Nearly 60,000 HRT items supplied under SSPs last year

Nearly 60,000 hormone replacement therapy (HRT) items were supplied under a serious shortage protocol (SSP) in England last year, new data has revealed.

And more than 13 million HRT items were supplied overall in England last year, according to the latest figures from the NHS Business Services Authority (NHSBSA).

HRT shortages increase sixfold in a year

The proportion of HRT items affected by shortages has increased sixfold in the last year.

Some 57,580 items covered by the HRT pre-payment certificate (PPC) were supplied under an SSP in England in 2023/24, compared to 7,969 in 2022/23 and 208 in 2021/22.

This is out of an overall total of 3,285,168 HRT items supplied overall in England last year - up from 10,933,456 in 2022/23 and 7,440,662 in 2021/22.

While the total number of HRT items increased, so did the proportion affected by shortages, with the percentage of HRT items supplied under an SSP increasing from 0.003% in 2021/22 to 0.07% in 2022/23 and 0.4% in 2023/24.

The medication defined as HRT items by this dataset includes all patient demographics and may or may not be prescribed for the menopause.

Utrogestan / progesterone micronised 100mg capsules and estradiol 50micrograms/24hours and 100micrograms/24hours transdermal patches were the items most affected by shortages.

These drugs were also among the most frequently prescribed HRT items, with 1,330,000 Utrogestan and 994,000 progesterone micronised 100mg capsules being prescribed and dispensed in the community in England in 2023/24.

'SSPs don’t make full use of community pharmacists’ expertise'

Suraj Shah, drug tariff and reimbursement manager at Community Pharmacy England (CPE) said the negotiator was 'extremely concerned about the impact [medicines supply issues were] having on patients and pharmacy teams'.

'While SSPs can be a useful tool to help patients get the treatment they need more quickly, they are still restrictive and difficult to use, putting pharmacy owners at risk of losing money if their claims are not endorsed correctly.'

And he said that 'SSPs don’t make full use of community pharmacists’ expertise'.

'We have been pressing DHSC to think more broadly about what else could make a difference, as well as requesting that they issue more communications on supply issues to reassure patients and the public.'

And he said CPE would want to see pharmacists allowed 'to make minor adjustments to prescriptions' such as supplying alternative strengths or formulations if deemed clinically appropriate.

'Growing concerns about the resilience of the supply chain'

Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA), told The Pharmacist that the growing number of HRT items supplied under SSP was 'another example of growing concerns about the resilience of the supply chain'.

'Over recent years Drug Tariff prices have been driven down so much that some manufacturers are prioritising other global markets for some of their medicines,' he said.

And he said the CCA was 'working hard with partners across the medicines supply chain to understand more about the challengers it faces, and to develop the solution to ensure patients can continue to access the vital medicines they need'.

Mr Harrison also noted that 'more research is needed to understand the reasons for differences in HRT use across the country'.

Pharmacists' time and expertise could be spent 'advising and treating more patients'

Meanwhile, Tase Oputu, England board chair of the Royal Pharmaceutical Society (RPS), said pharmacists were 'working tirelessly to ensure women receive their medication'.

But she added that their time and expertise spent 'tracking down supplies' could be spent 'advising and treating more patients'.

'We’d like to see manufacturers, wholesalers and the new government work together on long-term solutions for HRT supply and address the health inequalities faced by women in deprived areas,' said Ms Oputu.

Women in more deprived areas half as likely to access HRT

Analysis by The Pharmacist has also found that women in deprived areas are accessing HRT on the NHS at nearly half the rate of women in more affluent areas.

Ms Oputu commented that 'all women, regardless of where they live, should have equal access to essential reproductive healthcare'.

'Pharmacists play a crucial role in providing this care, and standardising access will significantly benefit women and reduce health inequalities,' she said.

Meanwhile, Dr Leyla Hannbeck, chief executive of the Independent Pharmacies Association (IPA), said that issues around access lay 'largely around access, education, awareness and ability to navigate the NHS system, which are all of a greater challenge in certain socio-economic areas than others'.

She said the NHS needed to resolve this 'by creating a landscape and platform for all individuals to access equally', particularly for those who are vulnerable. 'Exactly the opposite is happening,' she added, commenting on our analysis.

And Nisha Mistry, lead advice and support pharmacist at the National Pharmacy Association (NPA), told The Pharmacist that uptake of HRT was variable 'for several reasons including cultural factors'.

'HRT can be a life-changing treatment, so it’s important to find ways to improve access and ensure that more women benefit, whatever their socio-economic situation,' she said.

In response to our findings, Dr Sue Mann, NHS England clinical director for women’s health acknowledged that there was 'more work to do to increase awareness and reduce inequalities in access'.