Any pharmacist can tell you that they are spending more time than ever trying to source the right medicines for their patients.
In the 18 months since the government’s new portal for manufacturers to report supply disruptions and discontinuations was set up in October 2020, a total of 1,700 shortages and 1,500 drug discontinuations were recorded. This is not the mark of a healthy supply chain.
In just the past few weeks, there have been shortages of chicken pox vaccine, along with certain types of insulin and inhalers, and these disruptions are getting more serious. On 3 August 2022, the government warned hospital trusts to conserve stock of some thrombolytic drugs, including alteplase, used for patients with acute ischaemic stroke “given the lack of an alternative and the significant risk of harm”.
The Pharmaceutical Journal reported earlier in August 2022 that shortages of the osteoporosis medicine alendronic acid are contributing to medication errors, and that problems with the supply of the antipsychotic aripiprazole are causing concern for patients with bipolar disorder and schizophrenia.
This is having an impact on care. The Pharmaceutical Journal’s annual salary and job satisfaction survey, carried out in July 2022, found that 847 out of 1,562 (54%) UK-based pharmacists working in all sectors of the profession answered ‘Yes’ when asked if medicines shortages have put patients at risk “in the past six months”.
Respondents to the survey recounted numerous examples where treatments had to be rationed, patients were at risk of missing doses or even, in one case, a patient at the end of their life who had to deal with an additional symptom owing to the lack of available treatment.
There is a massive opportunity cost here — think of what good could be done if pharmacy teams were not firefighting the whole time and GPs were not having to rewrite their prescriptions?
It is clear that the UK’s medicines supply system is not fit for purpose. Yes, the government does act when there are serious shortages — for example, by introducing protocols to give pharmacists limited freedom to supply alternatives — but this is the same as closing the gate after the horse has bolted.
Pharmacy organisations, such as the Royal Pharmaceutical Society, have been arguing that pharmacists require far more wide-ranging powers to make minor changes to any prescription if they need to, to mitigate the impact of shortages on patients, but this call has so far been ignored by ministers.
The root of the problem is that the NHS is competing for drugs in a global market, with the odds stacked against it. The trade barriers post-Brexit may be playing a role, say experts, but there are many other factors.
For instance, industry leaders have written about the problems of supplying the UK with generic medicines, which make up the vast majority of drugs prescribed in the NHS. The unstable pricing structures and lack of incentives for innovation in this sector are real problems that the government must address.
But perhaps we need to think even more radically. We call for ministers of all four UK nations to come together and carry out a major review of medicines supply in the UK.
This review should consider proposals for a root and branch overhaul of the medicines supply system, using the financial muscle of the NHS to shape the market, rather than constantly being buffeted by it.
Radical ideas could include investment to shorten supply chains, or even reshoring or nationalising the supply of essential medicines. We should be diversifying the sources of raw materials, so we are not dependent on just one or two countries, and reducing the reliance on “just-in-time” manufacturing processes. We should also be looking closely about how to ensure greater sustainability and reduce the environmental impact of the medicines we use.
It cannot be right that the health service, which is under severe pressure already, is spending so much of its energy on something as basic as medicines supply. Ministers must act now to shore up a failing system. PJ
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Reform of the generic medicines procurement and supply system is essential for patients, the NHS and the future of our profession. It won’t be easy as change is difficult for everyone.