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Pharmacists unconvinced SSPs are helping address HRT crisis

Pharmacists are not positive about whether recently introduced serious shortage protocols (SSPs) are helping to address the current hormone replacement therapy (HRT) shortages, they have told C+D. 

The HRT crisis has reached new levels, with health secretary Sajid Javid meeting with pharmacists and key suppliers including Aspen Pharmacare, Besins-Healthcare, Gedeon Richter, and Pfizer last week (May 5) to increase HRT supply to meet inflated demand.

Prior to that meeting, the government granted pharmacists the power to limit the supply of HRT products Oestrogel, Ovestin cream and Premique Low Dose to three months, regardless of the prescription, without needing to seek authorisation from the prescriber.

These three SSPs are due to expire on July 29, but some pharmacists are unsure whether these protocols alone will help solve the crisis.


Issues with stock


Davinder Singh Virdee, owner of Pillbox Chemists, said that while the SSPs “kick in automatically… [they are] actually pointless if you can’t get the products in the first place”.


While SSPs have only been introduced for Oestrogel, Ovestin cream and Premique Low Dose, Mr Virdee told C+D that his branches are also struggling to get hold of Sandrena sachets and Estradot patches, too.


“In many branches, we have patients waiting for these and it’s very difficult,” he said.


“I thought we might be able to redistribute drugs between our pharmacies but when I try to order online, they’re out of stock everywhere,” Mr Virdee added.

Shabbir Damani, pharmacist and owner of Halls The Chemist, Peterborough, wondered whether the SSPs would have been introduced were it not for the increased media focus on access to HRT products.

Speaking with C+D last week (May 6), Mr Damani said that his pharmacy was particularly struggling to get hold of Oestrogel.

Reflecting on the SSPs, he said: “As much as you can be told to just give three months' [supply] according to SSPs, if you can’t even get one month’s worth, then the SSPs don’t work.

“We need to be grateful everyone is trying to find a solution, but we need a solution that gets an end result,” Mr Damani added.

Hodgson Pharmacy owner Amish Patel echoed Mr Damani’s views. “I don’t think the SSP is making any significant difference just yet,” he said.

“The other day, I had so many prescriptions for which I couldn’t obtain stock. GPs need to prescribe in a generic form, and manufactures need to increase supply,” he added.


Are three-month scripts realistic?


Rifat Asghar-Hussain, superintendent pharmacist at the Evergreen Pharmacy in the Midlands, was also concerned about the availability of Oestrogel. 


Therefore, she welcomed the possibility of being able to redistribute the medicine more evenly to patients thanks to the introduction of the SSP. 


Nahim Khan, a portfolio pharmacist based in general practice and a community pharmacy in Warrington, Cheshire told C+D that women seem to prefer gel preparations of HRT products.


“Regarding the SSPs, it says you can't get more than three months’ supply. It's not that helpful because [we] can't get hold of the stuff. I've never seen a script for more than three months and, at the moment, I don't see a script for more than a month,” Mr Khan added.


“I'm not 100% sure how effective SSPs will be but I guess it's better [to give] women some, than one woman having lots of it,” he said.


Women travelling miles to source HRT products


Ms Asghar-Hussain told C+D that women from “other areas” are calling her pharmacy to ask if they have stock of a particular HRT medicine.

Women based as far as 35 miles away from Mr Damani’s pharmacy are also calling to check if they can help with their HRT prescription, he said.

Smita Patel, owner of Guildford Chemist in Surrey told C+D that her pharmacy is also receiving calls from women all over Guildford, while one made the trip to her pharmacy from London.

Sometimes women are so desperate for HRT that they take it out on pharmacists, Ms Patel said.

“The desperation can mean that some of them come in and be very demanding because they’re so upset that this is the sixth pharmacy they come to, and they can’t get hold of it,” she added.

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