Medicine shortages now a ‘systemic threat’ to care, MPs find

Medicine shortages have become ‘a permanent and escalating’ threat to patient care, placing an unsustainable burden on pharmacy teams and disrupting the safe delivery of treatment across England, the All-Party Parliamentary Group (APPG) on Pharmacy has warned.

In a newly published report following its inquiry into the issue, the APPG said supply chain problems are now routine, with 84% of pharmacists and 75% of prescribers reporting that shortages occur daily.

Drawing on evidence from frontline pharmacists, prescribers, patients, wholesalers, manufacturers and regulators, the report concludes that medicine shortages are directly affecting clinical outcomes, patient safety, and the financial and operational stability of healthcare services.

The APPG found widespread disruption across several key therapeutic areas, including ADHD, diabetes, epilepsy, hormone replacement therapy and antimicrobials.

It recorded numerous examples of treatment interruptions, patient anxiety, adverse events and, in some cases, serious harm resulting from the unavailability of prescribed medicines.

Steve Race MP, chair of the APPG on Pharmacy, said shortages had become a ‘chronic structural challenge’ for both the NHS and community pharmacy sector.

He added: ‘As government continues to recognise and invest in the expanded clinical role of community pharmacy, we must ensure the medicines supply chain underpinning that care is equally robust, resilient and patient-focused.’

The report also highlights the impact on workforce and resources, with pharmacy teams spending several hours each day sourcing alternatives, contacting prescribers, and reassuring patients – diverting time away from care delivery and adding pressure to an already stretched sector.

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The Nuffield Trust estimated that medicine shortages added £220m to NHS costs in 2022/23 alone.

According to the APPG, the causes of shortages include: fragile global supply chains and an overreliance on overseas manufacturing of active pharmaceutical ingredients; a decline in domestic production capacity; the added regulatory and cost burdens following Brexit; and growing demand fuelled by changes in prescribing practices and off-label use.

A lack of real-time supply data and poor system visibility were also identified as contributing factors.

To address the issue – which the APPG warned was now ‘a systemic threat to NHS patient care’ – the group of MPs has made a number of recommendations.

These include: a full review of the Community Pharmacy Contractual Framework; the creation of a national real-time communication system for medicine shortages; regulatory changes to allow pharmacists to substitute medicines more flexibly during shortages; and investment in domestic manufacturing for critical medicines and ingredients.

The group has also called for a fully independent review of the UK medicines supply chain to support longer-term reform.

The APPG warned that unless urgent action is taken, medicine shortages will continue to undermine service delivery and public confidence, and could jeopardise efforts to expand the clinical role of pharmacy teams.

Janet Morrison, chief executive of Community Pharmacy England (CPE), said the APPG’s inquiry report was 'yet another strong piece of evidence highlighting the medicines supply situation', and that medicine supply issues are a 'constant worry for community pharmacy teams up and down the country'.

CPE's own recent medicines supply report found that one in four pharmacy teams are now spending more than two hours each day sourcing alternatives for their patients.

Ms Morrison said: 'This is a longstanding issue that must not become the new norm. It is simply unacceptable, and without decisive action, we risk these challenges persisting for many more years to come.'

She added that CPE agreed a 'full reform and robust review of the Community Pharmacy Contractual Framework is fundamental – not only for sustainable funding, but also to ensure we have an operating model that addresses mounting financial pressures and meets rising patient needs'.

Alwyn Fortune, the Royal Pharmaceutical Society's (RPS) policy lead on medicine shortages, also recognised that medicine shortages are affecting patient care and creating 'immense pressure' on pharmacy teams.

He added that the APPG's recommended actions echoed the RPS report on medicine shortages last year, which also called for a national strategy to streamline efforts across the NHS.

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'We urge policymakers to act on the recommendations from both reports to help make a difference for patients,' he said.

Meanwhile, Henry Gregg, chief executive of the National Pharmacy Association, echoed the report's call to allow pharmacists to use their professional judgment to supply an appropriate alternative medication when the prescribed version is unavailable.

He said: 'Pharmacy teams are under enormous pressure but are forced to spend hours hunting down stock for distressed and frustrated patients.

'MPs are right that it is madness to send someone back to their GP to get a prescription changed, and it risks a patient either delaying taking vital medication or forgoing it altogether, which poses a clear risk to patient safety.'

The Company Chemists’ Association (CCA) also welcomed the APPG's recommendations and warned that shortages could get worse without action.

CCA chief executive Malcolm Harrison said: 'The government must invest in competitive pricing for medicines to make the UK an attractive place in the global market for medicine manufacturers and suppliers.

'We urgently need an end-to-end review of the medicines supply chain to ensure it is as resilient as possible, so patients can access the medicines they need, today and in the future.'

A recent Healthwatch England survey uncovered persistent problems experienced by pharmacy patients in accessing medication due to supply-side issues.

Despite the ongoing problems, the government has effectively ruled out a review on the impact of medicine shortages on pharmacies.

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Today, a Department of Health and Social Care spokesperson said: ‘This government inherited ongoing global supply problems, but we have robust measures in place to mitigate disruption for patients.

‘We are working to build the resilience of medicine supply chains and prevent future disruption as we get the NHS back on its feet.

‘We have recently agreed an extra £617m of funding over two years with Community Pharmacy England to support the sector and provide patients with more services closer to home as part of our 10 Year Health Plan.’

To inform the inquiry, the APPG collected evidence through a survey of 112 pharmacists and pharmacy team members, a separate survey of 51 GPs and prescribers, a written call for evidence that attracted responses from 60 organisations and patients and a parliamentary oral evidence session with key stakeholders.