The Royal Pharmaceutical Society (RPS) report was commissioned in January 2024 to “examine the causes of medicines shortages and help tackle their impact on patients and pharmacy practice” as it “is not a new issue, but it is persistent and getting worse”.
RPS Director for England James Davies said the suggested legislation change for community pharmacists is needed because the “current outdated system inconveniences patients, wastes time and causes frustration”.
“The Secretary of State for Health should give pharmacists the authority to act in the best interests of their patients, rather than remain subject to ‘empty shelf syndrome’,” he added.
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The report added that patients having to return to their GP to amend their prescriptions increases bureaucracy and pressure on “an already overburdened system”.
This change in legislation would be “in line with existing hospital practice, RPS policy and the recommendation of the Health and Social Care Select Committee report into pharmacy”.
Community Pharmacy England chief executive Janet Morrison backed the change and said it would allow “pharmacists to make minor adjustments to prescriptions” to “protect patients and community pharmacies from ongoing supply chain disruptions”.
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She added that “problems with sourcing their medications have become a daily challenge for pharmacy teams” and the negotiator is “fully supportive of many of its recommendations”.
The General Pharmaceutical Council (GPhC) chief executive Duncan Rudkin said “we fully agree with the report’s conclusion that further action is needed now“ and it is ”determined to play our part in the next steps wherever possible, including in educating pharmacy teams about medicines shortages”.
National strategy
The RPS also calls for a “national strategy to manage medicine shortages” which “would streamline efforts across the NHS” and “reduce inefficiencies caused by duplication of effort”, that happens across local NHS organisations.
The body added it wants to “ensure information and guidance for professionals and patients is available as soon as shortages occur”.
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The report says major drivers of medicines shortages include manufacturing problems, less resilient supply chains and cost-drive pressures which alongside “international competitive procurement practices, have limited the ability for investment in strengthening supply chains”.
It also referenced social media’s role in surges of demand and spikes that “supply chains struggle to meet” as the “speed at which information or misinformation spreads about medicines has increased dramatically in recent years”.
The report says around 3% of medicines are in shortage, but the impact of this on patients can be “catastrophic” as they ration “their medicines to make their supplies last”.
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It says patients have “many hours wasted calling round pharmacists to track down medication” and this can be “impossible for those that do not have access to private transport, flexible working hours, access to a phone during the day, or are digitally excluded”.
Healthwatch England chief executive Louise Ansari commented “our research showed that one in four people experienced shortages last year when trying to get medicine, while nearly half experienced problems getting medicine in general”.
“This often leads to people having to play ‘pharmacy bingo’, going from one pharmacy to another to find the medication they need, feeling stressed and anxious while putting their health at risk,” she said.
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The report referenced CPE’s medicines supply report published earlier this year that suggests “almost three-quarters of community pharmacy staff estimate spending 1–2 hours a day or more trying to obtain medicine stock or alternatives”.
RPS says this impacts “professional relationships and the mental health and wellness of healthcare teams” and this takes up time that “could be used elsewhere to support patient care”.
RPS’ Davies said a new strategy would “relieve stress and anxiety for patients and free up time for pharmacists to focus on patient care rather than constantly chasing down supplies”.
Community pharmacy recommendations
The report says that community pharmacy’s “unstable economic model” is “potentially contributing to local shortages”, as a “lack of visibility into stock levels in primary care hampers collaboration to manage shortages effectively”.
One of its recommendations was for the community pharmacy contract in all UK nations to be reviewed to ensure it “minimises the risk of individual contractors incurring a potential loss on the purchase of medicines and supports a stable supply of medicines to patients”.
And it called for organisations, professional bodies and regulators to develop pathways for pharmacists to “use their prescribing qualification to help manage the impact of medicines shortages on patients”.
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Former deputy chief pharmaceutical officer for NHS England (NHSE) Bruce Warner, who chaired the report’s advisory group, said “better collaboration across the whole medicines supply chain is needed”.
The report says that community pharmacy and general practice need to “urgently develop patient-centred ways of working together to communicate about shortages and find alternatives”.
It acknowledged there are local examples of this working but “regional facilitation with good practice” should be shared more widely.
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Warner also added that “improving early reporting of shortages by manufacturers to the Department of Health and Social Care is of critical importance”.
The report says further understanding of automated purchasing platforms community pharmacies use to source medicines is needed, particularly looking at wholesalers “ability to forecast demand”.
It recommended these systems provide “resupply dates for medicines out of stock to enable more meaningful communication with patients”.
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Further education for pharmacy teams about the “causes of shortages, and how to manage them” should be introduced too.
This would include covering what “actions to avoid that could either make shortages worse, such as, stockpiling, or that could be unsafe, such as buying medicines online from unregulated websites”.
The report comes after the health and social care committee (HSCC) urged the government in May to update regulations on “dose and formulation” substitutions within three months to address medicines shortages, as community pharmacists should be able to “dispense what they have available” when they encounter stock shortages.
And last week (November 20), RPS board member Steve Churton resigned from its England board after taking a “principled stance” over how the body is working towards becoming a royal college, a move announced back in September.
