It’s one of the most formidable challenges the health sector encounters every day.

Community Pharmacy England (CPE) highlights it as the most severe pressure confronting community pharmacies, while the British Generic Manufacturers Association (BGMA) has also been highlighting the danger of shortages.

The situation has worsened to such an extent that medicine shortages now appear regularly in the media. Shortages in medications vital for conditions such as ADHD, epilepsy and diabetes reveal a fundamental breakdown in everyday supply.

The financial toll of these shortages affects both pharmacy and the NHS. The community sector feels the economic impact of shortages even more keenly because as private businesses they absorb the customer service problem that shortages create and they are hit by price increases.

Current pricing and reimbursement structures create significant uncertainties when supply costs and reimbursement amounts sway dramatically. The resultant financial imbalance forces pharmacies to dispense at a loss or to not dispense the medication at all, compounding the health crisis.

The government's stance attempts to address these issues through price concessions, but this approach introduces its own set of uncertainties and challenges, potential pricing swings and operational decisions without certainty of reimbursement.

The situation is particularly acute for category M products. Take Primidone 250mg tablets, whose drug tariff price has changed monthly since July 2019 when the product was reclassified from cat A to cat M.

Recognising that medicine shortage incidents are likely to persist, if not worsen, I think it becomes essential to rethink policy frameworks.

In community pharmacy, any changes to quantities, strength or formulation, can legally only be done by the prescriber.

One potential solution lies in affording community pharmacy greater latitude in altering prescriptions - a practice that could save immense amounts of NHS funds and ease the mounting pressure on pharmacy resources.

A change to medicines legislation is needed to enable pharmacists to speed up access to medicines. This would allow pharmacists to make minor adjustments to prescriptions to help alleviate some of the issues for patients and reduce burdens on primary care – with the added benefit of reducing the workload of GPs.

Pharmacists in hospital, and in community pharmacies in Scotland, already routinely alter prescriptions for the benefit of patients.

This imbalance must be addressed.

The prescription substitution strategy offers a dual advantage of financial resilience and operational efficiency.

While the implementation of such a scheme is not without its complexities, the potential benefits outweigh the challenges. By bridging the gap that currently causes pharmacies to operate at the brink of financial viability and by offering a lifeline to the stretched resources of the NHS, policy adjustments could redefine the response to medicine shortages.

Debra Ainge is the chief executive and co-founder of iEthico