24th June 2014
Medicines shortages are piling more pressure on an already stretched surgery workload, and resulting drug substitutions are delaying care and potential harming patients. Basic pharmaceuticals required every day in the NHS have become increasingly difficult to obtain, and GPs say the problems are getting worse. According to a report in the Telegraph earlier this month, one in three GPs say their patients have suffered as a result of shortages of common prescription drugs. A related poll has revealed that nine in 10 family doctors have been forced to write prescriptions for ‘second choice’ medicines in light of the stock issues. However, one GP quoted that “for some drugs, there is just no equivalent available and patients’ treatment is comprised.”
GP leaders called for doctors to receive regular updates about local shortages, with MPs demanding that the government take action to solve the problem. While only 18 generic and 20 branded products were listed by the Pharmaceutical Services Negotiating Committee as officially in short supply, one must first remember that though small on paper, these figures are having serious knock-on effects on patients. In an interview with pharmacy minister Earl Lowe, however, the government has made clear its rejection of ‘increased patient harm’; “don’t exaggerate the effects of shortages.” Lowe remarked that “while distress and worry are regrettable and should be avoided, if a pharmacy doesn’t have a particular medicine it will normally be there in a few hours. There are tried and tested processes for pharmacists to access medicines on an emergency basis direct from the manufacturer, and that is what usually happens if there is a delay in delivery. No one wants to see patients inconvenienced, but I think the definition of harm is one that we need to stick to.”
A 2012 inquiry by the MPs’ All-Party Pharmacy Group found shortages were mainly caused by the export of branded medicines intended for the UK to other EU countries. While Chairman Sir Kevin Barron MP said that the strengthening pound has eroded concern, manufacturer and wholesale quotas continue to restrict pharmacists’ access to certain medicines, leading to rationing in some cases. Recent high-profile cases include the continuing shortage of hypertension drug valsartan, and problems with the supply of Zostavax, now resolved. Dr Andrew Green, chairman of the GPC clinical and prescribing subcommittee, was less optimistic: Supply problems caused by parallel export had diminished only because of changing exchange rates, “not because anyone has done anything to address it.” Dr Green said GPs receive little in the way of supply information, quoting “if you’re a prescribing GP, the first you know about a shortage of a drug is when patients tell you.”
The Medical Defence Union warned GPs to alert NHS England area teams immediately if shortages threatened patient safety. A DH spokesperson said: “We are actively involved in a number of pieces of work to tackle these problems, both at a UK level and at a European and global level.” Warwick Smith, director general of the British Generic Manufacturers Association, disputed the comments made by Sir Kevin Barron and said supply services levels were returning to normal. Once again however, these issues have their roots in GP workload, and regardless of political or public stance, threaten the morale of general practice still further.