Why is Britain being hit by a medicine shortage?

The latest drug to be in short supply in Britain is a treatment for seizures. A notice from the Department of Health and Social Care last Wednesday informed doctors and pharmacists that Tegretol – or carbamazepine – 200mg extended-release tablets would not be available until mid-January. It said it would have a “medium impact,” as is the case with such supply shortages. Using low-risk therapeutic alternatives, unlicensed imports, or alternative strengths or formulations were the ways forward.

An inconvenience on this occasion, but a week earlier doctors had been informed that the supply of glucagon-like peptide-1 receptor agonists, used by people with type 2 diabetes, would be problematic in 2024, and that doctors should immediately stop prescribing them to people looking for diabetes. to fall off. This time there was also a national patient safety alert that required “healthcare providers to take action to reduce the risk of death or disability.”

Days earlier, there had been reports that a tablet used by cancer patients to treat high blood calcium levels would not be available until the end of March. There is also a shortage of a brand of tablets for treating heart-related chest pain, heart failure and esophageal spasms. Menopausal women using the Estring 7.5 microgram estradiol vaginal ring also need to look elsewhere and there is a supply problem with a range of tablets used by people with angina.

As of December 18, Britain’s drug shortage list included 96 products. That is down from the 111 shortages at the end of October, but since then there have been a further ten delivery notifications from DHSC. The total is almost double the 52 medicines for which there was a problem in January 2022.

The trend of recent years is clear. A 2023 pressure survey by Community Pharmacy England found that 92% of pharmacy teams were experiencing medicine supply issues on a daily basis, up from 67% the year before. They reported that 87% of pharmacy team members believed that patient health was at risk.

It’s not just a British phenomenon. A recent survey by the European Association of Hospital Pharmacists found that 95% of hospital pharmacists across Europe were experiencing shortages. An EU working group on medicine shortages met last month to discuss a critical shortage of five key medicines, with supply barriers including the impact of the war in Ukraine on supply chains, and a recommendation from the European Medicines Agency to reduce the use of around 400 drugs tested by an Indian laboratory, as well as attacks on shipping in the Red Sea and the extra regulatory paperwork created in some supply chains as a result of Brexit.

All this also has consequences for Great Britain. But industry insiders say there are problems unique to Britain. The plummeting value of the pound after the Brexit referendum has made it more expensive for the NHS to buy medicines. Then there’s the voluntary scheme that the government introduced in 2019 in a bid to ensure that NHS spending on branded medicines doesn’t increase by more than 2% in a year. At the end of 2023, there was a 26% levy on the revenues of drug manufacturers earning above the limit. The companies claim this has made Britain an unattractive place to do business. It has, they say, put a brake on investments. From this year, that ceiling will increase, so that expenditure can increase by 4% annually. The British Generic Manufacturers Association says the government is still pinching.

Then there is a lack of joint planning and communication. In 2015, guidelines published by the National Institute for Health and Care Excellence (Nice) led to a rise in prescriptions for hormone replacement therapy (HRT), but manufacturers proved unable to meet demand. Last year there were still shortages of HRT. In November 2022, pharmacists in Great Britain began reporting problems purchasing the antibiotic amoxicillin. At the same time, Rishi Sunak said there was sufficient supply. A week later, a shortage of medicines was reported, followed by an export ban. It’s no wonder that four in five pharmacy owners say they have experienced patient aggression due to drug supply problems. Patience with the system is also quickly running out.