An unprecedented shortage of medicines in the NHS is putting lives at risk, pharmacists say, as unpublished figures show the number of products in short supply has doubled in two years.
A treatment for controlling seizures was the latest to be added on Wednesday to a UK drug shortage list that includes treatments for conditions ranging from cancer to schizophrenia and type 2 diabetes.
The causes of the crisis are believed to include the plunging purchasing value of the pound since the Brexit referendum, which has reduced the NHS’s ability to source medicines abroad, and a government policy to tax manufacturers.
According to Department of Health and Social Care (DHSC) figures provided to the British Generic Manufacturers Association, there were 111 medicines on a shortage list on October 30 last year and 96 on December 18, with supply notifications for a further 10 treatments to the NHS were dispatched. providers in Britain since then.
It represents a 100% increase in shortages compared to January 2022, with pharmacists and charities claiming some patients’ conditions worsened as a result.
Delyth Morgan, CEO of Breast Cancer Now, said her organization had been contacted by several patients over the past 12 months who were unable to obtain the medicines they needed to control the spread of their disease.
She said: “Last year, many people shared with us, via the Breast Cancer Now helpline, that they had experienced difficulties accessing their hormone treatment, including letrozole, anastrozole and tamoxifen, which caused them great worry and anxiety. Trying to track down a treatment by traveling to a number of different pharmacies is an added burden for patients at an already difficult time.
“It may also happen that certain brands of medicine are out of stock and that people have to switch to another brand or medicine. In the worst case, a person may go a period of time without medication, a medication that can help reduce the risk of breast cancer coming back or spreading.”
Douglas Twenefour, head of healthcare at Diabetes UK, said: “Ongoing shortages of many GLP-1 drugs are having serious consequences for many people with type 2 diabetes and are still a major problem. As these shortages are likely to continue for at least the remainder of this year, this will have a significant impact on whether many people with type 2 diabetes can access the best treatment for them.”
The war in Ukraine and problems in global supply chains have generally affected the drug supply of many European countries, with concerns raised about the instability of the fresh market in light of the violence in the Red Sea, a key shipping corridor for essential ingredients.
The EU, of which Britain is no longer a member, recently agreed to stockpile key medicines and invest in increased domestic production.
There are well-documented shortages of hormone replacement therapy and ADHD products, partly due to increased demand.
Janet Morrison, director of Community Pharmacy England, said the shortages were unprecedented and were starting to hit patients hard. “Pharmacy teams have struggled to obtain prescription medicines for months, but the problem is now worse than ever,” she said.
“It has become worryingly common for hundreds of medicines to experience price and other issues every month, while problems now occur every day at pharmacies. Pharmacies spend hours – an average of eleven extra hours per week – tracking down the medicines their patients need.
“All this is causing worrying delays for patients, and in the worst cases it can lead to a deterioration of their health: last year we surveyed people working in pharmacies and 87% told us that their patients’ health was at risk as a result of medicine supply problems. This is shocking and the government and the NHS must step in to solve these problems.”
The NHS is increasingly having to give price concessions on products, agreeing to increase the level of reimbursement to pharmacists due to spikes in demand and market prices.
There were 152 such concessions in December 2023, compared to 20 in June 2016, the month of the Brexit referendum, when Britain’s intention to leave the EU hit the value of sterling.
There are also concerns that a government policy to limit NHS spending on branded drugs is having an effect on the pharmaceutical industry’s willingness to invest in supplying Britain. There is a limit each year on the total allowable sales value of branded medicines to the NHS, which grows at an agreed rate of 2% per year.
All drug sales above the ceiling are reimbursed to the government through a levy on companies’ sales revenues. After consultation with the pharmaceutical industry, a scheme with a ceiling of 4% has been introduced for the next five years.
Morrison said the government was underinvesting in the supply of medicines.
She said: “Price concessions are a sign that companies are unwilling or unable to supply a type of medicine at the price officials previously thought would be sufficient. While they show that the system is responding, they are a symptom of the tightness that disruptions and shortages bring.”
Mark Dayan, head of the Brexit program at the Nuffield Trust, said there is evidence of a drop in imports of medical products from the EU since Brexit, suggesting companies have responded by changing their supply chains, causing major Britain may be more exposed to supply problems.
He said: “For Britain, this situation has been exacerbated by pressure on drug prices from 2016, likely linked to the Brexit referendum which has driven down the value of sterling.
“A payment mechanism to claw back money from companies when turnover rose too high saved the NHS money but reduced the incentive to sell branded products here.
“Over the past two years, being outside the single market has increased costs at the EU border, resulting in a decline in the number of products entering this country.”
A spokesperson for the DHSC said: “There are a number of reasons why a limited number of medicines may not be available, such as production issues, raw material supply, sudden peaks in demand or distribution issues.
“The department has established procedures in place to deal with such issues and works closely with industry, the NHS and others to prevent shortages and resolve any issues as they arise.
“This includes working closely with the NHS so they can put in place proposed plans to limit the risk of the shortage impacting patients.”