quantity), community pharmacists will be able to do this without referring back to the prescriber. However, there will still be a place for SSPs, for example, where there is not a simple alternative or there is not enough of the alternative to fulfil the increased demand of the shortage.

If there are no restrictions as to when pharmacist flexibilities can be used, pharmacists could frequently utilise the flexibilities and for multiple medicines. This could significantly reduce the ability of the supply chain to predict demand and could damage longer-term supply resilience.

Conflict of interest

For NHS prescriptions, the prescriber is free to choose the most suitable treatment for the patient, considering what is cost-effective. In the main, community pharmacies purchase the products to be dispensed and are reimbursed by the NHS. Reimbursement for medicines being supplied by a pharmacy includes ‘medicine margin’ (the difference between what the pharmacy pays for the medicine and what they are reimbursed by the NHS). With the current arrangement, generally, the separation between the prescriber and the dispenser supports value for money for the NHS.

Where there are no restrictions in place, there is a risk of pharmacists being intentionally or inadvertently incentivised to utilise flexibilities for financial gain - for example, where they retain more medicine margin for one pharmaceutical form over another.

Our proposal

The flexibilities being proposed would allow pharmacists working in a community pharmacy to supply a different strength or formulation (which may mean a different quantity) of the same medicine originally prescribed where the prescribed medicine is unavailable. This is where, in the pharmacist’s professional opinion, it is safe and in the patient’s best interest - and on the condition that:

• there is an ‘urgent need’ (see below for what this covers)
• it would be impractical to obtain the medicine without undue delay
• any alternative will enable the patient to have the same medicine at the same dose, dosage regimen and treatment cycle as prescribed

However, pharmacist flexibilities would not be enabled when there is a known serious shortage of a medicine prescribed or the alternative to be supplied, except in limited exceptions. This is to avoid the risk of causing knock-on shortages and disruption to the medicine supply chain. We define a serious shortage as where a medicine’s supply is being actively managed through the issuing of any or all of the following (and, where these apply, the equivalent arrangements in the devolved governments):

• an SSP
• an MSN
• an alert through the CAS

The limited exception is where an MSN or CAS (and, where these apply, the equivalent arrangements in the devolved governments) specifically allows pharmacist flexibilities to manage a particular shortage.

For ‘urgent need’ this includes:

• urgent clinical need - for example, where a patient requires an acute medicine, such as an antibiotic or painkiller, that needs to be started straight away or they have run out of their repeat medicine
• when the delay would cause serious inconvenience to the patient (or their representative) such as where a patient has not necessarily run out of a regular medicine but would find it difficult to return to the pharmacy or go to another pharmacy, before they do run out of the medicine

We consider that this proposed approach to pharmacist flexibilities balances the risks to patient safety, the supply chain and conflict of interest but still enables the pharmacist to provide better person-centred care that supports patients’ access to their medicines.

Examples of when pharmacist flexibilities could be used

Example 1: a different strength of the same medicine that enables the patient to follow the same dosing regimen and treatment cycle to that prescribed (which may mean supplying a different quantity).

In this example, a patient has an acute prescription:

• 100ml Amoxicillin 250mg/5ml oral suspension
• dose prescribed is 250mg (or 5ml) 3 times a day for 5 days

Pharmacist flexibilities as described above would enable the pharmacist to supply the following without having to get a new prescription:

• 200ml Amoxicillin 125mg/5ml oral suspension
• dose prescribed is 250mg (or 10ml) 3 times a day for 5 days

Example 2: a different formulation such as a liquid instead of a tablet that enables the patient to follow the same dosing regimen and treatment cycle to that prescribed.

In this example, a patient has a repeat prescription for Ramipril 10mg capsules once daily for 28 days.

Pharmacist flexibilities as described above would enable the pharmacist to supply the following without having to get a new prescription: Ramipril 10mg tablets once daily for 28 days.

Evidence to quantify the potential benefits

To enable us to better quantify the potential benefits of the proposal, as part of this consultation we are seeking evidence on:

• how often pharmacists, GP practices and other relevant stakeholders are dealing with minor amendments, in particular referring patients or prescriptions to prescribers to have strength and formulation changes
• delays to treatment that could have been avoided by allowing supply of a different formulation or strength to achieve the same dosage, so long as the same dosage regimen can be achieved

Implementation

Record keeping in the pharmacy and labelling

To ensure there is an audit trail of any pharmacist flexibilities used, and in particular if and why a prescriber queries what a patient received, we propose there should be a provision for a pharmacist to make a record in a similar way to the current ‘emergency supply’ provisions. This will also enable superintendent pharmacists and regulatory bodies to have oversight of when the flexibilities have been used, and the rationale. We would also expect the correct labelling of the alternative product dispensed.

Notifying the prescriber

When utilising pharmacist flexibilities in line with our proposal, the prescriber may be uncertain as to what the patient received. In most circumstances this will be of no consequence as it will still offer the same treatment as prescribed. However, there may be occasions when the patient queries a medicine with the prescriber, and it will be unclear why the patient has received something different from what was prescribed.

It may be considered an administrative burden if pharmacists must notify prescribers each time. As part of this consultation, we are seeking views on whether there should be a separate requirement to notify the prescriber if an alternative is supplied or whether it should be left to the professional judgement of the pharmacist. Potentially, if there are to be requirements to notify, the obligations to do so could be managed as part of NHS terms of service rather than amendments to the HMRs.

Controlled drugs, unlicensed and non-POMs

Due to the additional safety risks if misused and the risk of divergency, there are additional legislative requirements under the Misuse of Drugs Act 1971 around prescriptions, record keeping and storage requirements for all controlled drugs.

However, those in schedule 5 do not raise such a high level of concern as those in schedules 2 to 4 and in turn do not have so many extra legislative requirements.

Therefore, although there could be some justification for including all controlled drugs, we propose that pharmacist flexibilities are only enabled for controlled drugs in schedule 5 and not enabled at this point for controlled drugs in schedule 2 to 4.

Additionally, we do not think pharmacist flexibilities should be enabled for unlicensed medicines as these medicines are prescribed to meet a specific individual patient need and therefore an alternative is not appropriate in most cases.

Although the HMRs only cover POMs, many medicines prescribed in the NHS in primary care are non-POMs, which include categories such as:

• pharmacy medicines
• general sales list
• medicines with no licensing (such as food supplements and appliances)

In these cases, the pharmacist is not constrained by the HMRs as to what they dispense (that is, “in accordance with the prescription”) but they are constrained by their NHS terms of service and what they will be reimbursed.

It will be an issue for each of the devolved governments as part of their NHS service commissioning arrangements to consider whether to extend pharmacist flexibilities to non-POMs.

Pharmacy technician supervision rules

These proposals would come into force once the new arrangements enabling pharmacy technicians to supervise the supply of medicines in a pharmacy have come into effect. However, we propose that pharmacist flexibilities cannot be supervised by pharmacy technicians but are seeking views on this point through this consultation.

Dispensing doctors

Amending the HMRs to allow the equivalent of pharmacist flexibilities for dispensing doctors is not required. The equivalent can be provided for by amending their NHS terms of service and what they will be reimbursed. It will be an issue for each of the devolved governments as part of their NHS service commissioning arrangements to consider whether to extend the equivalent of pharmacist flexibilities to dispensing doctors.

NHS impact

Each administration will need to consider how the use of pharmacist flexibilities is implemented within the NHS pharmaceutical services they commission and in turn reimbursement.

It is difficult at this point to consider the impact on NHS spend. However, taking into account the benefits of reduced administrative burden on pharmacies and GP practices, it may be cost neutral (or any change in costs will be marginal). We welcome any views from respondents on the likely impact on the NHS medicines spend so that this can be factored into our impact assessment.

For NHS prescriptions, Northern Ireland is specifically proposing to have a transitional provision so that pharmacist flexibilities apply once provision has been made in their NHS pharmaceutical services regulatory provision to that effect.

Legislation

Enabling our proposal will require amendments to the HMRs using the powers in the Medicines and Medical Devices Act 2021 (MMD). We propose making these legislative changes using powers in part 2 of the MMD, which provides powers to make, among other things, amendments to the HMRs. The proposed amendments are for amending the HMRs only.

The consultation is being carried out in accordance with the requirement in section 2 of the MMD  that provides that when regulations are made under the powers that would be used in this case, patient safety must be the overarching objective of the appropriate authority when making the regulations.

Section 2 also requires that, when assessing whether regulations would contribute to the objective of safeguarding public health, the appropriate authority must have regard to 3 factors:

• the safety of human medicines
• the availability of medicines
• the likelihood of the relevant part of the UK being seen as a favourable place in which to:
  • carry out research relating to human medicines
  • conduct clinical trials
  • manufacture or supply human medicines

As set out in section 2 (4) of the MMD, where regulations under section 2 (1) may have an impact on the safety of human medicines, the appropriate authority may make the regulations only if the authority considers that the benefits of doing so outweigh the risks. The appropriate authority is the Secretary of State for Health and Social Care in relation to Great Britain and, in relation to Northern Ireland, it is the Department of Health in Northern Ireland and the Secretary of State acting jointly.

In enabling pharmacists to exercise their skill and professional judgement to be able to supply an alternative where appropriate, our aim is to improve patient safety and person-centred care. The reduced administrative burden in dealing with medicines access means pharmacies will have more time to focus on services. Where it is critical that the patient receives the exact strength and formulation prescribed, then the pharmacist must not supply the alternative to uphold patient safety.

Regarding the availability of medicines, we consider that, overall, the proposal should increase patients’ access to medicines but the impact on availability overall should be neutral in that the provision is not to be used where there is a known shortage of a medicine.

We do not consider there will be any impact on the likelihood of the relevant part of the UK being seen as a favourable place in which to carry out research relating to human medicines, conduct clinical trials and on the manufacture or supply of human medicines, although we have considered this as an issue.

Timescales

Amending the HMRs may take several months after the consultation has concluded. Parliamentary agreement would be required through the ‘affirmative procedure’, requiring debates in both Houses of Parliament and the Northern Ireland Assembly.

‘Affirmative procedure’ is a type of Parliamentary procedure that applies to statutory instruments (SIs). Its name describes the form of scrutiny that the SI receives from Parliament. An SI laid under the affirmative procedure must be actively approved by both Houses of Parliament.

If the proposal is agreed and brought into force in the HMRs, each of the 4 UK countries would have to decide how the new flexibilities would be made to work within the terms of service of each country’s NHS.

Statutory duties

In considering the amendments to the HMRs, UK ministers must comply with the public sector equality duties.

In Northern Ireland, new policies must be screened under section 75 of the Northern Ireland Act 1998, which places a statutory duty on public authorities to consider equality in all its functions - so that equality of opportunity and good relations are central to policy making and service delivery.

In addition, new or revised policies must be ‘rural proofed’ in line with the Rural Needs Act (Northern Ireland) 2016, which requires public authorities to have due regard to rural needs.

We believe that this proposal will help ensure the Secretary of State for Health and Social Care and Department of Health in Northern Ireland continue to promote a comprehensive health service and that the proposed flexibility supports patients’ access to medicines.

Impact assessment

As part of this consultation, we are asking respondents to let us know of any measurable impacts or impacts we have not considered. Following this consultation, we will carry out another impact assessment, considering information we gather through responses.

How to respond

Please respond through our online survey.

This consultation is intended to provide healthcare professionals who deal with prescriptions and members of the public with information about the policy proposal and an opportunity to comment. We welcome responses from any interested person or organisation.

Do not provide personal data when responding to free-text survey questions. Any personal data included will be removed prior to analysis of these responses and will therefore not be considered in the consultation outcome.

The consultation is being made available in England, Wales, Scotland and Northern Ireland and the proposed changes to the HMRs would apply throughout the UK.

The consultation is open for 12 weeks and will close at 11:59pm on 11 December 2025. If you respond after this date, your response will not be considered.

Consultation questions

About you

In what capacity are you responding to this survey?

• An individual sharing my personal views and experiences
• An individual sharing my professional views
• On behalf of an organisation

Questions for individuals

What is your age? (Optional)

• Under 16
• 16 to 24
• 25 to 34
• 35 to 44
• 45 to 54
• 55 to 64
• 65 to 74
• 75 or above
• Prefer not to say

What is your sex? (Optional)

• Male
• Female
• Prefer not to say

Question for professionals and organisations

Which of the following best describes your area of work? (Optional)

• NHS or health service delivery
• Other public sector
• Charity or voluntary sector
• Private sector
• Other, please specify

Question for professionals

How would you best describe your profession?

• Community pharmacist or pharmacy worker
• Medical prescriber (such as a GP or dentist)
• Non-medical prescriber (such as a pharmacist or nurse)
• Other, please specify

Questions for organisations

What is the name of your organisation? (Optional)

Where does your organisation operate or provide services? (Optional, select all that apply)  

• England
• Wales
• Scotland
• Northern Ireland
• The whole of the UK
• Outside the UK

Which of the following best describes the work of your organisation? (Optional)

• An organisation representing pharmacy professionals
• An organisation representing other healthcare professionals
• An organisation representing patients, the public and carers
• A provider of goods or services to the NHS
• Other, please specify

Confidentiality

As part of our assessment of consultation responses, we may name responses from significant stakeholders such as trade bodies. If you do not want to be named, you’ll be given the chance to opt out in the online survey.

Questions on the proposals

We propose to enable pharmacist flexibilities, allowing pharmacists to use their professional judgement to supply an alternative strength or formulation (which may mean a different quantity) of the same medicine originally prescribed, without getting another prescription from the prescriber, but only under restricted circumstances.

To what extent do you agree or disagree with this proposal?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

To what extent do you agree or disagree that increasing pharmacist flexibilities would offer better patient-centred care?   

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We propose to increase pharmacist flexibilities, but only under restricted circumstances where the pharmacist considers that:

• there is an ‘urgent need’
• it would be impracticable to obtain the product to meet the patient’s needs without undue delay
• any alternative will enable the patient to have the same medicine at the same dose, dosage regimen and treatment cycle as prescribed

This flexibility would not apply if there was a known serious shortage of a medicine prescribed or the alternative to be supplied, subject to an easement relating to the messaging systems which are used where there are shortages which would allow those messaging systems to recommend continued use of the flexibilities during a shortage. This is to mitigate risks to patient safety, conflict of interest and the medicine supply chain.

To what extent do you agree or disagree with our proposal that increased pharmacist flexibilities should have these restrictions in place?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

We have outlined some of the considerations around patient safety, medicine supply chain and conflict of interest as part of these proposals.

If there are any other factors you think we should consider, please include them here. (Optional, maximum 250 words)

Do not provide personal data in your response. Any personal data included will be removed prior to analysis and will therefore not be considered in the consultation outcome.

We propose that pharmacist flexibilities would not apply for controlled drugs in schedules 2 to 4.

To what extent do you agree or disagree with this proposal?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

What impact, if any, would introducing pharmacist flexibilities have on patient health? (Optional, maximum 250 words)

We would value advice on both the likelihood and size of any health impacts. Do not provide personal data in your response. Any personal data included will be removed prior to analysis and will therefore not be considered in the consultation outcome.

Data gathering

These questions are about primary care.

Questions for individuals sharing personal views

For the following questions, consider your experience as a patient over the past 12 months.

Approximately how many prescription items have you received in the past 12 months?

• None
• Fewer than 5
• Between 5 and 9
• Between 10 and 19
• Between 20 and 30
• More than 30
• Don’t know

If you answered that you have received prescription items, how often have you had difficulty in obtaining prescription items in the past 12 months, due to lack of availability at the pharmacy?

• None
• Fewer than 5 times
• Between 5 and 10 times
• More than 10 times
• Don’t know

If you answered that you have had difficulties, when these difficulties occurred, typically how long did it take for you to get your prescribed medicine?  

• Less than 1 hour
• Several hours
• 1 to 2 days
• 3 to 7 days
• More than 1 week
• I was unable to get my prescribed medicine
• Don’t know

Questions for pharmacy workers

For the following questions, consider your experience as a community pharmacist or pharmacy worker over the past 12 months.

In a typical working week, how many prescriptions were you unable to fulfil in a timely manner due to medicine stock issues in the pharmacy?  

By ‘timely manner’, we mean where the patient was able to collect the medicine on the same day or in the following days, meaning they did not miss a dose or have a delay to starting their medicine.

• None
• 1 to 5
• 6 to 10
• 11 to 15
• 16 to 20
• More than 20
• Don’t know

If you did not select ‘none’, in a typical working week, how many prescription items that you were unable to fulfil would have met the criteria for pharmacist flexibilities?

That is, the prescription medicine was not immediately available and there was either an urgent ‘clinical need’ and/or it was impracticable for the patient to return.

• None
• 1 to 5
• 6 to 10
• 11 to 15
• 16 to 20
• More than 20
• Don’t know

When a prescribed medicine was not immediately available, on average how long did it take you to either order the medicine or advise the patient on other routes as per guidance?

This includes time spent talking through options, speaking to the prescriber or signposting (referring a patient to another service or healthcare professional).

• Less than 1 minute
• Between 1 and 5 minutes
• Between 5 and 15 minutes
• Between 15 minutes and 1 hour
• Over 1 hour
• Not applicable

If the proposed flexibilities were in place, how often do you think you would use them under the specified restrictions?  

That is, the prescription medicine is not immediately available and there is either an urgent ‘clinical need’ and/or it would be impracticable for the patient to return, and the alternative will enable the patient to have the same medicine at the same dose, dosage regimen and treatment cycle as prescribed.

• All of the time
• Most of the time
• About half the time
• Some of the time
• None of the time
• Don’t know

If the proposed flexibilities were in place and you had an alternative available, how long do you think it would take you to discuss and supply the alternative medicine?  

• Less than 1 minute
• Between 1 and 5 minutes
• Between 5 and 15 minutes
• Between 15 minutes and 1 hour
• Over 1 hour
• Don’t know

Questions for prescribers

For the following questions, consider your experience as a prescriber over the past 12 months.

In an average working week, how many prescription items have you issued in a primary care setting? 

• None
• 1 to 20
• 21 to 40
• 41 to 60
• 61 to 80
• More than 80
• Don’t know

In an average working week, how many prescriptions have you had to re-write due to medicine stock issues in pharmacies?  

• None
• 1 to 10
• 11 to 20
• 21 to 30
• 31 to 40
• More than 40
• Don’t know

When these issues occurred, typically how long did it take for you to re-write each prescription?  

• Less than 5 minutes
• Between 5 and 15 minutes
• Between 15 and 30 minutes
• Between 30 minutes and 1 hour
• More than 1 hour
• Not applicable

Questions for professionals and organisations

To what extent do you agree or disagree with our assessment that the impact of the proposal around pharmacist flexibilities on NHS medicine costs will either be cost-neutral or marginal?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

If you have any case studies, descriptions, analysis and quantification that could be helpful for discussion and/or inclusion in any overall assessment, please include them here. (Optional, maximum 500 words)

Do not provide personal data in your response. Any personal data included will be removed prior to analysis and will therefore not be considered in the consultation outcome.

Where a pharmacist has utilised flexibility to supply an alternative medicine, to what extent do you agree or disagree that the pharmacy should notify the prescriber?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Do you expect pharmacists would need specific training if pharmacist flexibilities were enabled? 

• Yes
• No
• Don’t know

If you answered ‘yes’, please provide details about the training that would be required. (Optional, maximum 250 words)

Do not provide personal data in your response. Any personal data included will be removed prior to analysis and will therefore not be considered in the consultation outcome.

We propose that if pharmacist flexibilities were enabled, they would not be supervised by pharmacy technicians.

To what extent do you agree or disagree with this?

• Strongly agree
• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Statutory duties

Do you agree or disagree with DHSC and the Department of Health in Northern Ireland, who do not consider that these policy proposals will create inequalities or adversely impact individuals with protected characteristics?

The protected characteristics under the Equality Act 2010 are age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you selected ‘disagree’, please provide further information. (Optional, maximum 250 words)

Do not provide personal data in your response. Any personal data included will be removed prior to analysis and will therefore not be considered in the consultation outcome.

The Department of Health in Northern Ireland does not consider that these policy proposals will impact people differently with regard to where they live geographically in Northern Ireland. 

Do you agree or disagree with this assessment?

• Agree
• Neither agree nor disagree
• Disagree
• Don’t know

If you selected ‘disagree’, please provide further information. (Optional, maximum 250 words)

Do not provide personal data in your response. Any personal data included will be removed prior to analysis and will therefore not be considered in the consultation outcome.

Privacy notice

We manage the information you provide in response to this consultation in accordance with DHSC’s personal information charter and privacy notice, which explains your rights under the Data Protection Act 2018 (DPA) and the United Kingdom General Data Protection Regulation.

The information we receive may be published or disclosed in accordance with the access to information regimes (primarily the Freedom of Information Act 2000 (FOIA), the DPA and the Environmental Information Regulations 2004). Under FOIA, personal data is not disclosed. The only data that would be disclosed of the people that have filled out this questionnaire is fully anonymised and/or aggregated data.

DHSC will process your personal data in accordance with the DPA, and in most circumstances your personal data will not be disclosed to third parties.