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‘New normal’ of medicine shortages a ‘significant burden on pharmacists’

Constantly elevated medicines shortages have cost NHS England (NHSE) £220 million more than usual in a year and created “a great deal of extra work” for pharmacists, a new report has found.

“The UK risks being left in the cold” when it comes to tackling a “new normal of frequent disruption to crucial products”, a new report by the Nuffield Trust and funded by the Health Foundation has warned.

Published today (April 18), the report said that “all available indicators suggest that serious problems securing medicines…continued or worsened through the remainder of 2022 and throughout 2023”.

“This has placed a significant burden on” and created “a great deal of extra work for” pharmacists, the think tank added.

Read more: RPS launches new project to tackle medicines shortages

The Nuffield Trust revealed that from mid-2016, the number of price concessions offered to pharmacists to secure scarce drugs spiked.

It said that numbers peaked with 199 simultaneous concessions in late 2022 and have remained “highly elevated ever since”.

The think tank said that while a “precise calculation [was] not possible”, a “highly cautious” analysis of prescription data between October 2022 and September 2023 found “total excess costs for medicines in the months when they were on the concessions list…came to £220 million”.

Read more: One slight alteration could avert a crisis as medicine shortages deepen

This meant that increased medicines prices “cost £220m more in one year than the same products would have at their previous costs”, it added.

The report also found that Brexit “contributed to difficulties” in the global drugs market “by lowering the value of sterling and removing the UK from EU supply chains”.

It warned that Brexit “will pose the additional risk of being left out of EU measures to respond” to shortages.

“Medicine authorisations for products that the EU approves centrally are typically slower in Great Britain than they would be if it were still a member state”, it added.


“Paucity of data”


Meanwhile, the report found that the UK lacks data on medicine shortages – it said there was a “paucity of data for the UK” compared with EU countries.

It added that “those involved in community pharmacy” told the think tank that “they often experienced shortages of products not officially classed as experiencing supply issues”.

It suggested that the government “could survey community pharmacists or their representative groups to track their experience of shortages, as the Pharmaceutical Group of the European Union (PGEU) does at a basic level across the entire EU”.

Read more: Pharmacists altering prescriptions could ‘exacerbate’ shortages, says minister

“This should enable more monitoring of how well pharmacists understand reporting and response options, and what they see as the dynamics and drivers of problems,” it said.

“Better anticipation of medicine shortages, more openness about shortages” and “being careful that sudden squeezes on cost do not drive instability…would all be positive steps” the government could take, it added.

Read more: ‘No published assessment’ on pharmacist drug substitution, DH reveals

The report flagged that solutions for shortages in EU countries “range from generic substitution, to offering alternative dose sizes or mixtures”.

This comes as UK pharmacy bodies have argued that pharmacist substitution without a serious shortage protocol (SSP) would be “a successful way forward” for the profession and a way to focus on pharmacists’ “unique skills”.

But last month, C+D reported that the Department of Health and Social Care (DH) had produced “no published…assessment” on proposals to allow pharmacists to substitute an out-of-stock medicine without an SSP in place.


“A wake-up call”


Reacting to the report, Community Pharmacy England (CPE) chief executive Janet Morrison said that “medicine shortages and market instability are at the worst that pharmacies have ever seen”.

She added that the “report should serve as another wake-up call: [the] government and NHS need to step in and do more to protect community pharmacies and their patients from these ongoing issues” such as “giving more powers to pharmacists” to manage shortages.

Meanwhile, National Pharmacy Association (NPA) chief executive Paul Rees said that the “government needs to create the conditions for enough medicines to flow into and around the UK system”.

Read more: Guanfacine ADHD medication ‘out of stock’ until May

He added that “at the sharp end of this complicated problem, pharmacists…are spending hours a day hunting down stock yet too often have to turn patients away”.

Company Chemists’ Association (CCA) chief executive Malcolm Harrison stressed that the sector “urgently [needs] an end-to-end review of the medicines supply chain to ensure it is fit for purpose”.

And Royal Pharmaceutical Society (RPS) director James Davies urged the government “to help ease shortages by allowing all community pharmacists to make minor amendments to prescriptions”.

Read more: Negotiator slams government for imposing ‘untested’ concession changes

A DH spokesperson stressed that “concessionary prices can arise for various reasons and cannot be linked to shortages”.

“Our priority is to ensure patients continue to get the treatments they need [and] there are around 14,000 licensed medicines and the overwhelming majority are in good supply,” they said.

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