Welcome to the ‘About that bus…?’ weekly newsletter – giving you the inside track on how the fallout from Brexit is affecting the NHS at national and local level, edited by James Illman. Contact me in confidence.

Ministers are opting for a ‘watchful waiting’ approach to addressing concerns that drugs stockpiled for a no-deal Brexit could be sold off by wholesalers if there is a deterioration in the pound ahead of 31 October, senior sources have told HSJ. But do the arrangements go far enough?

The alarming gaps in protections against medicine shortages in case there is a no-deal Brexit, highlighted in last Friday’s National Audit Office report, emphasises the importance of protecting the stockpiled supplies.

The government has been working with industry and the NHS to ensure the UK has stockpiled six weeks’ worth of commonly used medicines, a process which began last August.

The process has been shrouded in secrecy. So, it was only when the NAO report dropped on Friday that we learned around 9 per cent of medical product lines identified as suitable for stockpiling had not yet been secured.

The Nuffield Trust described this as “too high” and said “there was little [in the NAO report] to reassure us that [the government is] ready for shortages or supplier failure”.

And this already worrying position could get considerably worse if, as drugs company bosses warned earlier this month, the prospect of a no-deal Brexit triggers a sell-off of stockpiled drugs by wholesalers. This could happen if the pound deteriorates against the Euro.

The Association of British Pharmaceutical Industry called for what effectively amounts to a short-term ban on the so-called parallel exporting of drugs.

Parallel exporting involves a wholesaler buying up products intended by manufacturers for one market, in this case the UK, and then exporting them to another EU state. The practice is usually driven by the seller trying to take advantage of price and currency variations.

So, how much of a threat does this pose and what is government doing about it?

The honest answer on the scale of the threat is – as so often is the case with Brexit risks – no one really knows.

There are also concerns the unintended consequences of any mitigations put in place could prove worse than the initial threat, which is also another concern common with a lot of other parts of the Brexit preparations.

HSJ has established the government is taking a “watchful waiting” approach to the risk.

Senior sources confirmed plans for what effectively amounts to a temporary ban on parallel exporting have been drawn up, although, as of Friday, they had not been signed off by ministers. 

One senior source familiar with negotiations told HSJ the plan would only be rolled out if the government sees evidence of parallel exporting of stockpiled drugs.

Despite the lack of clarity and finality of the plan, HSJ also understands senior NHS system leaders are satisfied their government counterparts are taking the appropriate steps to cover off the risk.

Two senior industry sources were, however, less convinced. They both raised concerns around how such a ban would be policed.

One would hope the raft of pharmaceutical wholesalers involved in the supply chain would think twice about seeking to make a quick buck at the expense of patient safety – and the risk of being outed for their actions in the media and being made public enemy number one. But the profit motive is a powerful incentive.

Officials are also keen not to talk about which drugs could be the most vulnerable to being sold off, because they fear this could spark patients to stockpile the drugs themselves, which could then create shortages for those most in need.

A senior industry figure told HSJ, however, primary care drugs were at far greater risk than secondary care products, which went through far more tightly controlled supply chains.

Clearly shortages of numerous products dispensed through community pharmacies, such as pain medications and antidepressants, could have catastrophic consequences, and not least insulin, every drop of which is imported to the UK.

Both the Department of Health and Social Care and the ABPI declined to make substantive comment.

This week’s further essential Brexit reading:

  • The NAO report published on Friday, Exiting the EU: supplying the health and social care sectors, represents the most detailed assessment of Brexit preparations published by an official body yet. The DHSC and NHS England send out numerous Brexit alerts, but rarely do they actually provide the NHS and other healthcare professionals with anything like the depth of detail in this easily readable synopsis of where the process is up to.
  • For the rest of the most up-to-date Brexit news, including our piece on the NAO report on Brexit readiness, go to HSJ’s daily updated ’About that Bus…?’ Brexit blog.