Demand, meet supply?

This month, our health policy columnist responds to national headlines highlighting the persistent issue with medicine shortages.

It is always an interesting moment when a subject that has been preoccupying the trade press jumps the fence and makes it through to national media attention, as the issue of medicine shortages has just done.

Features in The Guardian and The Times earlier this month may have brought this issue to the front of Westminster’s minds. 

If so, not before time. The Times quotes Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies (AIMp), whose 4,500 members make up 52% of independent community pharmacies, as describing the current supply shortage as the worst seen yet, adding that rising prices were leaving pharmacy operators out of pocket.

“Every week we get a message informing us that a particular popular medicine is going to be out of stock for a period of time. It is an unviable and broken system. Many pharmacies are closing their doors for good because of funding challenges,” she said.

This problem is not UK-specific. In October 2023, the Financial Times (FT) reported on the EU’s plans for sharing of medicines in short supply. The FT reported that the European Commission planned “a ‘voluntary solidarity mechanism’ requested by France and Germany and an early warning system flagging when drugs become scarce … if insufficient donors come forward, EU capitals will be allowed to tap into an EU-funded stockpile set up during the COVID-19 pandemic and take other emergency measures”.

Curious. Is solidarity really a voluntary kind of thing?

The PJ has, of course, been tracking the emergence of this set of issues for some time. In June 2023, a special report from Dawn Connelly, senior features editor, gave a salient overview of the essential issues.

Connelly’s feature reminded us of the HRT shortages, and indeed those of common antibiotics. She noted that serious shortage protocols (SSPs) were first introduced in October 2019 as part of preparations for a ‘no-deal’ Brexit and that, since then, “the Department of Health and Social Care has issued 56 SSPs, with the number of active protocols peaking at 9 SSPs in July and September 2022”.

A growing problem

However, the pharmaceutical supply problem has worsened since then. An article by Breen, Silcock and Edwards published in The Conversation in December 2023 brings the overall narrative fairly up to date, as did this episode of the Tonight programme on ITV earlier this month, which did well to highlight the impact of shortages on pharmacy teams and patients.

The Conversation article suggests that “while it’s difficult to correlate current drug shortages with Brexit, anecdotally, the changes in trade agreements between the UK and EU have led to additional bureaucracy, costs, supplier changes and delays”.

“There are concerns that government agreements regarding pricing and supplier taxation (via the ‘Voluntary scheme for pricing, access and growth‘) may discourage suppliers trading with the UK. This could lead to fewer suppliers and products in the UK system,” it adds.

The situation is generating extra work for pharmacists who sometimes have to liaise with prescribers about substitutions

This is not about switching people out of preferred brands, nor (in the main) about new blockbusters. Results from The PJ‘s 2023 salary and job satisfaction survey revealed that 902 out of 1,578 (57%) UK pharmacists working in all sectors of the profession said medicines shortages had put patients at risk “in the past six months”. Problems were particularly acute in community pharmacy, where two-thirds of respondents (67%; 256 of 381) said shortages have put patients at risk. 

The problem is not only the shortage of the products. The situation is generating extra work for pharmacists who sometimes have to liaise with prescribers about substitutions. The PJ survey also revealed that 15% (235 of 1,570) of respondents said they were spending six or more hours per week on activities related to medicines shortages, with 22% of community pharmacists (84 of 381) doing so.

Shortages are obviously driving further ‘failure demand’ back into primary care and the acute sector — neither is exactly under-occupied already. 

Supply-induced demand?

The root causes of the problem — in theoretical terms, a simple imbalance between supply and demand — are multiple. Connelly’s special report in June 2023 had a good, if slightly depressing, summary of the various factors, but manufacturing issues are widely cited as the main reason.

Are they unresolvable, for a global economy that reconfigured itself in response firstly to the COVID-19 pandemic; then to the blockage of the Panama Canal by the grounded container ship; then to the energy crisis caused by Russia’s invasion of Ukraine? We would want to hope not, but they do seem to be persistent.

In May 2023, guests at a roundtable published in The PJ came up with a sensible set list of suggestions for the government for improving the ongoing problem, including producing an app — similar to the Argos model — that shows availability of medicines in community pharmacy. It also included reconsidering how manufacturers are incentivised for supplying generic medicines to the NHS since their sale price is now lower than the cost of manufacturing them.

‘Something must be done’

Clearly, in a well-governed country, the government would not need to be told that it needs to get a handle on these shortages (not only for patient safety, but also to sustain the community pharmacy network). 

It is a sub-optimal use of pharmacists’ time to be avoidably sourcing medicines or verifying substitutions, particularly given the policy driver for the pharmacy sector to take increasing pressure off the rest of the healthcare system.

Alas, the topic doesn’t seem to be attracting urgent attention from the current administration. Nor has the opposition yet picked up on what may seem like a prosaic issue: that is, until it is your loved one’s medicine that is out of supply — or indeed, your own.

Andy Cowper is the editor of Health Policy Insight

Last updated
The Pharmaceutical Journal, PJ, January 2024, Vol 312, No 7981;312(7981)::DOI:10.1211/PJ.2024.1.218114

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