Manufacturers, wholesalers and community pharmacy all signed up to measures to ease stock shortages at a summit in March, but AAH managing director Mark James warns it might not be all that simple

From the numerous recent conversations I have had, there is a tangible sense of expectation that the March summit hosted by the English health secretary Andy Burnham will imminently produce a solution to the problem of drug shortages.

I welcome Mr Burnham’s involvement, albeit a bit late in the day, and we have seen welcome progress: there is a shared recognition of the seriousness of the problem and there is less finger pointing, which has resulted in more constructive conversations about how to tackle the problem.

But I am often asked how confident I am that the summit working group will come up with a workable solution that could be implemented quickly.

The answer is that I am optimistic the group will be able to identify useful steps that all parties concerned could take to ease the situation. But given the potential implications for both manufacturers and pharmacists, I am much more cautious about whether the group will be able to propose a big bang solution that can be implemented almost overnight.

For example, those involved in the summit and the subsequent working  group – the ABPI, health departments, BAPW, PSNC and others – are discussing a proposal to produce a definitive list of products in short supply. In theory nobody should export those products as they are required for UK patients, and various professional and legal penalties have been suggested in order to make that enforceable.

But what is the definition of a product in short supply? Is it when a pharmacist has to spend an inordinate amount of time phoning emergency supply numbers to fulfil a prescription? Or does it apply when wholesalers see customer demand exceed supply from manufacturers? The criteria you use to decide which products are in short supply is critical and is not an easy question to answer. Yet it needs to be bullet proof if you intend to prosecute someone for exporting that line against the national interest and expect to get a conviction.

There are also the practical implications of products coming on the list and dropping off. We could see quotas being switched on and off, product by product, month by month. The impact of that on stock management will be, shall we say, interesting. For pharmacists and potentially the DH there could also be a significant price tag attached to a solution to end drug shortages. The health minister has described exporting from the UK medicines that are in short supply as immoral, unacceptable and unprofessional. But if you accept that is the case – and I know many people do – then it follows that importing medicines from other EU countries, where there are shortages, is equally immoral, unacceptable and unprofessional.

We could end up with the government prosecuting UK pharmacists for exporting while at the same time financially incentivising the same pharmacists to buy medicines imported from other EU countries.

If ever we do see such court cases I will be fascinated to hear the government’s lawyers explain how exporting Zyprexa from the UK is worthy of criminal sanction, yet importing Zyprexa is a good thing because PIs save the NHS tens of millions of pounds each year.

We know a solution has to be found but to arrive at one we need to be realistic about the potential challenges it may pose for both manufacturers and pharmacists.

What will the solution look like and how long will it take the summit working group to draft some proposals? I do not know, but I think it will be a lot longer and more difficult than many people currently expect.

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Your views

“I would have liked to see some improvement in the situation by now but it’s worse than ever. I think the summit helped make the ministers feel better but it hasn’t had any impact on the ground. I can’t see a solution being found without involving the EU – this is a Europe-wide issue so we can’t look at the UK in isolation.” Mike Hewitson, Beaminster Pharmacy, Dorset
“I still talk to pharmacists who are having problems obtaining stock and I can’t see any quick fix for this. It has to be sorted out, but a lot of the things that came out of the summit were quite soft.” Mark Stone, Devon LPC pharmacist