The community pharmacy contractual framework in each UK nation must minimise the risk of individual contractors incurring a potential loss on the purchase of medicines, the Royal Pharmaceutical Society (RPS) has said.

In response to the All-Party Parliamentary Group (APPG) on Pharmacy's call for written evidence on medicines shortages, the RPS warned pharmacy funding must support a stable supply of medicines to patients.

'The current contractual framework remuneration system for community pharmacy means that it is imperative for pharmacy teams to source medicines at as competitive a price as possible so as not to lose money,' the RPS said in its response.

'We heard from our members of price increases in medicines when a shortage is in place, putting the cost of medicines significantly higher than drug tariff reimbursement.

'Thus, members are sourcing medicines at potentially a significant loss, in the hope that price concessions are in place at the end of a month to reflect these increased prices.'

And it said that 'the system costs involved in managing shortages' are often not captured, but should be.

'These costs include; the lost opportunity to see other patients, time spent setting up and managing shortage processes, extending waiting lists for treatment, reversing medicine management plans once a medicine returns to stock, re-designing care pathways for an alternative medication, managing the complexities of unlicensed or imported medicines that may be used as alternatives,' the RPS said.

And it added that more research on the costs of medicines shortages was needed 'to inform resourcing decisions and underpin investment in resources and the implementation of quality improvement programmes'.

'Poor communication' on medicines shortages

The RPS also  highlighted 'poor communication to the front line' about medicines shortages.

'We heard from our members how frontline pharmacy teams are already dealing and trying to manage medicines shortages well before official communication and guidance is issued.

'While it is recognised that national guidance inevitably takes time and requires quality assurance processes prior to publication, this was a consistent theme,' the RPS reported.

It proposed that the NHS and manufacturers and wholesalers should 'proactively collaborate to share data', including to be able to predict demand.

The RPS also suggested that 'the DHSC/NHS medicines supply tool hosted on the SPS website (sps.nhs.uk). should be the single source of accessible, consistent, accurate and rapidly updated information about medicines shortages for healthcare teams across the UK'.

'Wholesaler and community pharmacy IT systems should be developed to provide resupply dates for medicines out of stock to enable more meaningful communication with patients and help pharmacists to more rapidly distinguish short-term supply disruptions from national shortages,' the RPS added.

'How is it possible for critical medicines to not be available?'

Pharmacy teams are also under pressure 'from colleagues unable to understand how it is possible for critical medicines to not be available', with staff wellbeing impacted by the pressures of shortages, the RPS said.

It pointed to findings from its workforce wellbeing report that suggested 40% of patients were being put at risk by medicines shortages.

'Cross-sector emergency protocols for life-critical medicines where patients have no alternative treatment should be developed. This will require collaborative working across local systems and the use of regulatory flexibility to allow medicines to flow between primary and secondary care,' the RPS proposed.

Existing and potential regulatory flexibilities should be explored

The RPS stressed that 'existing and potential regulatory flexibilities should be explored' to speed up access to medicines where necessary.

In particular, it reiterated that the government 'should enact legislation to enable community pharmacists to make minor amendments to prescriptions in line with existing hospital practice, RPS policy and the recommendation of the Health and Social Care Select Committee report into pharmacy'.

Last week, the government said it was considering enabling pharmacists to substitute a different dose or formulation in specified circumstances.

This came as a coroner raised concerns around the death of a child who was delayed in obtaining antibiotics because the pharmacy did not have the prescribed dose in stock.