There seems to be a health reset under way with the new Labour government.
In opposition, shadow health secretary Wes Streeting’s media-facing communications made him seem determined to be the patient’s champion, far ahead of showing willingness to understand provider interests.
In office, Streeting and health minister Karin Smyth have negotiated a relatively prompt deal on the longstanding pay dispute with junior doctors (although it is yet to be put to a vote of the relevant British Medical Association members) and, overall, have adopted a far more emollient tone with primary care.
The pharmacy sector has yet to make much noise about its need of immediate political attention, but it may well not be too far off, particularly given the ongoing problems of medicines accessibility. We touched on this topic previously in January 2024 and it certainly hasn’t gone away.
The non-availability of pancreatic enzyme replacement therapy drugs Nutrirzym (pancreatin; Zentiva) until this August and Creon (lipase, amylase, protease; Mylan) until 2026 has been the latest issue to hit national media headlines, but all readers will be well aware that the problem is not unique to these products.
Results from The Pharmaceutical Journal’s survey of more than 1,200 UK pharmacists, published in July 2024, showed that medicines shortages are putting patients in “distressing situations”, with 68% of respondents warning that shortages have put patients at risk “in the past six months”. This is a 14 percentage point increase on The Pharmaceutical Journal’s 2022 survey, to which 54% of pharmacists answered ‘Yes’ to the same question.
Medicines shortages risk driving failure demand back in to an already-stressed primary care sector
Pharmacists responding to the 2024 survey highlighted particularly concerning shortages of ADHD medicines, antiepileptics and medicine to treat diabetes, including insulin and glucagon-like peptide-1 receptor agonists (GLP-1 RAs). ADHD medicines have been in short supply persistently since 2022 owing to increased global demand and manufacturing issues.
As well as being an evident stressor for patients and for community pharmacists, this issue risks driving failure demand back in to an already-stressed primary care sector. Patients unable to get sufficient (or indeed, any) supplies of their medications may feel that they have to resort to grey market purchases of medicines through the internet, whose safety is evidently uncertain.
Ensuring these medicines are appropriately prescribed in the first place is another challenge shared across the pharmacy profession, particularly through structured medication reviews (SMRs).
A feature by David Lipanovic, published in July 2024 in The Pharmaceutical Journal, looked at the current state of play here. NHS England’s ending of financial incentives for primary care networks (PCNs) to carry out SMRs in April 2023 has meant that pharmacists have been told to deprioritise SMRs.
Lipanovic’s analysis cites a PCN pharmacist, who suggests that this deprioritisation was a deliberate policy: “There was very much a conversation of ‘we’re not being incentivised to prioritise SMRs, so pharmacists can be tasked with doing transfer of care and discharges’”.
SMRs were first introduced in October 2020 with priority given to high-risk patients. However, the loss of the associated payment, combined with GP workforce shortages, mean that GP pharmacists are now having to take on more duties in practices, leaving management of these kinds of chronic and complex medicines to take a lower priority.
One problem explored in the feature is the lack of a single authoritative source of data on the total number of SMRs conducted. The numbers don’t add up: NHS England data on appointments in general practice (an experimental dataset that comes from the appointments system) show a significant increase, while those from Network Contract Directed Enhanced Service data — which come from clinical codes within the patient record in the GP system — show a big fall. This suggests a greater intention to provide SMRs but a decline in the number actually being carried out.
Polypharmacy is not an imaginary problem. According to an observational study of 1,187 hospital admissions conducted in England, published by the British Medical Journal in June 2022, adverse drug reactions (ADRs) accounted for 16.5% of total admissions, 40.4% of which were classified as ‘avoidable’ or ‘possibly avoidable’. Those with an ADR were on average taking more medicines than those without an ADR (10.5 vs 7.8; P<0.01).
The researchers concluded that ADR admissions projected an annual cost of £2.21bn to the NHS in England and advised that “reducing inappropriate polypharmacy should be a major aim for preventing ADRs”.
That is quite a bit of money. It’s at least the start of an interesting conversation with financial planners. The Royal Pharmaceutical Society has thrown its weight behind enabling pharmacists in PCNs to prioritise SMRs, but the argument is — as ever — likely to come down to money. Good luck making it.
Andy Cowper is the editor of Health Policy Insight
