Throughout my 40-year career in hospital pharmacy, the substitution of originator-branded (proprietary) medicines by their generic alternatives has been accepted as custom and practice. In the UK, hospital drug and therapeutic committees have adopted policies that enable pharmacists to automatically substitute generic alternatives without the need to consult prescribers, even when the original prescription has been written using the brand name. This practice has worked well for the vast majority of drugs, with relatively few exceptions or problems. As a general rule, because of potential differences in bioequivalence, UK hospital pharmacists do not substitute branded modified release formulations with alternative products in line with British National Formulary recommendations.

Throughout the UK, there are national hospital contracts for both oral and injectable generic medicines which enable the adoption of strictly applied quality standards for labelling, packaging and patient information leaflets. Regrettably, within contract terms and conditions, it is not possible to specify the size, shape and colour of solid doses to achieve a consistent approach across manufacturers. These contracts generally last for two years and have the benefit of facilitating market and supply chain management within the hospital service. On the other hand, the vast majority of repeat medicines are prescribed by family doctors and dispensed by community pharmacists. In primary care, the automatic substitution of generic …

Correspondence to Peter Sharott, Pharmaceutical Adviser, NHS England (London Region), Mezzanine Floor, Southside, 105 Victoria Street, London SW1E 6QT, UK; peter.sharott{at}btinternet.com