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We must stop starting conversations with ‘I’m really sorry, but…’

Pharmacy teams do all they can to make sure they have a steady supply of vital medicines. But patients aren’t getting the memo, says Ade Williams

If, like me, you are running a community pharmacy, you will probably recognise the increasing frequency with which you have to start customer conversations with “I’m really sorry, but we don’t have that medicine in stock”.

Medicine shortages are the worst thing for our profession’s public image – resulting in what feels like an all-time high in public dissatisfaction and a spike in violence and aggression towards pharmacy staff.

Read more: Wholesalers: Media 'horror stories' cause 'self-fulfilling’ shortages

This is incredibly frustrating and, for some in our industry, demoralising, because many of us are excited about the prospect of expanding the role of community pharmacies, where we’ll have even more involvement in patient care. Sadly though, right now our relationship with patients is being damaged, because supply underpins the trust they have in us. Getting supply right is a gateway to offering more of our expertise.

GPs, patients and pharmacies have taken it for granted that medicines will be available, but the reality today is that, often, we simply do not know what medicines are available from one day to the next.

The market-driven approach to medicine supply in this country may be feeding into the issue. But when you’re at the coal-face every day, it’s clear to see that’s irrelevant for patients, who assume it’s the pharmacy that has failed to source the medicines they need. How often do you hear the questions: “What is it you don’t have this time?” “Why are you not getting this medicine for me?” “Why did you have it yesterday for someone else?”

Read more: ‘Four-figure loss’: Pharmacy contractors rage at atorvastatin crisis

I completely understand patients’ frustration and why they are unsympathetic to the time we take to try and resolve these issues. In their eyes, pharmacies are not delivering what patients need when they need it, which creates worrying cascading effects.

From experience, we can all cite examples of patients making decisions about their medicines in light of shortages. They should not be in a position where they are rationing their medication. I have also seen examples of patients telling others in their community about shortages and sharing medicines with them – for example hormone replacement therapy (HRT) and diabetes drugs.

Read more:‘Out of stock’: Prices ‘sky high’ as cold and flu meds shortages persist

I can completely understand the desire to help one another, but this obviously creates patient safety issues. More importantly, it also underlines health disparities; a patient’s care is diminished when a medicine is not available and it can increase the patient’s level of inequity. On the other hand, if you are in the right social network, you will likely be OK. This supply issue contradicts the fundamental principle of universal access, and we should not be asking patients to solve it.

This may seem like a dramatic statement, but now medicine shortages are the new norm, it does beg the question: is the current pharmacy model fit for purpose?

There are indications that the supply chain is broken, and it has not moved with the times. It would be easy to point the finger at Brexit or demand changes to manufacturing processes, but the bottom line is that the current situation is unsustainable.

Read more: Pharmacy time spent sourcing medicines more than doubles to 11 hours a week

We must accept we are going to be in this situation for the foreseeable future, so investment in the underlying resources to support community pharmacies is required now. We cannot expect community pharmacy to once again bear the burden of doing what is right unaided. We must empower them with the right information, tools and skills.

Some of the key priorities are:

Resource and financial support

A key part of the solution, I believe, is acknowledging the supply role of the community pharmacy is of great value and requires investment. Only then can we can address the additional workload pharmacies are expending on resolving shortages.

Read more: ‘Frustrating’: DH 'imposed' atorvastatin 20mg and 80mg concessions, says CPE

The way community pharmacies are funded should be re-evaluated, as almost all community pharmacists are reimbursed based on the supply of medicines, which means they are very reliant on the process working. Given the amount of time we are spending on looking for medicines and the potential for lost revenue that comes with it, continuing with the current reimbursement structure will potentially lead to further community pharmacy closures.

Access to Information

We require more data and information sharing. Today, we are reliant on getting updates from our wholesalers’ websites, but I find the information is often vague. It is critical that we receive more specific information about when medicines will be supplied and what alternatives exist when there are shortages. Equally, though, this could have a knock-on effect because switching to an alternative product can create further shortages.

Read more: ‘There’s no escape from it’: How stress is pushing contractors to the limit

Additionally, there is a cost issue, because shortages push up the price of medicines due to demand. There is a danger that we could feed stockpiling habits among pharmacies. We’re not there yet, but we must do more to build trust between pharmacies and the pharmaceutical provider by developing collaborative solutions to this global supply chain problem.

Get this right, and we will enable pharmacies and patients to make decisions from a position of knowledge and confidence.

Legislation

We need to remove the legislative bottlenecks to allow community pharmacies make simple medication switches. To achieve this, we must develop more dynamic and intuitive frameworks for addressing medicine supply issue and we should set clear parameters to decide the different steps pharmacies should follow in case of a shortage. We should give community pharmacies more agency to solve problems and give them more opportunities to propose innovative evidence-based solutions, similar to what happened during the COVID-19 pandemic.

New skills

Pharmacists also need help to develop new skills, as dealing with anxious patients requires effective communication and customer service approaches. It will be essential to help pharmacies navigate the process of finding medicines using the latest technologies and analytical tools. What technical skills should we be developing to manage disruptive stock supply?

The future that you deserve is the one that you help to create, and we, as community pharmacists, need to help develop a medicines supply chain that is fit for purpose. The supply issue is in my view the fault line that will potentially bring everything down. It is the existential disruption of the bricks-and-mortar model.

Read more: Hours spent hunting downs meds as supply issues persist, PDA survey reveals

If we do not resolve this issue, how can we prove our ability to respond to more clinically complicated patient concerns? Consequently, it will become difficult to convince the public and policymakers that community pharmacies can fulfil an expanded role in clinical services. Why would you ask us to do more if we cannot address the basics of supply?

If we’re not careful, we’ll be defined by our problems and not by the solutions we propose. For community pharmacy, the most adaptive and innovative part of the NHS, this must not be the case.

Ade Williams is superintendent pharmacist at MJ Williams Pharmacy and non-exec director Southern Health NHS Foundation Trust

 

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