Medicine shortages are a longstanding problem in pharmacy - and it’s an issue that’s only been exacerbated by the COVID-19 pandemic. Paracetamol had some of the worst shortages following the outbreak, with contractors resorting to purchasing larger packs before splitting them to distribute the tablets in smaller quantities. The paracetamol shortages were accompanied by an increase in wholesaler prices due to the increased demand.
Ajay Berry, owner of Severn Pharmacy in Oadby, Leicestershire, says that after paracetamol prices shot up, he was left with no choice but to charge slightly more for the tablets. But in doing so, he found himself accused on social media of exploiting patients during the pandemic. There was “a lot of nastiness”, he says.
“I just said: ‘Let it be.’ I’ve been here for 25 years, people trust me. We have a reputation for being honest and fair.”
A rise in abusive behaviour from patients towards pharmacy teams across the UK during the pandemic has been widely reported. Mr Berry says the incident he encountered is something that’s never happened before, but that pharmacy teams are feeling the brunt of patients’ frustrations on shortages.
The finger of blame is pointed at them because they are on the frontline of medicine supply, rather than the wholesalers or manufacturers who decide the prices, he says.
Mr Berry understands that his patients are struggling, worried about stock and prescriptions not being fulfilled and unsure whether they should be isolating. “We’re managing, but it is affecting patients a lot,” he says.
In March, the Severn Pharmacy team had to manage what felt like “three Christmases together”, Mr Berry says. They handled a 20% increase in demand for prescriptions and triple the usual amount of phone calls, he says. “The phone is ringing all the time and somebody has to answer it,” he says.
He’s also received an increase in demand for items like toothpaste, which patients wouldn’t usually buy in the pharmacy, due to difficulty finding them elsewhere, he says. “Although the profit has been better, the amount of people coming in has been overwhelming.”
Time-consuming deliveries service
As is the case for many pharmacies around the country, Mr Berry says the demand for medicines has been accompanied by an increase in demand for deliveries. The government and NHS England’s solution – the community pharmacy pandemic delivery service – was announced on April 10.
The service requires pharmacies to help patients in the shielded group receive their prescriptions. Pharmacists must identify who these patients are by checking summary care records, before seeing whether they have someone else, like a relative or friend, who can collect their medicines. If they don’t, then the pharmacy must provide advice on how to access volunteers, and only deliver themselves as a last resort. Mr Berry says this process is “really long-winded and time-consuming”.
When asked what extra support he’d like to see from the government and the Pharmaceutical Services Negotiating Committee, Mr Berry says faster action on medicine prices is needed. After purchasing sertraline 100mg tablets at £14.99 a pack throughout April without knowing if he would be reimbursed, the medicine finally appeared on the price concessions list for the month – but at £14.07 a pack.
“The government always takes such a long time to do things,” he says. In the meantime, contractors remain “massively affected by prices” – waiting in blind hope for the “lottery” of price concessions.
“A different world”
Satyan Kotecha, an executive member of Leicestershire and Rutland local pharmaceutical committee (LPC), says that pharmacies in Mr Berry’s region are operating in “a very different world” than before the COVID-19 outbreak.
The LPC organised for the local fire service to carry out occasional controlled drugs deliveries, Mr Kotecha says, which has “gone down really well”.
“It’s something that’s available as and when needed. Having something that’s robust [to deliver controlled drugs] means people aren’t having to make it up as they go along,” he says.
“When you are really busy and doing a palliative care script, the last thing you want to be doing is thinking about how you are going to get the delivery organised.”
“When we had the initial lockdown, there was a huge surge in prescriptions, which was, in most senses, unmanageable,” he continues. GPs went into overdrive, with some issuing three months worth of prescriptions at a time, he says.
To remedy this, another action taken by the LPC was to encourage GPs to only prescribe a 28-day supply of medicine, Mr Kotecha says.
“We managed to get all clinical commissioning groups communicating very robustly to prescribers to not prescribe more than 28 days at a time, unless that’s what they already did.”
There have been no pharmacy closures in the area yet, Mr Kotecha says, but a significant number of pharmacies have had to reduce their hours. The NHS England COVID-19 standard operating procedure for community pharmacy allows contractors to close to the public for up to two and a half hours a day, to help alleviate workload pressures.
Mr Kotecha says the reduced hours have led to a lot of complaints from GPs, but these have been “batted back” by the LPC, with the explanation that pharmacies are allowed to do this. “It is difficult because if a pharmacy’s doors are closed, patients may potentially revert to the GP,” he says.
“Everybody says we should have business continuity plans in place, but this is not a fire, or flood, or flu,” he says. “COVID-19 is very different. If a single member of the team is infected or has symptoms, you have to start thinking about the entire team, and you can’t mitigate against that.”