Exclusive: Medicine supply problems double in a year

Analysis of NHS supply alerts shared with HSJ shows a persistent monthly rise over the past year in the number of unavailable drugs (see chart below). It also reveals that 12 “serious shortage protocols” – a more serious level of alert which allow pharmacists to dispense alternatives more easily – have been issued this month, compared to three in January last year.

This is based on an analysis by the British Generics Manufacturers Association of NHS Specialist Pharmacy Service medicines supply tool data.

The trend in the supply alerts is reinforced by results of a survey of community pharmacists by the Pharmacists’ Defence Association, also shared exclusively with HSJ. Thirty-five per cent of 347 PDA members surveyed over Christmas said it was now difficult to obtain stock for the majority of commonly prescribed medicines. Sixty-three per cent said it was difficult for at least some commonly prescribed medicines.

The growing shortages are largely driven by the rising cost of selling drugs in the UK – including for shipping (increasing sixfold in the last year), active pharmaceutical ingredients (trebling in the last year) and energy (rising by 230 per cent since 2021) – industry leaders believe.

BGMA chief executive Mark Samuels said there were disproportionate shortages among branded generics. Even though these account for only 10 per cent of NHS supply, they make up 44 per cent of off-patent shortages. Non-branded generic medicines consitute 70 per cent of supply.

He said supply of branded generics was being dented by steep increases in the past year in the government’s voluntary pricing scheme (VPAS) payment rate for manufacturers, linked to high price inflation. Mr Samuels said: “Generic and branded generics run on razor-thin margins because once a medicine’s patent expires, competition can take place, which drives down the price.”

SPS data, seen by HSJ, shows several “high impact” shortages, which means they have the potential to change clinical practice or have safety implications. These include:

Speaking about the unavailability since November of Capimune (ciclosporin), which is used to treat arthritis, the charity Versus Arthritis pointed out that switching to the alternative brand, Deximune, is not advised.

Its senior clinical policy adviser Benjamin Ellis, a consultant rheumatologist, said: “Even a short gap in treatment can cause an agonising flare-up of painful and stiff joints, where people may be unable to work or carry out every day tasks.”

Roya Vaziri, medical director at drug and alcohol recovery charity Humankind, said chlordiazepoxide being out of stock meant users needed to be switched to an alternative, diazepam, requiring developing a new regime and dosage, and updating alcohol services staff to ensure this was done.

“Chlordiazepoxide is the first drug of choice for individuals in the community, as there is a smaller risk of sedation, so it would be ideal if we could have it back in stock,” she added.

Pharmacists’ Defence Association director of policy Alison Jones said members who responded to its medicine shortages survey said they “are spending up to four hours a day sourcing common medicines for patients”, taking them away from patient care amid high demand.

The Department of Health and Social Care said it knew shortages were distressing but it had well-established processes to prevent, manage and mitigate shortages. This included working closely with suppliers, NHS England, the MHRA, and others.