Medicines shortages across the UK have become a ‘new normal’ that has placed a ‘significant burden’ on pharmacists, an independent health think tank has warned.

In a report published today, the Nuffield Trust said medicines shortages had been ‘constantly elevated’ over the past two years and that the UK was at risk of ‘being left in the cold’ when it comes to co-ordinated European Union (EU) attempts to tackle them.

While it suggested that the UK’s exit from the EU ‘had not caused the recent spike’ in shortages, it warned the nation was split from European supply chains, authorisations and collective efforts to respond.

For example, the researchers said the UK was left out of the Critical Medicines Alliance and Voluntary Solidarity Mechanism – initiatives led by EU member states to ‘insulate themselves’ from the impact of shortages.

‘New normal of frequent disruption to crucial products’

The research, informed by a roundtable with pharmacists and other key stakeholders, said price concessions had ‘risen sharply’ in recent months.

It noted that prior to 2016 the total rarely went above 20 per month, but in late 2022 they peaked at 199 and have ‘remained high ever since’.

The excess cost of medicines in months when they were subject to price concessions was £220m across the year to September 2023.

In addition, the Nuffield Trust flagged there were now more than double the number of notifications by drugs companies warning of impending shortages than there were three years ago.

‘Multiple indicators show that the past two years have seen constantly elevated medicines shortages, in a new normal of frequent disruption to crucial products, which if anything worsened in 2023,’ the report said.

‘This has placed a significant burden on pharmacists, and has affected the medicines available to patients.’

‘It is the consequence of policy choices’

Professor Tamara Hervey, of the City Law School, said: ‘There is nothing inevitable about this “new normal” where Great Britain is isolated in efforts to manage fragilities in global supply of the products and people we need to run the NHS.

‘It is the consequence of policy choices and those could be different.’

The researchers argued that addressing the issue of shortages would require ‘a more co-operative and proactive approach’ to EU-UK relations.

Though the report stressed the health sector could not rely on ‘big formal changes to the EU-UK relationship anytime soon’.

‘How much change is possible will depend on what the UK is willing to offer across all sectors,’ it said.

It added: ‘If formal agreements between the EU and UK were reopened, which would require either real give and take across sectors or an ambitious framework to cooperate over health specifically, there are certain provisions that would be significantly positive for life sciences, medicine supply and other aspects of health security in the UK.’

Government must ‘be more open’

Authors urged the government to ‘better anticipate’ medicines shortages; to ‘be more open’ with patients and the health service about the situation; and to have ‘better planning’ on stockpiling drugs.

Those informing the research from the community pharmacy sector said they ‘often experienced shortages of products not officially classed as experiencing supply issues’, the report noted.

But the Department of Health and Social Care and NHS England had said ‘these were only localised problems’.

‘It is unclear why localised shortages should be prevalent in a fairly sophisticated national market with proportionately low transport costs,’ the report added.

‘It may be that this reflects a bar set at a higher level, or the diversity of problems emerging. A more transparent approach including products that are still only facing limited or localised issues could help.’

Fresh calls for enabling ‘minor amendments to prescriptions’

Responding to the report, director of the Royal Pharmaceutical Society in England, James Davies, said the research demonstrated ‘the challenges in assuring effective medication supply’.

He said it was ‘right to call for better data-sharing on medicine shortages, as other countries have more transparent, publicly available data’.

‘A lack of clarity on why a medicine is in shortage and when it is likely to return are huge issues for patients, who are naturally anxious about getting the treatments they need,’ added Mr Davies.

In addition, the RPS director reiterated calls for pharmacists to be able to make ‘minor amendments to prescriptions’ amid shortages.

Janet Morrison, chief executive of Community Pharmacy England, said CPE was also calling for more power to be given to pharmacists ‘to help them better manage their patients’ medicines when shortages do occur’, and for a ‘strategic review of medicines supply’.

She added: ‘It’s extremely worrying that medicine shortages have become the norm: community pharmacies and patients know this to be the case, and this report further evidences this alarming reality.

‘Medicine shortages and market instability are at the worst that pharmacies have ever seen, making life incredibly difficult for community pharmacies and for their patients.’

She added: ‘The relationship between price concessions and shortages isn't always straightforward, but it’s clear to us that both the medicine supply and reimbursement systems are at crisis point.

‘Pharmacy teams are spending hours trying to source medicines, and pharmacies now often end up supplying medicines at a financial loss, significantly impacting their bottom line and destabilising the pharmacy sector, with many pharmacies on the brink of closure.’

Paul Rees, chief executive of the National Pharmacy Association (NPA), said it was ‘totally unacceptable’ that medicines shortages in the UK have become ‘common place’, as highlighted by the report.

‘It’s distressing when pharmacy teams find themselves unable to provide a prompt medicines service, through no fault of their own,’ he said.

‘Pharmacy teams have seen the problems get worse in this country over recent years, putting more patients at risk.

‘Ensuring an adequate supply of medicines is surely a basic function of any modern health system.’

Meanwhile, Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA), said pharmacy teams were having to deal with medicines shortages ‘on a daily basis’.

‘We are aware that there are problems throughout the supply chain, but medicines procurement, in particular, needs to be urgently reviewed,’ he added.

A Department of Health and Social Care spokesperson said: ‘Concessionary prices can arise for various reasons and cannot be linked to shortages.

‘Our priority is to ensure patients continue to get the treatments they need. There are around 14,000 licensed medicines and the overwhelming majority are in good supply.’