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NPA renews call for shortages powers, as no-deal Brexit risk grows

Last night's parliamentary vote brought the likelihood of a no-deal Brexit closer
Last night's parliamentary vote brought the likelihood of a no-deal Brexit closer

Pharmacists must receive the emergency powers proposed by the government to tackle medicines shortages, the NPA has stressed, as the risk of a no-deal Brexit grows.

MPs rejected the Prime Minister’s proposed deal on Britain leaving the EU last night (January 15) by 230 votes. The default option if no new agreement is reached before March 29 is for the UK to leave the EU without a deal, although many MPs have stressed they will not allow this to happen.

Ahead of last night's vote, the National Pharmacy Association (NPA) told C+D that “major disruption to medicines supplies is something to be avoided at all costs”.

“What may seem like parliamentary games are in fact very serious matters for our members and their patients,” head of corporate affairs Gareth Jones said.

The Department of Health and Social Care (DH) has proposed a “serious shortages protocol” – due to go before parliament later this month – which would amend the Human Medicines Regulations 2012 to enable pharmacists to dispense an alternative medicine in accordance with the protocol, rather than the prescription, and without having to contact a GP.

The DH told C+D last month that the amendments “will come into force before March, regardless of the situation with Brexit”, and later said the proposals had been “prompted by the preparations for the UK’s exit from the EU”.

The NPA's Mr Jones said the shortages legislation is “something we and other pharmacy bodies lobbied for and is a sensible contingency”.

However, “more needs to be done” by the government, as pharmacies “should be able to share medicines with each other”.

“Brexit is bringing to a head a number of issues that should have been grappled with years ago. Medicines shortages have been a growing problem for months, so while Brexit appears to be exacerbating the situation, it is not the root cause,” Mr Jones said.

“By now it’s plain that there are structural faults in the medicines supply chain that too often leave patients waiting and pharmacists taking the rap for a situation beyond their control.”

CCA working with DH

The Company Chemists’ Association (CCA) – which represents the UK's largest multiples and supermarket pharmacies – told C+D: “Regardless of the outcome of the vote, the CCA’s priority remains the safe supply of medicines to patients.”

Chief executive Malcolm Harrison added that the organisation will continue working with the DH to deliver this.

ABPI: We need to be prepared for all eventualities

When asked about the impact of parliament rejecting Ms May's deal, Association of the British Pharmaceutical Industry (ABPI) president Erik Nordkamp said: “We need to be prepared for all eventualities in all scenarios.

“Within those scenarios, we've always communicated publicly that a no-deal [Brexit] should be avoided.”

PSNC: Brexit has delayed funding negotiations

The Pharmaceutical Services Negotiating Committee (PSNC) announced this morning (January 16) that funding negotiations for the 2019-20 contract have not yet started, because of the DH’s focus on Brexit.

“This is not an exclusive problem to pharmacy,” PSNC chief executive Simon Dukes said, “but we are concerned that this delay is now likely to continue”.

Commenting on last night’s Brexit vote, Mr Dukes said: “Maintaining the supply of medicines to patients and community pharmacies must be a priority, whatever the eventual approach to Brexit.

“Given the ongoing uncertainty, this work is now more critical than ever and PSNC will be deploying all necessary resources to it,” he added.

What do you make of the parliamentary vote result?

C A, Community pharmacist

What are the deadlines for the PSNC negotiations if they haven't started?

T Jenns, Community pharmacist

I cannot see how substitution will work with eps, unless there is to be a major IT change, as eps only pays for what it on the script. We can endorse what we like but it won't make any difference. The script will still need to go back to the gp.

Paul Dishman, Pharmaceutical Adviser

I have one relative who voted Leave and is now worried about not being able to obtain Desmopressin, Hydrocortisone and Levothyroxine. I am biting my tongue.

Beta Blocker, Primary care pharmacist

The leave vote was a vote of self harm!

N O, Pharmaceutical Adviser

It is 16-01-2019 and yet there is no news about NCSO so far. Prices of more than 100 lines have shot the roof, any idea anyone???

Lucky Ex-Boots Slave, Primary care pharmacist

NHS simply don't want to fund community pharmacies anymore. They just expect you to suck it all up! 

Adam Hall, Community pharmacist

If granted, I will accept and exercise the new powers, and accept the associated responsibilities, on one condition - that we are paid accordingly by the government. Otherwise, I'll stick to the status quo and refer patients back to those oh so overworked & underpaid GPs

C A, Community pharmacist

Underpaid GPs, now that is a funny comment!

Lucky Ex-Boots Slave, Primary care pharmacist

I won't even worry about getting 'paid' for doing that, because we will never do. Everyone just expect everything to be free while being accurate, fast and efficient. Do we even get paid for buying softwares and hardwares to comply with FMD? No for sure!

Benie Locum, Locum pharmacist

Most community pharmacists feed into this. They don't value themselves. I still know of people offering free deliveries to entice prescriptions. Hilarious!! 

Lucky Ex-Boots Slave, Primary care pharmacist

There will soon hardly be anything to stack on shelves. And people will be rioting about medicine shortages if it does end up being no deal Brexit. My condolences on the front line pharmacy staff who will be taking the wrath of people blaming the pharmacist why isn't there any medication. Should probably employ more security staff to stop people from breaking in to rob the meds! 

Watto 59, Community pharmacist

It is my understanding that imports will not be affected by brexit (deal or no deal).  Exports may be more problematic but that is not relevant to uk domestic stock holding.  Medicine shortages should not be attributed to brexit, it is more scare mongering by parties with vested interests.



Lucky Ex-Boots Slave, Primary care pharmacist

How are imports not being affected while the Dover port will be cramped with thousands of lorries stuck for clearance? Do you really put your trust in the helicopters and ferries transport that Matt Hancock promised? Please enlighten me how will it be practical and realistic about your claims that 'imports will not be affected' in a no-deal scenario

Watto 59, Community pharmacist

What comes into the country is a matter for HM customs and associated agencies.  HM Gov presumably has no problem in the quality of goods meeting EU standards coming in from Europe and this position to my knowledge has been confirmed by the UK authorities .  Why would we (i.e British Customs) wish to delay access to such goods coming in on 29th March and beyond compared with  similar imports  brought in before the 29th March ?  Exports are a  different matter and that is where there may be some difficulties as EU authorities may impose additional regulations on UK produce leaving the country. 

C A, Community pharmacist

Watto 59 - 

As best I can tell when importing from the EU after a no-deal brexit the medications will need to pass through customs, and any import duties will need to be paid on them prior to this. This currently doesn't happen as we have free trade with Europe.

Without free trade it will then need to be determined if the medicine is part of Pharmaceutical Tariff Elimination Agreement, which was last updated in 2010, so it is a bit out of date! AstraZeneca have stated that active pharmaceutical ingredients and intermediates could still face duties of between 4 and 6.5 per cent. Delays in obtaining the required ingredients or intermediates could lead to delays in the manufacture of the final medicine. (Creon anyone?)

Also in passing through customs the medication potentially needs to be inspected, to confirm that what is coming in matches the commercial invoice, a step that currently doesn't happen.

If there is no deal, the medications leaving Europe will need to be decommissioned in line with FMD as the UK will be a “third country”, again a step that doesn't currently happen. Hell FMD isn't even a thing yet!

While the HMRC are in the process of hiring an extra 3000 staff to handle these and other tasks, how many of them will be trained and ready for the 29/3/19? How many of them will find that pharmacy like workload is unpalatable and quit? How many of the current workforce will find a massive increase in workload unpalatable and go off sick with stress, or quit?

I don't think anyone knows, and if a delay happens at any of those points or any paperwork is incorrect then you have a problem!

Leon The Apothecary, Student


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