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‘Medicines supply to pharmacies was severely flexed during COVID-19’

“Every stage must be functioning efficiently for patients to receive their medicines”

The medicines supply chain has remained afloat in spite of COVID-19 thanks to the collaboration between wholesalers and pharmacy teams, says HDA executive director Martin Sawer

As the COVID-19 pandemic has swept the world, the vital roles of certain sectors that have for a long time been under-appreciated have been thrown into sharp relief. A good example of this is pharmacy.

Having long been a pillar of local communities, pharmacies and pharmacy teams sit at the heart of a well-functioning healthcare system. Yet this sector is often taken for granted, especially by those in government – it is underfunded and not given enough recognition.

Suddenly, pharmacy and the associated medicines supply are in the spotlight as key players in the frontline fight against COVID-19. It was therefore vital for those working with community pharmacy to rise to the challenge of providing support during the pandemic.

Understandably, many people are unaware of the number of medicines partners supporting pharmacy. These include the manufacturers of active pharmaceutical ingredients around the globe, the freight providers moving medicines, the vast warehouses containing pre-wholesale products and the network of smaller wholesale depots across all four UK countries. The medicines supply chain before a pack reaches a community pharmacy is long. 

But all that matters to patients is whether the pharmacist is able to hand over their medicines when they need them. This task became immeasurably harder in March and April this year due to the COVID-19 outbreak. The rapid and unpredicted increase in demand for drugs dramatically impacted each complex moving component further up the chain.

The challenges

Take the healthcare distributors that the Healthcare Distribution Alliance (HDA) represents. In many ways, they faced a similar challenge to supermarkets. Although patients can’t panic-buy prescription medicines, the increase in prescriptions and number of days they were written for meant an unpredicted, massive volume of medicines had to arrive at pharmacies very quickly. 

One HDA member’s warehouse reported distributing one week’s worth of Ventolin inhalers in one day in March, for example. Make no mistake, the government was worried and offered military support – the existing system was severely flexed, but critically, did not fall over.

This is a tribute to a terrific team effort: from pharmacists ordering accurately and on time, to the pre-wholesalers moving vast quantities of medicines, while pharmaceutical manufacturers reacted quickly to changing market dynamics. To accommodate this, HDA members committed millions of pounds to purchasing huge quantities of medicines at very short notice.

The level of detail that has been addressed to ensure the continuity of UK medicines supply has been simply astounding. It is a reminder of just how complex and interdependent the supply chain is.  Every stage must function efficiently for patients to receive their medicines. When every stage is being severely challenged as a result of COVID-19 then the potential for a breakdown is very high.

Thankfully, we have not so far experienced any significant breakdown in the overall continuity of supply – with wholesalers and pharmacies closely collaborating. This is not only at the day-to-day wholesaler to pharmacy level, but also at the more macro policy level.

The HDA is aligning with the Pharmaceutical Services Negotiating Committee (PSNC) and National Pharmacy Association (NPA), among others, to identify and mitigate potential risk factors. The HDA has also been working very closely with the Department of Health and Social Care (DH), NHS England & Improvement, Public Health England (PHE) and the Medicines and Healthcare products Regulatory Agency (MHRA) to have issues formally addressed by government guidance or by the short-term easing of certain less critical regulations.

One in five workers absent

Like pharmacy, wholesalers have faced many new challenges in the day-to-day operation of their businesses during the pandemic. Due to strong personal commitment, staff absences at the latter were thankfully lower than many expected. Nonetheless, normal ways of working had to be flexed or redesigned – especially in late March when absences hit the 20% mark. 

Many office staff members have been redeployed to increase capacity in service centres, while extra hours and shifts are being added across our members’ businesses. For example, one company moved to working 24-hour-days seven days a week to serve hospitals in London and south east England.   

Following sustained lobbying we were grateful that the government has classified pharmaceutical wholesalers as key workers, allowing our sector’s staff members all the valid recognition and flexibilities this continues to bring.  This has meant more team members can be on the warehouse floor to get pharmacy orders packed and out for delivery.

Like many other sectors, agency staff have had to be taken on to fill gaps left by absences.  Given the technical skills required to safely and securely distribute medicines to the letter of complex regulations, agency staff have required training in a very short space of time.

In many ways, medicines distribution is the hidden player in the supply chain.  The delivery service provided by HDA members often goes unseen. Across all our member companies, there are numerous examples of individuals working selflessly and tirelessly to ensure medicines are delivered safely and on time. 

It has been a time of unprecedented challenge, and as with other supply chains, of course not everything has been perfect. However, in the most part the efforts of our member companies, manufacturers and pharmacy teams have underpinned our joint obligation to ensure patients receive their medicines.

In an unprecedented time like this we are all in it together, and we need to continue working collaboratively in the coming weeks and months. Let’s really applaud the efforts of everybody involved in the medicines supply chain, recognise the challenges we all have and work constructively to solve them.

In the meantime, I am signing off with a comment from a colleague working for an HDA member company: “Let us never forget what we do and the difference it makes – this is brought into sharp focus at times of crisis.”

Martin Sawer is executive director of Healthcare Distribution Association, which represents the UK's largest medicine wholesalers.

11 Comments

Ebers Papyrus, Pharmaceutical Adviser

The wholesale market with respect to ethicals is too monopolised. Competition authority should reflect on the steady reduction in rebate, service offering and surcharge additions. 

Lucky Ex-Locum, Superintendent Pharmacist

'flexed' - that's an interesting term. I can think of another word beginning with 'f'' and ending in 'ed' that sums up pharmacy today.

Leon The Apothecary, Student

I am in total agreement with you there. Our supply chains are strained as it is at the moment and the government seem keen to push the country into Brexit with drained reserves and insecure future supply chains, with no explanation or evidence to suggest the opposite.

Kevin Western, Community pharmacist

"Every stage must function efficiently for patients to receive their medicines. "

How can this be true when your members are creating artificial shortages and quotas to boost their profits in a time of utter crisis?
How does it help "efficiency" when we have to wait to see if something which has been accepted on our order is going to arrive then work our way through a torturous begging system, set up with minimal resources because they know we have to use it.
One wholesaler, when asked if we could have our quota raised, replied, no, THE WHOLE QUOTA TEAM have been furloughed!!!!
How is that supposed to help Pharmacy? What does it say about your member's true attitude to us?
Stop being hypocritical - at least be honest about your motives and methods.

Leon The Apothecary, Student

The thing that bugs me is that "efficient" supply has a major weakness. It is not resistant. This is evidential from the last few months of Covid-19.

Lucky Ex-Locum, Superintendent Pharmacist

Trouble is, the margins are so small for the wholesalers that they can't afford to keep the massive amounts of stock needed, in exactly the same way as we can't. The entire industry is dependent on a reliable flow in and out and covid is the dam that has buggered up that flow and left us like the proverbial fish out of water, flapping around and gasping for breath.

N O, Pharmaceutical Adviser

Do you think 8% +++ without any clawbacks and no NCSO , a less margin? Plus add the margins from their Pharmacies, they do make a hell of a lot of margin than what you think.

Lucky Ex-Locum, Superintendent Pharmacist

Fair enough.....point taken!

Kevin Western, Community pharmacist

I think you will find the margins are excellent for large wholesalers generally, its screwing the last penny out that keeps stocks low. 

Lucky Ex-Locum, Superintendent Pharmacist

Thing is though, it isn't the wholesalers responsible for the stock shortages - they WANT to sell us their stock (generally speaking although I refer you to my comment below!). Its the manufacturers not supplying that is the issue.

One thing that is scandalous though is that GP dispensaries get better terms than pharmacies, hence why so many of them operate wholesale businesses on the side.

Lucky Ex-Locum, Superintendent Pharmacist

The one I can never understand is when the wholesaler says 'no right to buy'. What's that all about??

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