In a searing opening statement to the sub-committee for the Ireland/Northern Ireland protocol last week (January 18), Healthcare Distribution Association (HDA) executive director Martin Sawer said that supplying medicines to Northern Ireland was becoming costly and bureaucratic for wholesalers.

“Distributing medicines into Northern Ireland is challenging, problematic, inefficient, and a sort of slow strangulation by 1,000 cuts if you like,” he stated.

Although drug supply to the country “is still OK…most of [the HDA’s] concerns are about the future” and the “uncertainty” it holds, he continued.

Read more: Northern Ireland drug supply crisis: £5.3m support package not enough

Mr Sawer gave testimony along with other pharmaceutical industry representatives and compiled evidence from HDA members – who distribute mostly prescription medicines across the UK – on how the Northern Ireland protocol is affecting supply to the country.

 

Supply “uneconomic”

 

Speaking to C+D before his House of Lords Committee session, Mr Sawer said the protocol “brings in complicated regulatory differences, which…could lead eventually to a divergence in the sort of medicines that people in Northern Ireland have access to”.

This is because the regulations “will make it uneconomic [for wholesalers] to distribute some of the medicines” to the country “in due course”, he said.  

Mr Sawer told C+D that HDA members “supply Northern Ireland like they supply England, Wales and Scotland”.

But he described Northern Ireland as “a bit of a small market” for UK wholesalers, as its population “is only 1.8 million”, equivalent to that of “the West Midlands”.  

 

“Slow build-up” of costs

 

The HDA has not seen “a huge disparity yet” in terms of the medicines supplied to Northern Ireland compared to the rest of the UK, he added, but this is because “regulations have been amended as we've been going along to make it legally possible to supply” medicines to the country.

There has been “a slow build-up” of “manually operated workarounds” to supply medicines to Northern Ireland since the introduction of the protocol, Mr Sawer said.

But this “might make the efficient and speedy distribution of medicines more difficult [and] may make the cost of distribution more expensive in Northern Ireland, which it already is a bit”, he continued.

Read more: Peer calls on UK government to curb ‘developing crisis’ for NI pharmacies

“You could have disparity in what medicines are accessible for patients in Northern Ireland because it costs too much to distribute,” Mr Sawer stated.

Speaking to the committee, Mr Sawer described regulatory changes as “sticking plasters”.

“The tectonic plates between Great Britain and Northern Ireland are slowly moving apart and all the regulations have been stuck on top like sticking plasters,” he said.

 

Added checks and manual work

 

New regulatory approaches and the falsified medicines directive – which still exists in Northern Ireland but has lapsed in the rest of the UK – “have created a much more manual approach to doing business for [wholesalers] in Belfast”, Mr Sawer told committee members.

He explained that trader support service (TSS) declarations – which wholesalers must complete for every consignment sent over the Irish Sea – add “about £2.5 million of extra cost in labour and IT and declarations per year at the moment”.   

Read more: Emergency review of community pharmacy services in Northern Ireland announced

That tallies up to “£5 million already” in the two years since Brexit, he said.

Wholesalers have had to recruit more workers to manage TSS declarations, as well as to receive smaller and more frequent deliveries in Belfast from manufacturers.

“We're employing more people in Belfast, the cost has gone up,” he continued.

 

Illegal medicines in the supply chain?

 

Mr Sawer also flagged that wholesalers might also be “unknowingly” supplying medicines that are not licensed for Northern Ireland because of differing EU and UK licensing requirements.  

The MHRA is “catching up” to this issue but wholesalers “don't know what to do when they're found in the supply chain”, he added.

He continued: “We're supposed to not supply them to patients. But what does a doctor or a pharmacist or hospital pharmacists do when they get one of those medicines in front of them?”

 

What’s the solution?

 

“The actual fundamental core of the problem is, in our view, the Northern Ireland protocol because of Brexit,” Mr Sawer told committee members.

“Medicines need to be available universally to all citizens of the UK equally and we believe the divergence will put that under threat,” he continued.

Speaking to C+D, Mr Sawer proposed taking “medicines out of the Northern Ireland [protocol] altogether in the interest of public health” and trying to get the EU and UK to “agree that UK medicines would continue as they always have done before Brexit and be valid in all four countries”.

Read more: Boots parent company forecasts up to £6m loss in post-Brexit Northern Ireland

Although this would be a “big move” involving “lot of big politics”, it “would make things a lot easier”, Mr Sawer said.

This “makes perfect sense to us as wholesale distributors,” he added.

C+D reported in October that drug shortages and “skyrocketing” wholesale prices have left contractors in Northern Ireland warning that they will no longer be able to pay for commonly prescribed drugs for conditions such as osteoporosis, mental health and coronary issues – unless the Department of Health steps in.

Read more: Brexit: NPA ‘encouraged’ by EU’s proposals on Northern Ireland medicines availability