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RPS to Boris Johnson: Brexit no-deal strategy must include flu season

Sandra Gidley was one of 17 representatives to sign a letter to Boris Johnson on August 21
Sandra Gidley was one of 17 representatives to sign a letter to Boris Johnson on August 21

The RPS has joined 16 other health organisations in writing to the Prime Minister warning of the consequences of a no-deal Brexit and calling for provision for the flu season.

Despite ongoing engagement with the Department of Health and Social Care (DH), 17 healthcare organisations – including the Royal Pharmaceutical Society (RPS) and Royal College of General Practitioners – have “significant concerns about shortages of medical supplies” should the UK exit the EU without a deal on October 31.

There is also a “very real possibility” that deliveries of “life-saving medication and devices” will be delayed from entering the UK, the organisations said in a joint letter sent to Boris Johnson yesterday (August 21).

“We are simply unable to reassure patients that their health and care won’t be negatively impacted by the UK’s exit from the EU,” they warned. “Even the smallest of problems could have huge consequences for the lives and wellbeing of millions of people.”

Brexit clash with flu season

The issues are further compounded by the fact that the UK is due to leave the EU on October 31, just as the flu season begins, they warned.

“Even a moderate flu season places significant additional pressure on the NHS,” they stressed.

The organisations called on Mr Johnson to include health secretary Matt Hancock in the government’s ‘exiting the EU committee’ – a group of MPs tasked with “examining the expenditure, administration and policy” of the UK’s exit from the EU.

There are currently no members of the DH on the committee. But the 17 healthcare organisations argue that: “The implications of a no-deal exit from the EU for the NHS and wider health and care system must be considered at the highest levels of government decision making.”

For example, the EU exit strategy “must include provision for different flu scenarios” and Mr Hancock is well placed to coordinate that, they said.

DH responds

The DH told C+D that Mr Hancock is regularly invited to attend the EU exit committee’s meetings and NHS England and Public Health England are working closely with all suppliers of the flu vaccines to maintain overall supply for patients ahead of winter.

“The government is doing everything appropriate to prepare to leave the EU on October 31, whatever the circumstance,” it said.

“Patients can be reassured that our plans should ensure the supply of medicines and medical products remains uninterrupted and they will continue to receive the excellent standard of care they currently do.”

Read the letter in full.

Have you had queries from patients concerned about the impact of Brexit on their medicines supply?

Leon The Apothecary, Student

Flu Season is going  to be a repeat of every other year. I have some predictions:

1) We'll have a delay in stock arriving, delaying the start of the flu jabs.

2) Tensions will increase between GP and Pharmacy as both rush to acquire patients.

3) Stock will become unavailable for weeks at a time.

4) Adrenaline will go out of stock (Jokes, already is)

5) Pharmacy will do significantly well in vaccinating patients. 

Susan M Shepherd, Community pharmacist

It is not the companies stopping trading it is the physical difficulty in getting the stock into the UK. In a No Deal scenario the nymber of lorries coming in via the channel crossings is likely to drop by up tp 90% initially as people get used to the new paperwork and checks involved. So even if you have got yours right, the lorry is likely to be in a long queue waiting to get in. The govt predicts that it will take 3 months for the movement of lorries to be up to 70% of current levels. This is also during the busiest time of year. For regulatory purposes those lorries are "warehouses on wheels". The storage of the medicines, devices etc must be within the same range as for the bricks and mortar warehouses. Any new route, eg air freight, must be validated, temperature mapped etc. It was bad enough when we were having  Brexit with a 2 year transition to plan and carry out all this, but a crash out in November gives very little time to recruit + train the necessary staff and then do the work. Plus you are trying to build up extra stock at the same time as demand is increasing in mainland europe and around the world.

Lucky Ex-Locum, Superintendent Pharmacist

You obviously didn't hear the radio interview with the Port of Calais operator the other day who said it'll be business as usual and they are fully prepared. There is far too much doom-mongering about Brexit. We have far more important things to worry about.

C A, Community pharmacist

How high a level was the operator? At low levels they may not be aware of the planning and logistics required.

It's a bit like me saying my pharmacy is ready for Brexit, business will continue as normal, I have stock on my shelves and am good to go. 

The problems should be obvious - I'm ready for "Brexit Day" but what happens in the next weeks? What if the pharmacys deliveries are delayed, or people start to stockpile? Suddenly the shelves are bare, that patient in urgent need of medication can't be supplied, so they either do without, get stressed and complain, expecting the pharmacy to sort their problem (like the time most wasted chasing HRT? and who has the time or resources to do that hundreds of times?), or waste loads of time chasing round to get their medication. 

Lucky Ex-Locum, Superintendent Pharmacist

It was the OPERATOR, as in the man who operates the place, of the port of Calais, not one of the skivvies. I'd prefer to believe him than someone who has no idea how things will work.

Ranjeev Patel, Non Pharmacist Branch Manager

Why does the UK have to be a part of Europe to trade with them? We aren't part of Japan but we can trade with them just fine. It sounds like scaremongering rubbish to me.

C A, Community pharmacist

In case you aren't aware we currently trade with Japan as part of the Japanese-European free trade agreement. When we leave Europe we leave the trade agreement we have with Japan

Currently we are trying to form a new trade agreement with Japan - but the Japan-EU deal prevents Japan giving us more favourable terms that the EU deal, and "Japan is seeking tougher concessions from Britain", and Japanese trade negotiators are confident they can extract better terms due to the difficulties facing the UK. So the price of Japanese goods is likely to go up.

Lucky Ex-Locum, Superintendent Pharmacist

No problem there then. I don't have a smartphone and I don't drive a Nissan.

Charles Whitfield Bott, Pharmacist Director

Flu vacs are made in the UK AFAIK and will be delivered before 31/10/19, Brexit has nothing to do with it.

C A, Community pharmacist

The flu vaccine thing is a bit of a red herring - the real problem will likely be winter pressures - if the NHS supply lines are impacted people could end up clogging up hospitals, for various reasons, then you end up with the situation from a couple of years ago where people are stuck in the back of an ambulance because A+ E aren't coping, and people are waiting 9 hours to be seen in hospital, only to be stuck in a corner on a gurney because there are no beds. 

This also puts extra strain on primary care, as more people try to see their GP, which means getting an apointment becomes even more difficult, and in desperation people may turn to A+E making their problems worse. The end result is that patients suffer.

Lucky Ex-Locum, Superintendent Pharmacist

Strangely enough, the problems of a few years back were while we were part of the EU. Obviously they can't be blamed on Brexit so why would this winter be any different? I've been round the block several times in this sorry wreck of a profession and the same thing happens every few years regardless of who we happen to be trading with.

A B, Community pharmacist

I don't think they are referring solely to the supply of flu vaccines.

“Even a moderate flu season places significant additional pressure on the NHS,”

It seems to be referring to the Winter pressures the NHS faces which are made worse by possible flu outbreaks (which can occur whether people have been vaccinated or not). So even a small disruption to supplies of hospital medication and equipment is potentially worse at this time of year.

Hopefully it won't happen.

Lucky Ex-Locum, Superintendent Pharmacist

Remember the Swine flu mess from a few years back? If we get another one of those, it may be fun! Mind you, I could do with one because my stock of Tamiflu will be out of date soon.

A Long Serving Pharmacist, Community pharmacist

I cannot believe that European countries will simply stop trading with us after Brexit. They would be ‘cutting their nose to spite their face’. The drugs manufacturers must have put in place contingency plans for an interim trading agreement, and, if not, why not? They’ve had plenty of time. There are loads of drugs shortages at the moment and they are all being blamed on Brexit already, even the ones that have been out of stock, or even discontinued, years ago, and also including those made in the UK. This letter highlights an issue that should have started being discussed when Article 50 was triggered, but the ‘head-in-the-sand’ politicians and business community though they could ignore a democratic vote and it would just go away. 

C A, Community pharmacist

I feel you are grasping the wrong end of the stick, in a case of No-deal Brexit -

Businesses will still happily sell you goods, you will just pay tariffs, so things will be more expensive. Which is fine, because there is plenty of money in Community Pharmacy.

Also things will take longer to be delivered, as there will be additional paperwork required (think FMD, but for everything). Which again is fine, as there is plenty of time to do paperwork in Community Pharmacy.

You also need to factor errors into the new system, so if the company ship the goods without the right paperwork it will just sit in a customs office somewhere until the paperwork is fixed. Which is fine, because none of Community Pharmacy's work is time sensitive.

Then the goods need to be stored in the right way during the delays, which is fine because none of Community Pharmacy's goods are temperature sensitive.

Of course the companies selling you the goods will also have to deal with the additional administrative costs, so they will pass that expense on to you too. Again not a problem as cash flow is fine in Community Pharmacy, and the DH will instantly recognise the increased costs and amend the DT to compensate.

Finally the businesses are under no obligation to sell you anything, so if they think any of these factors are more trouble than they are worth, or if they think they can make the same money elsewhere more easily,  they are free to do so.

Lucky Ex-Locum, Superintendent Pharmacist

What you have to remember is we have the moneypit called the NHS. Every Tom Dick and Francois is going to want a part of that.

Lucky Ex-Locum, Superintendent Pharmacist

Well said. There is so much negativity about Brexit. Project Fear is still very much alive and kicking. As you say, Europe has just as much to lose, if not more, than we do.

Leon The Apothecary, Student

No-one wins.

Lucky Ex-Locum, Superintendent Pharmacist

Or alternatively, everyone wins.

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