Drug shortages are a “new normal” in the UK and are being exacerbated by Brexit, warned a report by the Nuffield Trust health think tank. A dramatic recent rise in the number of drugs being unavailable has created serious problems for doctors, pharmacists, the NHS and patients, it found.
The number of warnings issued by drug companies about impending supply problems for certain products more than doubled from 648 in 2020 to 1,634 last year.
Mark Dayan, the lead author of the report and the Nuffield Trust’s Brexit program leader, said: “The rise in shortages of essential medicines from rare to common was a shocking development that few would have expected a decade ago.”
The UK has been struggling since last year with major shortages of drugs to treat ADHD, type 2 diabetes and epilepsy. Three ADHD drugs that were in short supply were meant to be back in normal circulation by the end of 2023, but remain hard to come by.
Some drug shortages are so serious they are putting the health and even lives of patients with serious illnesses at risk, pharmacy bosses have warned.
Health organizations have seen a sharp increase in calls from patients unable to get their usual medication. Nicola Swanborough, head of external affairs at the Epilepsy Society, said: “Our helpline has been inundated with calls from desperate people who have to travel for miles, often visiting multiple pharmacies to access their medication.”
Paul Rees, chief executive of the National Pharmacy Association, which represents most of the UK’s 7,000 independent pharmacies, said: “Supply shortages are a real and present danger to patients who rely on life-saving medicines for their well-being. Pharmacy teams have seen the problems in this country worsen over the past few years, putting more patients at risk.
“Pharmacists… spend hours a day hunting down livestock, but too often have to turn patients away. It is distressing when pharmacy teams find themselves unable to provide prompt medicine services through no fault of their own.”
Global manufacturing problems linked to Covid, inflation, the war in Ukraine and global instability have helped cause the UK’s unprecedented inability to ensure patients have access to drugs.
But Britain’s departure from the EU in 2020 has significantly exacerbated the problem, exposing the “fragility” of the country’s drug supply networks and could lead to the situation worsening, the report said.
“A clear picture has emerged of underlying fragilities at a global and UK level, which are not fundamentally rooted in Brexit but have been exacerbated by it in some specific ways, notably as some companies have removed the UK from their supply chains ,” it said.
The UK’s exit from the single market has disrupted the previously smooth supply of drugs, for example by establishing a requirement for customs checks at the border, as well as Britain’s decision to leave the EU’s European Medicines Agency and start sourcing drugs itself approve The UK is now much slower than the EU to make new medicines available, the report found.
Post-Brexit red tape has prompted some firms to stop supplying the UK altogether.
The fact that the drop in sterling’s value after the Brexit vote in 2016 coincided with drugs being in much shorter supply worldwide due to pharmaceutical firms experiencing ingredient shortages, driving up prices, also played a key role in creating the deficits.
This has forced the Department of Health and Social Care (DHSC) to agree to pay above the usual price for rare drugs to try to ensure continuity of supply much more often than before. “Price concessions” have increased tenfold from around 20 per month before 2016 to 199 per month at the end of 2022, and have the NHS in England £220 million in 2022-23, the think tank found.
The report is based on Freedom of Information requests to health bodies as well as interviews and a roundtable discussion with key figures in the drug industry, senior DHSC civil servants and European health bodies.
It warned that Brexit created “further risks … for the UK”. The Nuffield Trust said drug shortages could worsen because the EU’s 27 countries recently decided to act as a united bloc to try to reduce the impact of global shortages, making Britain’s supply even less of a priority for drug companies can let.
Dr Andrew Hill, a drug industry expert at the University of Liverpool, said: “With this background stress on global supplies, the UK is now more vulnerable to drug shortages. The UK is now behind the US and Europe in the queue for essential drugs. Other countries offer high prices and easier access, with simpler regulations for supply.”
Ministers should agree to pay more for generic drugs, which are usually much cheaper than brands, to help tackle shortages, Hill added.
The Royal Pharmaceutical Society, which represents pharmacists, has called on ministers to amend the law to allow community pharmacists to circumvent shortages by giving patients slightly different prescriptions, as their hospital counterparts already do.
“If a liquid version of a medicine is available, but tablets have been prescribed and are out of stock, the pharmacist cannot supply the liquid version,” said James Davies, the association’s director for England. “The patient has no choice but to return to the prescriber for a new prescription, causing unnecessary workload for GPs and delay for the patient.”
DHSC said most drugs remain available. “Concession pricing can arise for a number of reasons and cannot be linked to shortages,” a DHSC spokesperson said.
“Our priority is to ensure that patients continue to receive the treatments they need. There are approximately 14,000 licensed medicines and the vast majority are in good stock.”
