Fears patients’ lives at risk as pharmacists struggle to provide vital drugs

Patients have been forced to visit multiple chemists or return to their GP to be prescribed an alternative drug due to supply chain problems. A poll of 1,562 pharmacists found more than half – 54 percent – thought people’s health had been put at risk in the last six months. One pharmacist working in a GP practice told the journal he was “always firefighting”.

He said: “Presently hardly a week goes by without at least one pharmacy asking us to give an alternative.

“Such requests are often not easy to navigate and can sometimes be quite dangerous. It creates a lot of stress to both patients and professionals alike.”

A pharmacist working in a children’s hospital raised concerns about supply of nutritional products. She said: “We had to ration it, and this has potentially put patients at risk of vitamin deficiencies.”

Another flagged issued with medicines used in end-of-life care, saying: “There was no alternative for one patient who had to deal with an additional symptom in his last days of life due to lack of available treatment.”

A fifth of those polled by The Pharmaceutical Journal did not think patients had been endangered and a quarter did not know.

Shortages of hormone replacement therapy products (HRT) used by women going through menopause sparked an outcry earlier this year.

Elizabeth Carr-Ellis, founder of the Pausitivity #KnowYourMenopause campaign, told the Daily Express last night: “It’s three years since I first talked about HRT shortages. In that time, I’ve paid for prescriptions that haven’t been filled, had to have my medication changed because it wasn’t in stock and generally just been worried every time I have to ask for more as I’m never sure if I’ll get it.

“Women contact me all the time to say they can’t get their HRT, adding huge stress onto a time that’s often already stressing them out.”

Following a backlash, ministers launched an HRT supply task force which has worked with manufacturers to improve access.

But since June, the Government has issued a number of other “medicine supply notifications” which highlight shortages.

These include: pain relief drugs used in childbirth; mouth ulcer medication; migraine treatment; an antihistamine; a drug used among prostate cancer and endomitosis patients; an antipsychotic drug used among bipolar disorder and schizophrenia patients; a type of inhaler and a certain brand of insulin.

Mike Dent, director of pharmacy funding at the Pharmaceutical Services Negotiating Committee (PSNC), said: “It is very worrying for anyone who cannot get their usual medicines when they need them.

“Community pharmacies are under immense pressure at the moment but they are working flat out trying to manage medicines supply issues – which are outside of their control – so that all patients’ needs can be met as quickly as possible.”

The PSNC said many pharmacies face “a critical situation trying to source medicines in [a] timely manner”.

Mr Dent added: “We are becoming increasingly concerned about medicine supply issues and the very serious impact this is having on both community pharmacy teams and their patients.

“Our own Pharmacy Pressures Survey confirmed the consequences of the issues pharmacy teams are now facing, with two-thirds of respondents telling us that medicines supply chain issues are now a daily occurrence, and 97 percent reporting that this led to frustration from patients.”

A spokesperson for the National Pharmacy Association said pharmacists were going to great lengths to source medicines but it was not always possible.

They said: “Delays are always inconvenient and frustrating, and they can also sometimes be a risk to the patient’s health.

“Pharmacists should be given greater flexibility to take decisions at the point of care to manage medical supplies.”

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The Pharmaceutical Journal also reported that last Wednesday ministers urged hospitals to “conserve stock” of an anti-clotting drug used to treat strokes.

Some pharmacists have expressed concerns about switching patients on certain medication to alternatives. Community pharmacists told the journal that shortages of the osteoporosis medicine alendronic acid were contributing to medication errors when alternatives were prescribed. The journal reported that talks have begun with pharmacy leaders and the Government about ways to ease the shortages.

A Department of Health and Social Care spokesperson said: “We take patient safety extremely seriously and we routinely share information about medicine supply issues directly with the NHS so they can put plans in place to reduce the risk of any shortage impacting patients, including offering alternative medication.

“We have well-established procedures to deal with medicine shortages and work closely with industry, the NHS and others to prevent shortages and resolve any issues as soon as possible.”

What drugs are affected?

If the Department of Health and Social Care decides there is a severe shortage of a product, a Serious Shortage Protocol (SSP) can be issued. This allows community pharmacists to offer an alternative drug without the patient having to return to their GP or another prescriber.

The protocols can also impose a limit on the quantity of a drug to be provided, as has been done for some HRT products which are subject to a three-month limit.

Drugs currently affected by active SSPs include:

● Combisal (Fluticasone 125microgram Salmeterol 25microgram): inhaler for treatment of asthma

● Paracetamol suppositories 120mg: usually prescribed for infants and children

● Atorvastatin (Lipitor): 10mg chewable tablets to treat high cholesterol

● Fluoxetine: 10mg tablets used to treat depression and other mental health conditions

● Oestrogel Pump-Pack 0.06% gel: a hormone replacement therapy product used by postmenopausal women.

When women need the medication, they can access it

Sally Potter, a 55-year-old hypnotherapist from Ivybridge, in South Devon, first encountered shortages of her HRT prescription in April this year, writes Helen Bennicke. She has been taking a hormone replacement gel called Oestrogel to combat symptoms of menopause for 18 months now.

She said: “In April 2022, I requested my prescription as I usually do through the NHS App and it was not available. In the end, my GP described oestrogen patches rather than a gel. I was a bit dubious about this because I had previously tried to take oestrogen tablets and it really didn’t suit me.

“I accepted the patches and I tried them but they didn’t particularly suit me, either, and I didn’t like them. Luckily, two weeks later the Oestrogel came back into our area and I’ve been able to get it prescribed since then. The last time I went to collect it, recently, the pharmacist told me I’d fallen on a lucky day for the medication, as they’d just had a delivery. If I’d arrived the next day, I wouldn’t have been so lucky as they couldn’t get hold of it – it’s a bit hit and miss, really.

“It’s not ideal for me to be chopping and changing medication and the uncertainty about the availability of the prescription can make you feel anxious about it – and I have been worried about it. Jokingly my husband Steve, who is sat next to me, said he was more worried about it – he knows what I’m like when I’ve not got it.

“Without it, I am not sleeping properly, I get brain fog, hot flushes and irrational behaviour as well as aching joints. These are all symptoms that make life difficult for me.

“I work as a hypnotherapist so you have to be on the ball with your clients and I like to be able to do the best for my clients and I need to be functioning as normal and having slept well.

“The HRT is not the only thing that’s helped, lifestyle changes have helped too in regards to menopause. In the line with what the government has said recently about pushing plans going forward to improve things for women it is a fundamental part of that – that when women need the medication, they can access it.

And she added it was important that GPs are “educated too and prescribe properly.”