‘Community pharmacists must be allowed to make minor changes to prescriptions during medicines shortages’
A new report from the Royal Pharmaceutical Society (RPS) has called on the government to create a national strategy to manage medicine shortages and to change legislation to empower community pharmacists to amend prescriptions when medicines are in short supply.
Currently, patients are required to return to their GP to get their prescriptions amended, leading to delayed access to medication, increased bureaucracy, and additional strain on an already overburdened system.
The RPS report, backed by charities and patient groups, proposes allowing pharmacists to make minor amendments, such as adjusting the quantity, strength, or form of prescribed medicines to ensure timely access for patients.
Additionally, the report highlighted key factors causing medicine shortages, including manufacturing and supply chain issues, exacerbated by cost pressures and consolidation of manufacturing outlets.
This along with unplanned spikes in demand, such as shifts in prescribing practice or increased diagnosis of some conditions, have created “a perfect storm of unstable supply”
James Davies, RPS Director for England and co-author of the report, emphasised the need for taking a new approach to medicine shortages.
He explained: “A properly resourced UK-wide medicines shortages strategy that helps prevent and manage shortages would greatly improve the resilience of the supply chain. This 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 pharmacists must be allowed to make minor changes to prescriptions during shortages,” he said, describing the current system as “outdated.”
“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.
Collaborative action needed
Bruce Warner, chair of the advisory group for the report, stressed the importance of improving collaboration across the supply chain and early reporting of shortages by manufacturers.
“Prompt notice of a supply problem allows time to act, find solutions and produce clear guidance, meaning health professionals are fully informed and patients are saved from delays and confusion that can cause distress and harm to health,” he stated.
Sharon Brennan, director of policy and external affairs at National Voices, a coalition of 200 health and social care charities in England, highlighted the challenges facing patients due to medicines shortages.
“Our members report that patients are rationing their medicines to make their supplies last, that deteriorations in health have led to job losses or dropping out of education, and that patients are buying falsified medicines from the internet.”
Brennan underscored that the situation is especially bad for those who are facing health inequalities.
“We urge the Department of Health and Social Care to recognise the serious and worsening impact medication shortages are having on patients, and to commit the same level of urgency to improving the situation as it has to other NHS access-to-care issues such as diagnosis and waiting lists,” she added.
The report also recommends:
- Improving reporting by manufacturers and imposing fines on those consistently failing to report.
- Building supply chain resilience by strengthening NHS procurement contracts to ensure manufacturers can meet supply demands and respond to shortages quickly.
- Boosting data connectivity by using better demand forecasting and sharing information across the supply chain to prevent stock issues before they happen.
- Enhancing systems for life critical medicines by improving collaboration across the health service to coordinate access to specific medicines.
A daily challenge for pharmacy teams
Janet Morrison, CEO of Community Pharmacy England (CPE), noted that the RPS study closely aligns with their own 2024 Medicines Supply Report, which also highlighted the frustration and inconvenience caused by increasing medicine shortages for pharmacy teams and their patients.
“Patients with a wide range of clinical and therapeutic needs are being impacted now more than ever before, and problems with sourcing their medications have become a daily challenge for pharmacy teams,” she said.
She underlined CPE’s contribution to the report's findings and expressed full support for many of its recommendations.
However, she stressed the urgent need for further action to protect patients and community pharmacies from ongoing supply chain disruptions.
Call for uplift in retained margin
Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA), has also raised concerns over the rising issue of medicine shortages, stressing the urgent need for “action to improve the resilience of the supply chain.”
He pointed out that since 2014, the volume of medicines has increased by 14% and value by 20%.
To tackle the problem, Harrison suggested, “Both retained margin and drug tariff reimbursement must be uplifted to stop avoidable medicine shortages, to ensure patients can access vital medicines.”
CCA welcomed the findings of the RPS report, which clearly highlight “the frustration felt by patients and pharmacy teams on the frontline.”
Drug shortages add pressure to GPs, pharmacists
Commenting on the release of the RPS report, Professor Kamila Hawthorne, chair of the Royal College of GPs, acknowledged that medicine supply constraints are a frequent source of concern for patients, and frustration for GPs and pharmacists.
She said: “GPs are already under enormous pressure and any medication shortages, even if they are only temporary, make the situation worse.
“There may be many reasons for medication shortages – it's essential that when they occur, the reason for them is identified and addressed as soon as possible.”
She believes that the recommendations outlined in this report, including a national strategy to prevent and manage medication shortages when they occur, would go a long way to making the situation easier for everyone involved.
Nick Kaye, chair of the National Pharmacy Association (NPA), also pointed out that medicine shortages put pressure on already overstretched pharmacy teams, forcing them to "spend hours hunting down stock when they could be helping patients."
To fix this frustrating situation for the long term, he urged the health secretary to instigate “an end-to-end review of the medicines supply chain” to ensure it is fit for the future.
NPA has been calling for the appointment of a medicine shortages Tsar, to get a grip within government on this growing and complex crisis.
About the RPS report, Kaye said: "This is a really important piece of work and rightly recognises that pharmacists are highly trained health care practitioners, who should be permitted to use their professional judgment to supply an appropriate alternative medicine in the event of the prescribed version being unavailable.”
Action is needed now
Duncan Rudkin, CEO of the General Pharmaceutical Council (GPhC), commented that they fully agree with the RPS report’s conclusion that further action is needed now.
He stated: “Although the GPhC has no direct role in medicines supply, we are determined to play our part in the next steps wherever possible, including in educating pharmacy teams about medicines shortages, and supporting them through our standards and guidance when they are facing challenging situations.”
Roz Gittins, chief pharmacy officer at the GPhC, added that they would welcome changes to legislation to enable community pharmacists to make minor changes to prescriptions when medicines are unavailable, as they do in hospital.
The council also strongly supports the call in the report to improve the sharing of data and information throughout the system, to enable national and local teams to more proactively manage supply and demand.
