PJ’s perspective: It’s time to overhaul the UK’s drug supply system

Any pharmacist can tell you that they are spending more time than ever trying to find the right drugs for their patients.

In the 18 months since the launch in October 2020 of the government’s new portal for manufacturers to report supply shortages and interruptions, a total of 1,700 medicine shortages and 1,500 interruptions have been recorded. This is not the hallmark of a healthy supply chain.

In the past few weeks alone, there have been shortages of varicella vaccines, as well as certain types of insulin and inhalers, and these disruptions are getting worse. On August 3, 2022, the government warned hospital trusts to keep stocks of certain thrombolytic drugs, including alteplase, used for acute ischemic stroke patients “given the lack of alternative and the significant risk of harm”.

The Pharmaceutical Journal reported earlier in August 2022 that shortages of the osteoporosis drug alendronic acid are contributing to medication errors and that supply issues with the antipsychotic aripiprazole are of concern to patients with bipolar disorder and schizophrenia.

This has an impact on care. The Pharmaceutical Journal‘s annual salary and job satisfaction survey, carried out in July 2022, found that 847 out of 1,562 (54%) UK pharmacists working in all areas of the profession answered ‘yes’ when asked. asked whether drug shortages had put patients at risk. “during the last six months”.

Survey respondents reported many examples where treatments had to be rationed, patients risked missing doses or even, in one case, a patient at the end of life who had to deal with an additional symptom due to lack of available means. treatment.

There is a huge opportunity cost here – think what good could be done if pharmacy crews weren’t fighting fires all the time and GPs didn’t have to rewrite their prescriptions?

Yes, the government acts when there are severe shortages, but that is like closing the door after the horse has run away

It is clear that the UK drug supply system is not fit for purpose. Yes, the government acts when there are severe shortages – for example, introducing protocols to give pharmacists limited freedom to provide alternatives – but that amounts to closing the door after the horse has run away.

Pharmaceutical organisations, such as the Royal Pharmaceutical Society, argue that pharmacists need much greater powers to make minor changes to any order if they need toto mitigate the impact of shortages on patients, but that call has so far been ignored by ministers.

The root of the problem is that the NHS is competing for drugs in a global market, with the odds stacked against it. Post-Brexit trade barriers may play a role, experts say, but there are many other factors.

For example, industry leaders have written about the UK’s supply problems with generic drugs, which make up the vast majority of drugs prescribed in the NHS. The unstable price structures and the lack of incentives for innovation in this sector are real problems that the government must address.

But maybe we need to think even more radically. We are calling on Ministers from all four UK countries to come together and undertake a major review of the supply of medicines in the UK.

This review should examine proposals for a fundamental overhaul of the drug supply system, using the financial muscle of the NHS to shape the market, rather than being constantly buffeted by it.

Radical ideas could include investments to shorten supply chains, or even relocate or nationalize the supply of essential medicines. We should diversify the sources of raw materials, so as not to depend on just one or two countries, and reduce reliance on just-in-time manufacturing processes. We should also look closely at how to ensure greater sustainability and reduce the environmental impact of the medicines we use.

It is unacceptable that the health service, which is already under great pressure, should devote so much energy to something as fundamental as the supply of medicines. Ministers must act now to shore up a broken system. PJ

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The Pharmaceutical Journal is the official journal of pharmacy in the UK and we want to explore radical ideas on how the health sector and services can improve patient care. If you, or someone you know, would like to write for us about the issues raised in this article, or any other topic, contact our editors with a brief summary of your idea by emailing [email protected] journal.com

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