The latest drug to be in short supply in the UK is a treatment for epileptic seizures. A notification from the Department of Health and Social Care last Wednesday informed doctors and pharmacists that Tegretol – or carbamazepine – 200mg prolonged release tablets would not be available until mid-January. It was said to be of “medium impact”, as such supply shortages go. The use of low-risk therapeutic alternatives, unlicensed imports or alternative strengths or formulations were the ways to proceed.
An inconvenience on this occasion but a week earlier practitioners had been informed that supply of glucagon-like peptide-1 receptor agonists, used by those with type 2 diabetes, would be problematic throughout 2024, and that doctors should immediately stop prescribing it to those seeking to lose weight. This time there was also a national patient safety alert requiring “action to be taken by healthcare providers to reduce the risk of death or disability”.
Days before that, there had been notification that a tablet used by cancer patients to treat high levels calcium of the blood would not be available until late March. There is also a shortage of a brand of tablets for the treatment of heart-related chest pain, heart failure and oesophageal spasms. Women experiencing menopause who use the Estring 7.5 micrograms estradiol vaginal ring need also to look elsewhere and there is a supply issue with a range of tablets used by people with angina.
As of 18 December, the list of medicinal shortages in the UK included 96 products. Thats is down on the 111 such shortages at the end of October but there have been a further 10 supply notifications from DHSC since then. The total is close to double the 52 medicines for which there was an issue in January 2022.
The trend over the last few years is clear. A 2023 pressures survey by Community Pharmacy England found that 92% of pharmacy teams were dealing with medicine supply issues daily, an increase from 67% the year before. They reported that 87% of pharmacy teams members believed patient health was being put at risk.
It is not just a UK phenomenon. A recent European Association of Hospital Pharmacists survey reported that 95% of hospital pharmacists across Europe were experiencing shortages. An EU medicines shortage working party met last month to discuss a critical shortage of five key medicines, with impediments to supply said to include the impact of the war in Ukraine on supply chains, a European Medicines Agency recommendation to suspend use of about 400 medicines tested by an Indian laboratory, as well as attacks on shipping in the Red Sea and the extra regulatory paperwork that arises in some chains of supply due to Brexit.
All these affect the UK too. But industry insiders say there are problems peculiar to Britain. The plummeting value of the pound following the Brexit referendum has made it more expensive for the NHS to buy medicines. Then there is the voluntary scheme introduced by the government in 2019 in an attempt to ensure that NHS spending on branded medicines did not grow by more than 2% in a year. As of the end of 2023, there was a 26% levy on revenues of drug manufacturers earned beyond the cap. The companies claim it has made the UK an unattractive place to do business. It has, they say, acted as a drag on investment. From this year that cap will rise to allow a 4% annual rise in spending. The British Generic Manufacturers Association says the government is still penny pinching.
Then there is a lack of joined up planning and communication. In 2015, guidance published by the National Institute for Health and Care Excellence (Nice) prompted a hike in hormone replacement therapy (HRT) prescriptions but manufacturers proved unable to meet demand. There were still HRT shortages last year. In November 2022, pharmacists in the UK began reporting difficulties in procuring the antibiotic amoxicillin. At the same time Rishi Sunak was saying there was ample supply. A week later, a medicine shortage notification was issued, followed by an export ban. It is perhaps little wonder then that four in five pharmacy owners say they have experienced aggression from patients due to medicine supply issues. Patience with the system is also running out fast.