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Revealed: How are HRT shortages impacting pharmacists across the UK?

Pharmacists described frustration, stress and hours wasted sourcing alternatives

As shortages of hormone replacement therapy (HRT) products continue, C+D spoke to pharmacists from each UK country to understand the toll they are taking

For months HRT shortages appeared to be a problem visible only to pharmacists and their patients, but finally they are starting to garner mainstream attention.

The issue is now so bad that it made national headlines this month, while the British Menopause Society announced yesterday it will be meeting with the government “as a matter of urgency to discuss how we can resolve the issue”.

C+D has previously reported on the sheer range of HRT products experiencing supply problems, and we now wanted to explore how pharmacies across the UK are coping. They told a story of hours spent trying to source alternatives and frustration at a lack of information.

Northern Ireland

Eoghan O’Brien, owner of the C+D Award-winning Bannside Pharmacy in Portglenone, says the shortages are adding a “lot of extra time”. “First we have to check with a few different wholesalers to see who’s got what, then go back to the GP.”

With so many products in short supply, even sourcing an alternative for a patient is a major headache. “Elleste Solo went short first, so we had to get Zumenon. Then Zumenon went short, so we had to get Progynova.”

The issue is getting worse, he believes, and the problem is heightened for patients who prefer a specific brand. “We’ve had a couple of patients who’ve got upset with that,” he says.

However, in general patients have been understanding “if you explain it to [them] and come across as being helpful”.

England

Rifat Asghar-Hussain, superintendent pharmacist of Evergreen Pharmacy and Green Cross Pharmacy in Birmingham, says dealing with the shortages is “really frustrating”.

She echoes Mr O’Brien’s issues with finding alternatives. “We are referring patients back to the surgery,” she says. “But unfortunately we aren’t able to give alternatives, because the alternatives are out of stock as well.”

While she cites Evorel Conti as particularly difficult to obtain, “it seems to be quite a few products” at once, which is “really bizarre”.

Patients have “reacted well” to the shortages, all things considered, she adds.

Scotland

Jonathan Burton, co-owner of the 27-strong Right Medicine Pharmacy chain, spends most of his time as a pharmacist at their branch on the University of Sterling’s campus. Its location means the team “don’t have an awful lot of patients on HRT”. However, a cohort of transgender students use oestrogen HRT off-licence as part of their gender reassignment programmes.

Mr Burton has experienced some issues with shortages over the past two months, “although it does seem to be easing up a little bit now”. Initially he only struggled to obtain Elleste Solo, but the issues soon spread to Elleste Duet, Estraderm MX patches and, most recently, Zumenon.

“With tablet formulations, we’ve always been able to find a solution, whether it’s been the direct equivalent or working with the patient’s GP to find an alternative HRT product,” Mr Burton says, before adding: “It’s been more complicated with patches.”

His pharmacy staff have been diligently communicating the situation to patients. “When we get an HRT script that we ascertain we can’t get the exact product [for], we have a sit-down consultation with them.

“Most of the patients are now actually aware of this, because of the coverage in the news. So they’re almost turning up with a prescription expecting to have some sort of issue.”

There is now “more guidance out there on HRT”, which “genuinely helps”, says Mr Burton. But difficulties obtaining concrete answers about availability from manufacturers is “a little strange”.

Wales

For Kate Thomas, superintendent pharmacist at the C+D Award-winning Sylvia Williams Chemist in Cowbridge, the HRT shortages have been a constant since last year and are causing “a lot of stress”.

As well as the time spent trying to source these products for patients, “we don’t get any real answers as to why they’re [dis]appearing”.

“Most” HRT items are in short supply, says Ms Thomas. But these are just one category of medicines that she is struggling to obtain – alongside diabetes drugs and EpiPens – and “all the shortages are getting worse”.

Frustrated patients are “taking it out on the pharmacists”, she adds. “We spend hours trying to get the medicines that are available, then hours going back and forth with the doctors.

“There’s no clarity on how long these shortages will last,” says Ms Thomas, adding: “I think the situation is only going to get worse.”

You can find a recent list of HRT shortages – and when they are expected to be resolved – on the Pharmaceutical Services Negotiating Committee website

15 Comments
Question: 
Are you experiencing shortages of any HRT products?

Ebers Papyrus, Pharmaceutical Adviser

It's quite simple, with branded drugs, a manufacturer sends medicine to a wholesaler. The wholesaler then distributes to the pharmacy network. If a wholesaler has exhausted all stock it should be mandatory for them to issue a notice to all pharmacies. The notice should state (a) Stock is zero; (b) When stock is expected.in

The notice should be sent as an order response file. This doesn't happen consistently and Alliance in particular will not on occasion even send a response as out of stock. Pharmacies have to wait until the order arrives to see if they've managed to send it. We need visibility to assist the patients and GPs and to improve our efficiency. The manufacturer also has a responsibility to inform the market of an issue. Mylan have failed repeatedly in this area recently. If they can't get product to market then front up and inform the market!

I would submit that they don’t much know how to inform the market. These are mysteries to get on the case of (business opportunities in plain speak), how might blockchain solutions potentially evolve is one question worth incubating. UK healthcare doesn’t appear to be having broad discussions in relation to these points. 

N O, Pharmaceutical Adviser

Very well said.

Unfortunately, only in UK, the Govt. and its care takers are so much hand in glove (many are even non executive directors I believe) with these companies that they don't care.

Would it be unreasonable to suggest and ask our large scale wholesalers to open a communications channel directly with the public, say via twitter, Facebook and the like, where they give the public details on what medicines are in stock like we’re able to access on AAH point/Alliance Heathcare direct? I have a mind to think there would need to be some well thought out policies around what info to share and it’d broadly fall under the label of communications management so I don’t know how fast competence could be expected, but I feel it’d be a welcomed evolution once it takes root (if). 

Farmer Cyst, Community pharmacist

My missus is going through the change and it's really upsetting to see her in this state :-(

Lucky Ex-Locum, Superintendent Pharmacist

You have my sympathy. It's difficult enough without a personal involvement.

N O, Pharmaceutical Adviser

At the moment, if you are a MALE Pharmacist (irrespective of your age) and have full stock of all HRT products, then you are like Elvis Presley -- all the women want to come to you :-))

Lucky Ex-Locum, Superintendent Pharmacist

What, fat and dead?? I reckon you could come up with a better one than that. If my co-workers are anything to go by, David Gandey is what floats the menopausal boat nowadays.

Paul Knapton, Community pharmacist

I'm not sure that kind of comment is really appropriate, and as a gay man I actually find it a little distasteful - which I'm sure was not the true intent.

Lucky Ex-Locum, Superintendent Pharmacist

Why? 

Ranjeev Patel, Non Pharmacist Branch Manager

*This comment has been deleted for breaching C+D's community principles*

N O, Pharmaceutical Adviser

In other news -- """MHRA Alert: Hormone replacement therapy (HRT) and increased risk of breast cancer"""

Reeyah H, Community pharmacist

I was amused by that too!! Old news repeated just at the right time. 

Leon The Apothecary, Student

Stock shortages are a little bit part of the course when it comes to daily running on pharmacy, which I think a lot of patients don't realise and don't experience. It's such the sheer quality of medications unavailable from a specific category that's causing the troubles.

Of course, there are some easy targets that will get blamed for the shortages and it would be disingenuous of me to echo them without knowing for certain.

Lucky Ex-Locum, Superintendent Pharmacist

In response to the question - yes of course I am!!!

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