The struggle around medicines shortages

Edition

November 2024

Medicines shortages can be distressing for all involved, including patients, the public and pharmacy teams. In this article we look at the extent of the problem, and at what pharmacy teams can do to help.

The impact of medicines shortages on pharmacy teams
Medicines shortages statistics
Patient experiences
The standards and guidance
How to deal with medicines shortages
Other related challenges
Useful resources

The impact of medicines shortages on pharmacy teams

Medicines shortages can be distressing for all involved, including patients, the public and pharmacy teams. There are thought to be many reasons for the shortages, including complex global supply chain issues and span across the globe.

We recognise that pharmacy teams are spending large amounts of time tracking down medicines that their patients need, which can put additional pressure on the team and can be frustrating. Delays can also be particularly worrying for patients and their carers, who cannot access the medicines that they need.

All medicines shortages have the potential to raise concerns for patient safety. In this article we will be highlighting some of the experiences patients have had with medicines shortages, how to minimise the impact of medicines shortages on patients, and how to meet our regulatory standards in these situations.

Medicines shortages statistics

Notifications of impending shortages have doubled in three years, rising from 648 in 2020 to 1,634 in 2023

1 in 4 people have experienced shortages when trying to get medicine, with older people over 65 experiencing problems more frequently

Information from Healthwatch and the Nuffield Trust shows that there are now over double the number of notifications by drugs companies warning of impending shortages than there were three years ago: in 2023 there were 1,634 such alerts issued, compared to 648 in 2020.

Almost one in four, 24%, have experienced shortages when trying to get medicine, and 42% have experienced problems getting medicine. A greater proportion of older people have experienced shortages than younger people. Three in ten (30%) of those over 65 said they had a problem getting medicine in the last year because of shortages, compared to 15% of people aged 18-to-24.

Patient experiences

More frequently, we are hearing from patients who are unable to source the medicines they need. One patient told us:

“It’s a constant stress at the moment that I may not be able to obtain my HRT medication. Without which, among other symptoms, I experience severe cognitive issues which mean I cannot drive, work or self-advocate – or chase around trying to find out where supplies are available. However, I recognise that supply issues are outside of the individual pharmacies’ control”.

We have also had people share their difficulties accessing their GLP-1 receptor agonists (GLP-1 RAs) for type 2 diabetes or their hormone replacement medicines, causing them anxiety and worry.

We have also heard from patients who feel they have not been supplied their medicines because the medicines have already been allocated to other patients or querying why they couldn’t be supplied with another brand or strength of the medicine instead. Some patients have told us they’ve been left confused when they have received a different medicine or brand of medicine to what they were expecting because they were not made aware of any change.

Several of the GPhC patient voice forum members shared their challenges with obtaining medicines due to ongoing shortages. They were required to visit multiple pharmacies to obtain their prescribed medicines and felt that the onus had been put on them to locate and source medicines, which could be challenging for more vulnerable patients and especially in more rural areas.

The standards and guidance

We know that pharmacy professionals are having to use their professional judgment and make decisions in challenging situations, balancing a range of factors such as individual patient needs and available supplies of medicines.

In these circumstances, pharmacy professionals must continue to meet our regulatory standards, which they are personally accountable for meeting, and should be able to justify the decisions they make.

Our standards require pharmacy professionals to deliver patient-centred care, which includes making the care of the patient their first concern and using their professional judgement at all times to make clinical and professional decisions.

In addition, our standards require pharmacy professionals to communicate effectively as this is essential to the delivery of person-centred care and to working in partnership with others. This includes asking questions and listening carefully to the responses, to understand the person’s needs and come to a shared decision about the care they provide.

Our Equality guidance for pharmacies states that there is a growing urgency, both in society as a whole and within pharmacy, to tackle all forms of inequality. The environment in a pharmacy should protect the safety and welfare of both your team and patients. This includes making sure that no one is unlawfully discriminated against, either in your workplace or when you provide services.

Medicines shortages may have a greater impact on people who share protected characteristics and therefore it is important to consider how medicines shortages might affect the people and population you serve. For example, recent ADHD medicines shortages had a greater impact on ADHD patients’ mental health. People with ADHD have a 30% higher risk of suicide.

We expect pharmacy professionals to consider our standards, their legal duties and any relevant national policy and guidance when making decisions.

How to deal with medicines shortages

The Human Medicines Regulations (HMR) 2012 as amended, requires that the sale or supply of a prescription-only medicine (POM) can only be in accordance with a prescription given by an appropriate practitioner. Therefore, community pharmacists are legally obliged to contact prescribers or refer people back to prescribers to amend original prescriptions.

The above regulations include a set of exemptions such as supplies made through Emergency Supply, under Patient Group Direction and under current Serious Shortage Protocols (SSPs).

If the pharmacy is unable to supply a particular medicine stated on a prescription, then they should talk to the patient to discuss their options. These can include:

calling the manufacturer(s) or checking their website for updates on when the medicine will be available
using a SSP to substitute the patient’s prescribed medicine for the active SSP
offering to contact the patient’s prescriber to jointly consider whether another suitable brand or medicine is available
checking whether the medicine is available at another local pharmacy

It is important to communicate openly with the patient in these situations and to make sure they are involved in the decision-making process so that they can make an informed choice.

Other related challenges

We are aware of the ongoing financial pressures that pharmacy owners, organisations and professionals may be facing. We also know that in some cases, the cost of dispensing some medications against NHS prescriptions exceeds the amount reimbursed. While we don’t have a direct role in negotiating funding or renumeration of medicines, we do understand that the current financial situation can be challenging.

Despite this, patients and the public have a right to expect safe and effective care. Behaviours of pharmacy professionals in their day-to-day work make the most significant contributions to the quality of care received by patients.

We have recently received concerns about pharmacy professionals refusing to dispense patient medication against NHS prescriptions because the cost of these exceeds the amount renumerated. We understand that this is a breach of the NHS contract.

In line with our Standards for Pharmacy Professionals we expect registrants to provide person-centred care, ensuring that it is not compromised. They must consider the impact of their practice when choosing not to provide treatment or care. Pharmacy professionals must use their professional judgement. This means that they make the care of their patient their first concern and act in their best interests. They should ensure they manage any personal and professional interests professionally and appropriately and not prioritise financial interests and incentives over their patient.

Pharmacy professionals must behave in a professional manner, be trustworthy and act with honesty and integrity.
The GPhC may need to take appropriate fitness to practise action against pharmacy professionals who compromise patient care in preference for financial motivation. We expect pharmacy owners and superintendents to provide adequate support to their pharmacy teams and empower them to make professional decisions that support the needs of their patients.

Where the cost of a medication is causing concern, pharmacy owners and professionals may wish to address this. This should be done professionally and appropriately avoiding any impact to their patient. This may be through:

discussion with the patient’s GP or regular prescriber
raising concerns through a professional body such as the Royal Pharmaceutical Society
escalating this to your Local Pharmaceutical Committee
reporting this to your representative body. This will be Community Pharmacy England, Community Pharmacy Scotland or Community Pharmacy Wales, depending on your location