Chris Lancelot: Generic substitution puts patients at risk

The government has decided that from January 2010, pharmacists will be entitled automatically to substitute generic products for branded drugs. What are ministers thinking? Can they not see the dangers? We have enough problems already with generic prescribing.

How often has the following happened to you? A patient is receiving a drug by repeat generic prescription. Then the pharmacist switches to a different supplier. The patient rings up, concerned that the wrong medication has been dispensed because it is a different shape and colour and the pack looks different. You reassure her that it is the same drug, but made by a different company.

The next month she gets another different-looking preparation. Again she questions it, again she is reassured. Eventually she stops contacting you.

But what if the pharmacist was to make a mistake and dispense the wrong drug? Accustomed to frequent changes in the look of her medication, the patient may not ask questions. She might take the incorrect drug and become ill, or even die.

Government ministers need to remember that drug names are bewildering to many patients. The situation is made even worse when patients are ill, confused or can't read. Together with a consistent pack design, the shape, colour and size of tablets help patients check that they have received the right medication. Abandoning this safety feature puts patients' lives at risk.

If generic prescribing increased the personal profits of the GP or chemist rather than saving the NHS money, I am sure the government would have outlawed it long ago because it clearly compromises patient safety.

Can ministers not see that generic prescribing is at best confusing and at worst dangerous? The situation is about to get worse, because under the proposal for automatic branded-to-generic substitutions by pharmacists, not only will the drug look different but the name on the label will change. It will be almost impossible for patients to check their routine prescriptions.

Obviously, we all need to prescribe economically but surely there are safer methods than these? I firmly believe that generic prescribing and branded-to-generic substitutions should be banned altogether.

Dr Lancelot is a GP from Lancashire. Email him at

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