‘About that bus…?’: In short supply this winter

The government’s ban on the so-called “parallel exporting” of certain medicines, starting with a list of 24 drugs, is well worth keeping very close tabs on for the whole NHS system this winter, says James Illman.

Hospitals are often one step removed from the debate around medicines shortages, which has of late focused largely on the squeeze on primary and community care medicines.

But this could change swiftly if, for example, another winter flu outbreak wreaks havoc in hospitals and across the rest of the health and care system this winter and there is a shortage of the relevant vaccines.

But firstly, a quick recap on what’s happened to date on the issue. Ministers announced last Thursday a ban on the “parallel exporting” of certain drugs, starting with a group of 24 medicines, which the UK is currently experiencing shortages of.

Parallel exporting is a legal practice where wholesalers import medicines for one market, in this case the UK, but then export them for a higher price to another EU market, often to take advantage of currency and price fluctuations.

The move follows sustained lobbying by drug chiefs who warned a no-deal Brexit could trigger a sell-off of stockpiled drugs by wholesalers looking to profit if the value of the pound drops even further, which has been widely predicted could happen in the run-up to 31 October.

The Department of Health and Social Care, however, insisted the parallel exports restrictions were “unrelated to Brexit”, because “there [was] currently no evidence of any supply constraints related to the UK leaving the European Union”.

There is some truth in this, in so far as the UK is always facing shortages of roughly around 100 medicines at any one time, the make-up of which varies due to a whole range of complex economic, supply chain and demand issues.

So, yes, even without Brexit, ministers could have theoretically opted to implement the restrictions.

But it seems a mighty coincidence that DHSC opted to make the move, unprecedented by a UK government, just 28 days ahead of a potential no-deal Brexit, when protecting drug stockpiles is of such strategic importance.

Drug companies and wholesalers are building up stockpiles of an extra six weeks’ worth of medicines as a buffer in case of supply issues following the UK’s exit from the EU with or without a deal.

NHS Confederation’s Brexit expert Layla McCay explains further: “The situation has gained this extra attention for two main reasons: first, some of the current shortages are of very commonly used medicines, so it’s being noticed more, and secondly, in the run-up to Brexit the government is especially keen to make sure we’re in a very good starting position of stocks of medicines in the country.”

The economic uncertainty already created by Brexit may also already be a contributory factor. The pound has consistently been weaker since the referendum and sterling dropped to its lowest ebb in September when it fell below $1.20 for the first time since the “flash crash” which followed the 2016 result.

The last edition of “About that bus…?” revealed that the proposals for a parallel exporting ban had been drawn up – but senior figures said then that officials were mindful to take a “watchful waiting” approach to prevent unintended consequences.

The DHSC has, however, appeared to have gone a step further by introducing the new restrictions concerning 24 medicines, which included 19 hormone replacement therapy drugs, as well as all adrenaline auto-injectors and Hepatitis B vaccines, and perhaps crucially, a flu vaccine.

The DHSC has committed to update the list weekly, which, if made public, should give a regular gauge on the temperature of how concerned the centre is about potential medicines and in which areas.

The decision to focus on HRT drugs in first instance appears sensible. A timely survey published last week by Chemist + Druggist found 84 per cent of the 402 community pharmacists they surveyed were experiencing shortages of HRT drugs.

You can see a neat graph here showing the survey’s results. The survey also found a large number of pharmacists were reporting shortages of contraceptives, antiepileptic drugs and painkilling creams and patches.

Again, it is worth stressing the experts’ assessment is that these shortages are down to supply chain and production issues and not to Brexit. But suffice to say, a no-deal Brexit could hugely exacerbate the problems.

And the appearance of Oseltamivir, better known by its brand name Tamiflu, on the list is also certainly worth tracking, regardless of the origins of the shortages. It goes without saying that shortages of the antiviral used to treat and prevent influenza A and B just as the flu season begins could have significant ramifications for the whole NHS system.