Government urged to review ‘broken’ drug supply chain amid shortages

The Government has been urged to carry out a review of the UK’s “broken” medicine supply chain after new research found the impact of Brexit has worsened the issue in recent years.

Experts described shortages of the likes of antibiotics and medication for epilepsy as a “shocking development” that is putting pressure on patients, GPs and pharmacists.

Pharmacy leaders also warned that they are unable to plan ahead to support patients due to a lack of communication with officials.

Research by think tank the Nuffield Trust and academics, which was funded by the Health Foundation, highlighted “underlying fragilities” in both the global and UK medicine supply chain.

It said while problems in the UK were not caused by Brexit, leaving the European Union (EU) has exacerbated them.

This is due to the fall in the value of sterling and the UK being removed from EU supply chains.

Mark Dayan, Brexit programme lead at the Nuffield Trust, said: “We know many of the problems are global and relate to fragile chains of imports from Asia, squeezed by Covid-19 shutdowns, inflation and global instability.

“Officials in the UK have put in place a much more sophisticated system to monitor and respond, and used extra payments to try to keep products flowing.

“But exiting the EU has left the UK with several additional problems – products no longer flow as smoothly across the borders with the EU, and in the long term our struggles to approve as many medicines might mean we have fewer alternatives available.”

There is also a risk of the UK being left out of EU measures to respond to shortages, such as bringing drug manufacturing back to Europe, the report warned.

Analysing freedom of information requests and public data on drug shortages, researchers found there is now more than double the number of notifications from drug companies warning of impending shortages.

Some 1,634 alerts were issued in 2023, up from 648 in 2020.

Researchers also pointed out that Britain has been slower to approve drugs than the EU.

Between 2022 and 2023, four drugs authorised by the European Commission (EC) had been approved faster in Britain. However, some 56 were approved after the EC and eight have not been approved at all as of March 2024.

However, the report also highlighted other unique issues for the UK market, including a change in demand to the medicines prescribed by doctors.

One example used was prescriptions for hormone replacement therapy (HRT) for menopausal women, which increased by 40% in 2021/22.

Researchers also found that UK policy and NHS decisions on medicine pricing and financing has added to the issue.

Mr Dayan added: “The rise in shortages of vital medicines from rare to commonplace has been a shocking development that few would have expected a decade ago.

“More and more patients across the UK are experiencing a pharmacist telling them that their medication is not available, it may not be available soon, and it may not be available anywhere nearby. This is also creating a great deal of extra work for both GPs and pharmacists.”

The report warned that the health sector cannot rely on any formal changes to the UK-EU relationship “any time soon” and there are “steps well within the powers of the UK Government to address these problems”.

These include better anticipating shortages and being more open about them, as well as being wary of sudden squeezes on cost driving instability.

Louise Ansari, chief executive at Healthwatch England, warned that “shortages of vital medication can have a detrimental impact on people’s condition, and their lives”.

“We are calling on the Government to carry out a review of the medicine supply chain to ensure medicine safety and resilience,” she added.

“Where safe to do so and in collaboration with patients, pharmacy teams should be given the flexibility to make changes to the medicines they dispense.

“Government and NHS England should better communicate serious shortage protocols to GP and pharmacy staff; and patients should be kept informed about shortages, and be given clear advice on what to do if they can’t get their medication.”

Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies (AIMp), said: “The medicines supply chain is broken at every level and unless the Department of Health reviews its processes and procedures, we will never achieve the stability that will guarantee patients their prescription when they need it.

“Pharmacists spend hours every day trying to source medicines for patients and they are often out of pocket due to a broken reimbursement mechanism.

“They see first hand the stress patients go through when they cannot obtain their regular stock. The system is overly complex and shrouded in secrecy – what we need is openness and transparency.

“Pharmacists are in the same position as patients – we are at the end of the supply chain but are not communicated with effectively by the officials. Consequently, we are unable to plan in advance and support the people who rely on us for their medications.”

Paul Rees, chief executive of the National Pharmacy Association (NPA), said medicine shortages “have become commonplace”, which is “totally unacceptable”.

He added that it is “distressing” for pharmacy teams when they cannot provide a prompt service to patients.

“Supply shortages are a real and present danger to those patients who rely on life-saving medicines for their wellbeing,” Mr Rees said.

“Ensuring an adequate supply of medicines is surely a basic function of any modern health system.

“The solutions have to be international as well as national, but our own government needs to create the conditions for enough medicines to flow into and around the UK system, by properly funding the supply chain at both ends.”

A Department of Health and Social Care spokesperson said: “Concessionary prices can arise for various reasons and cannot be linked to shortages.

“Our priority is to ensure patients continue to get the treatments they need. There are around 14,000 licensed medicines and the overwhelming majority are in good supply.”