Pharmacy teams have been shorter on time over the last couple of months than ever before, battling through a tide of demand for medicines during the COVID-19 pandemic. Shortages of these medicines only add to the daily stress.

Shortages of HRT drugs have been rife throughout the UK for some time. In 2019, HRT items caused the most shortages frustration for pharmacy professionals. A new survey from C+D pre-dating the outbreak of COVID-19 dives into the long-standing severity of the problem.

The reasons why shortages happen are complex and wide-ranging: from an unexpected increase in demand, to problems with patch adhesive. To better understand how they affect the pharmacy workload, C+D surveyed 537 community pharmacy professionals based in the UK about their experiences handling HRT shortages. The responses pre-date the onset of the COVID-19 lockdown, underlining how deep the crisis ran before the extra stresses on the supply chain from the virus outbreak.

The community pharmacy professionals who responded to C+D’s survey – which ran from February 24 to March 23 – reported shortages in every listed category over the previous six months. The number of respondents who experienced shortages of brands ranged from five with AndroFeme (making up 1% of respondents) to 365 (68% of respondents) with Evorel.

Shortages across all brands

The brands that most respondents to C+D’s survey experienced shortages of between October 2019 and March 2020 were Evorel (68%) FemSeven (54%) and Elleste (52%).

Brands where fewer than 1% of respondents reported shortages over the time period were Oestrogel, Utrogestan, Tridestra, Novofem, Trisequens, Mirena, Ovestin, Livial, Gyneva, AndroFeme, Duavive and Estring.

See below for manufacturer responses.

It feels like HRT shortages have been part of pharmacy life for years. But only half of respondents (51%) said they began to affect their working lives between March and September 2019. However, one fifth (18%) said HRT shortages hit their workload between March 2018 and March 2019.

Almost all pharmacy professionals surveyed (99%) reported problems sourcing HRT over the previous six months. This marked a significant increase from a C+D survey in September last year, when 84% of 402 respondents said they had struggled to source HRT over the previous six months.

Time wasting

HRT shortages inflict stress on pharmacy teams. Many respondents to the survey noted the demoralising frustration at sometimes having to spend hours calling GPs to ask them for an alternative treatment, often fruitlessly. 

“A large amount of time is wasted sourcing HRT and explaining the availability to patients,” one respondent said. “The lack of information on availability also largely inconveniences the team as we have to answer to the patients, who are already unhappy. It often results in complaints [on an issue] that the team has no control over.”

Another respondent said HRT shortages add “so much more unnecessary pressure – we have to keep apologising for something that is not our fault and some people just do not understand”.

One said they felt they were in a “never-ending situation” with “continuous phone calls to GP surgeries” when trying to track down the medicine.

Another said: “Staff members are having to act as gatekeepers and deal with understandably stressed and disgruntled customers – there doesn't seem to be a lot of information for us to share and this is negatively impacting the team's relationships with customers.”

These shortages impact patients' trust in pharmacies. Many respondents noted how patients were angry at not being able to get their medicines, with some customers incensed to the point of abusing pharmacy staff. “Some patients get abusive even when we bend over backwards to help them,” one respondent said. “We’ve been verbally abused by a few customers and told we are ‘rubbish’”, said another.

Despairing patients  

Some patients lash out at pharmacy staff because they are concerned about the effect on their health of not taking their HRT medication, with some in “despair”. Numerous respondents noted how upset their patients had become due to the shortages – with some pushed to extremes.

“They get anxious and panicking about the situation. Patients are even trying abroad and online to get supplies,” said one respondent.

Another said: “Some patients have been very distressed and have gone abroad for [supplies]. Many have been very selfish and have obtained prescriptions for very large amounts and have stockpiled.” One respondent reported that some of their patients had visited A&E to try to access HRT stocks.

“They are stressed, disappointed, anxious, angry,” said one respondent. “Some patients are heavily reliant on these HRT products [so their absence] may cause mood swings,” said another.

COVID-19 has placed unprecedented pressure on the medicines supply chain. Respondents to another C+D survey – which received 745 responses from April 1 to May 11 – said medicine shortages was the biggest factor affecting their business for 77% of respondents since the virus hit.

Although other issues related to COVID-19 have drowned out the HRT conversation in pharmacy, it remains a problem for the sector. Around the beginning of the virus outbreak in the UK on March 18, the HRT clamour reached the House of Lords. Lord James Bethell, the Conservative parliamentary under-secretary of state for the Department of Health and Social Care, admitted there were “ongoing supply issues” with HRT, which had been a “persistent problem for more than a year”.

Lord Bethell also claimed that the supply of HRT had not been affected by the COVID-19 outbreak. This point of view was not disputed by British Generics Manufacturers Association director general Warwick Smith, who told C+D he had not heard of any further deterioration of HRT supply during the pandemic. 

However, an update from the British Menopause Society, published on May 4, says that some HRT medicines will continue to have stock issues until the second half of 2020.

Although the supply chain has begun to recover following the onslaught of demand in March following the COVID-19 outbreak, HRT shortages remain a reality that pharmacy teams and patients must contend with.