“Hi, it’s the pharmacist. We can’t get hold of Mrs Smith’s HRT, could you suggest an alternative?”
This used to be an occasional event that was generally straightforward to sort out. Maybe a brand name had changed, or a device was listed slightly differently on our computer systems.
But of late, drug shortages have been an absolute nightmare that take up a significant amount of GP time, with hormone replacement therapy (HRT) being the current worst culprit. Other recently unavailable drugs include nifedipine, adrenaline auto-injectors and methadone, with shortages affecting both branded and generic medicines.
So, why is this happening? It's easy to jump to the conclusion that it’s all about Brexit. Indeed, if we leave the EU without a deal and there are massive delays at Dover, then we may look back to now as a golden age when only some drugs were out of stock rather than most of them.
But there are other reasons, including shortages of raw ingredients and manufacturing issues. For example, when Bayer had a problem at their factory in Germany in May, it led to a six-week gap in the supply of Microgynon 30 tablets.
I have already written about plans to allow pharmacists to dispense alternatives without consulting the GP, which, if the indemnity and clinical responsibility is sorted, seem eminently sensible. However, this will only happen if a serious shortage protocol is activated by the government.
Other ways around the problem largely involve GPs trying to find an evidence-based way to replace the missing prescription with a similar one. This takes up a lot of our time and causes patient harm. Time spent doing this is time I can’t spend with a patient who needs to see me.
Community pharmacists can really help by suggesting an alternative medicine. Useful resources to aid with HRT shortages are on the websites of the British Menopause Society and MIMS. To access the latter, pharmacists will need a subscription.
I massively appreciate a phone call saying: “We can’t get hold of Mrs Smith’s HRT, but we do have (an alternative) in stock – which would be appropriate.” Or: “We can’t get immediate-release nifedipine, but the modified-release version is in stock.” Even though I'll take responsibility for prescribing the new script, it saves me loads of time, while using the pharmacist’s skills and training to their best effect.
The general trend in primary care is definitely for professionals in different areas to work together, rather than in silos. Medicines shortages are a dangerous nuisance, but perhaps an unforeseen benefit will be that GPs and pharmacists start talking to each other more than we have in the past.
Toni Hazell is a GP based in a practice in London