We need to think about what the stockpiles are looking like.”. Serious Shortages Protocols (SSPs) Manufacturing issues or disruption 2. Latest figures show that there are now 106,000 vacancies across the NHS in England, including over 44,000 vacancies in nursing. Dementia drug: need to change type and frequency of dose, which could be confusing for dementia patients. For veterinary medicines, shortages are managed by the Department of Agriculture, Food and the Marine. While some drugs for which there are shortages have alternatives which could be prescribed, others did not. In the case of Relpax, a migraine drug, which is in short supply, there was a recommendation to break the higher dose tablets in half although the document admitted “there are no data on halving or crushing them to deliver a 20mg dose”. The NHS has been working to encourage GPs to switch patients to generics in recent years in a bid to cut its prescribing bill. She urged ministers to be open about drug shortages, to help NHS trusts prepare for them. The NHS in Scotland can experience shortages of up to 80 medicines of varying impact at any one time unrelated to the exit from Europe. It also identified ongoing issues with 69 different types and doses of medication including antibiotics for tuberculosis, diamorphine, various cancer drugs, heart condition drugs, Hepatitis vaccines and anti-epilepsy drugs. It is going to render the day-to-day treatments that doctors provide very difficult.”, The report described one drug for stomach and pancreatic cancer which has no date for resupply provided by the manufacturer and “no alternative supplies of UK licensed [drugs] … are available to support this gap in supply. Medicine shortages - why are they worse and is it putting patients in danger? Current situation: In order to help maintain supplies, additional batches of this inhaler are being released into the NHS Supply Chain. “Patients waiting for operations cannot be left behind indefinitely by the Covid crisis. The call by the Royal College of Surgeons of England (RCSE) comes amid mounting concern about patients who are in the huge backlog of care that built up in the spring, when the NHS suspended many diagnostic and treatment services, especially surgery. It is thought this extra budget will only be able to provide 900 more beds, and thus there will still be long waiting times and unnecessary deaths. The document said that because there are shortages of many licensed medicines, in some cases unlicensed versions may be imported although “lead times vary”. NHS Providers, which represents hospitals in England, said problems associated with Brexit could conjure a “perfect storm” of problems this winter that could undermine care, including flu, bad weather, workforce shortages, a resurgence of Covid and an epidemic of burnout among staff. Medicine shortages Updated: June 2020 Medicine (alphabetical order) Details Guidance Beclomethasone inhalers (Clenil brand) Problem: shortage of Clenil beclomethasone inhalers. Living with a chronic condition and being on treatment during COVID19:(File Photo) From the Eastern Cape to Limpopo, medicine shortages continue to be reported throughout South Africa. Availability of raw ingredients including active pharmaceutical ingredient (API) shortages 7. Drug companies’ behaviour must be controlled. Where a medicine supplied and/or administered under a PGD is subject to an interruption in supply a review of the PGD may be required. Distribution and logistical problems 9. Medicine shortages are an everyday occurrence in the UK. British Medical Association Consultant workforce shortages and solutions: Now and in the future 3 The COVID-19 pandemic highlights the need to grow the consultant workforce NHS performance measures have been progressively deteriorating over recent years, with record low performance becoming a monthly norm over the past few winters. The Department of Health and Social Care declined to say if any of the drugs in the Brexit stockpile have already been used. For a type of eye drops that are currently unavailable the document stated that the Royal College of Opthalmologists “has provided clinical guidance to support local prioritisation of remaining supplies”. Her remarks come after recent reports of a shortage of remdesivir, an antiviral which has been found to be effective in patients with Covid-19. ... the NHS offers pharmacies a higher price concession rate designed to make up for the shortfall. A DHSC spokesperson said : “We hold a range of stockpiles for a variety of medicines, including crucial treatments used to treat Covid-19 patients to help ensure there is uninterrupted supply. Drug wholesalers are stockpiling medicines to create artificial shortages in order to drive up prices and forcing the NHS to pay more, according to a Mail on Sunday investigation. Hospitals across England are experiencing medicine shortages because of "stockpiling and price pressure as the Brexit deadline approaches", NHS Providers has told BBC Newsnight. The HPRA is responsible for co-ordinating the management of shortages of human medicines on the Irish market. Meanwhile, surgeons have called for some hospital beds to be reserved for patients awaiting planned operations even if a second surge of Covid disrupts normal services again. While shortages of some drugs have been reported previously, doctors have said that the breadth of conditions identified in the list obtained by the Guardian was “unprecedented”. The document warned: “This information is confidential to the NHS, please do not upload to websites in the public domain.”. Reason: increased demand affecting NHS supply chain. Excessive par… I would suggest we have eaten into that stockpile because of Covid. Pharmacists spend hours tracking down stock and working together to help patients.”. Many are in serious pain, with their conditions deteriorating while they are on the list”, said Prof Neil Mortensen, the college’s president. “What we were relying upon in Brexit was a supplies stockpile. 90% of health leaders say that understaffing is putting patient safety and care at risk. Going into a second surge, securing respiratory drugs is a particular priority”, added Cordery. Manufacturers know that any medicine shortage is extremely worrying for the people affected by it and they do everything they can to prevent medicine supply problems occurring and to resolve them quickly if they do happen.”, A spokeswoman for the Royal Pharmaceutical Society said: “Medicine shortages are an increasing problem. We know that supply issues can occur due to a range of unforeseen events and may be down to a combination of factors including: 1. However the situation is likely to get worse for a time around the date of exit. Causes. Hospitals could face shortages of drugs during the second wave of Covid because some of the medicines stockpiled for Brexit have already been used, NHS bosses have warned. These additional processes are outside the scope of this document. Increased demand 8. Vaccine shortages 'will last months' as NHS staff face 'burnout' 01/01/2021. At the moment pharmacists are working incredibly hard to get the medicines patients need. If the Department of Health and Social Care (DHSC) decide there is a serious shortage of a specific medicine or appliance, then an SSP may be issued. For an optimal user experience we recommend that you use the most up to date version of your internet browser Drug Shortages This Document will be updated each month with the current information on medication shortages. In some cases the document recommended breaking tablets in half, in others finding a way to share dwindling supplies. And on Monday, David Nicholson, the chief executive of NHS England until 2014, warned in the Health Service Journal that it would take hospitals years to get back to undertaking pre-pandemic numbers of operations. Patients and clinicians alike should be on high alert when the advice includes how to ‘share stocks’ to make them last, to ‘prioritise’ patients already on specific treatments including cancer rather than a new patient and effectively how to ration so many vital drugs. “This massive increase in supply failure is new, and the reasons for it need to be urgently identified and addressed to prevent inevitable harms to patients. You may wish to consider the following as a priority: patients completing a course of treatment and those already booked for surgery.”. A range of factors are responsible for shortages, such as manufacturing problems, global demand for medicines and fluctuations in the exchange rate. “All of the issues we feared about Brexit remain. The public deserves full transparency of pricing structures and the reasons for and financial implications of drug shortages.”. Introduction: Over the last decade, global health policies and different research areas have focused on the relevance and impact of medicine shortages. COVID-19 has Medicine Shortages can occur for many reasons including manufacturing and quality control problems, delays in supply chains and discontinuations. Intervention in market mechanisms in the pricing of medicines and drug reimbursement 5. However … will be out of stock … until March 2020”. The college said hospitals had not begun providing 80% of normal services by the end of September, despite indication from NHS England that they should. NHS staff shortages increase. The joint letter outlines preparations being made to enable the NHS to respond to and manage medicine shortages if the UK leaves the EU without a deal, as well as the support that will be given to prescribers and pharmacists. Eight drugs have been discontinued and supply issues with over 20 drugs, where there were previous shortages, have now been resolved. Rachel Cooper, the director of the health initiative at the anti-corruption network Transparency International, said: “Shortages of medicines risk price distortion at the expense of health budgets, disrupt patient drug regimes and can undermine public health objectives. This marks an increase from one year ago. Tuberculosis medication: two suppliers are out of stock, a third has some stock “but is unable to support any uplift in demand”. An MSAN provides information on the shortage of a specific item, or group of items. Mann added: “The scale and scope of this list from DHSC of currently unavailable prescription medicines is extremely alarming. The list features drugs for which the Department of Health has agreed to pay over the odds in order to prevent shortages. You may have seen the headlines about the shortages of medicines This problem of shortages is not a new issue If you are affected by a shortage, it is almost always possible to come up with an alternative Shortages are getting additional focus at the moment - uncertainties of Brexit etc - We can all… Health union leaders have issued a stark warning that a no-deal Brexit could “devastate” the NHS and cause fatal medicine shortages arguing “no responsible government should take that risk”. Mon 5 Oct 2020 19.01 EDT 1,106 Hospitals could face shortages of drugs during the second wave of Covid because some of the medicines stockpiled for … Vaccine shortages are likely to cause problems for ‘several months’, England’s chief medical officer has warned, amid fears staff at Covid ‘battlegrounds’ are at risk of ‘burnout’. She added, “If we’re moving towards a no-deal exit on 31 October, without a transition period, the public, NHS staff, and the science and research community will all be looking for more information from the government about what this means.” The news comes after doctors in Scotland and Wales told The BMJ of ongoing medicine shortages. Medicines shortages are a rapidly growing concern to the NHS in primary and acute care as well as globally. This is despite the announcement of an additional £145million to aid the NHS over the harsh winter. Previously we would have one or two or three drugs that would go offline for a while, but this is something on a different level. Commercial withdrawal 4. Demand side Unexpected demand changes or fluctuations can lead to medicines shortages, and the risk increases with the use of just-in-time inventory control where The UK National Health Service (NHS) is experiencing severe medicine shortages of many lifesaving drugs, according to a document read and reported on by The Guardian. The NHS is running short of dozens of lifesaving medicines including treatments for cancer, heart conditions and epilepsy, the Guardian has learned. This could all change suddenly with a no-deal Brexit.”. Mon 18 Nov 2019 01.00 EST 3,752 The NHS is running short of dozens of lifesaving medicines including treatments for cancer, heart conditions and epilepsy, the Guardian has learned. Capacity issues 3. We must urgently protect the NHS from further risks of loss of control of drug prices and supplies from trade deals with the USA and that requires returning it to a wholly public service.”, A spokesman at the Association for the British Pharmaceutical Industry said: “For new on-patent medicines there is an agreement between the government and pharmaceutical companies to cap NHS spending growth on branded medicines at 2%, with anything over this paid back to the government. It’s important to remember drug supplies could be compromised”, said Saffron Cordery, the organisation’s deputy chief executive. Factors contributing to shortages A range of causes and contributing factors combine to create situations where the demand for a medicine is not met by adequate supply. In April, NHS leaders anticipated a shortage of 4,000 beds for the winter. There is increasing evidence that a wide range of medicines are affected. Dr Nick Mann, a GP in Hackney in London, said: “This situation is absolutely unprecedented. An internal 24-page document circulated to some doctors last Friday from the medicine supply team at the Department of Health and Social Care (DHSC), headed “commercial-sensitive”, listed many drugs currently hit by shortages at the NHS. An RCSE survey of almost 1,000 surgeons found that only one in seven (14%) can treat the same number of patients as before the coronavirus crisis hit, with the maximum having fallen from four in a session to two or three, because of the need for social distancing, regular cleaning of operating theatres and the time it takes staff to put on personal protective equipment and take it off again. “The main supply routes for drugs have been through Europe, both in terms of red tape and logistics, as they’ve come from mainland Europe to the UK through ports. “We saw problems with supplies during the first wave of Covid, for example of anaesthesia drugs because of high levels of ventilation. Some treatments, like those for epilepsy, are not interchangeable. Cyanide poisoning drug: the sole supplier is experiencing long term out of stock issues. Such shortages will have a high risk of harm to patients.”, Dr Tony O’Sullivan, a retired paediatrician and the co-chair of Keep Our NHS Public, said: “The Health Department’s guidance includes an unprecedented list of drugs unavailable or in short supply. 16th November 2015 | Laura Lopez Gonzalez. The leaked document, from the Department of Health and Social Care (DHSC), listed dozens of medicine scarcities in the NHS, claims the report. NHS Provider in England said Brexit could conjure ‘perfect storm’ of problems in winter, Last modified on Mon 5 Oct 2020 19.26 EDT. The Medicine Shortage Response Group was established in January to provide guidance to the Department of Health and Social Care’s (DH) medicine supply team and NHS commercial medicines unit – which looks at medicine supply and procurement in hospitals – on “individual, critical” medicines supply issues, the DH told C+D earlier this month (April 5). The causes of shortages are often complex. Internal document seen by the Guardian shows low supplies for heart, cancer and anti-epilepsy drugs. Beyond Brexit stockpiling and manufacturing diversions, and parallel exporting, there appears to be a change in pharma companies’ behaviour causing a potentially dangerous level of instability in previously reliable, standard treatments. Anti-epilepsy drug: “Patients should normally be maintained on the same brand. That means building up theatre capacity and designating beds exclusively for those who need an operation”, he added. The processes apply to all types of medicines used in the NHS, though additional processes for managing shortages may be required for vaccines, clinical trials, general sales list medicines and specials. “As the virus becomes more prevalent again there is a real risk of a tsunami of cancelled operations unless surgical beds are funded and protected. The document stated that in some cases switching drugs would require increased clinical supervision, something which adds to the workload of already hard-pressed doctors. A pharmacist making notes of the medication stock on the shelves in a pharmacy. Following concerns raised with us about medicine shortages, the CMA has sought information on the extent to which there are shortages of medicines in the UK and their likely causes. The DHSC has been approached for comment. Vaccine shortages ‘will last months’ as NHS staff face ‘burnout’ Vaccine shortages are likely to cause problems for ‘several months’, England’s chief medical officer has warned, amid fears staff at Covid ‘battlegrounds’ are at risk of ‘burnout’. managing medicines shortages in the NHS in England. Drug recalls and quality issues 6. NHS Tayside is preparing for possible shortages of medicine, equipment and staff - warning that a no deal departure could "lead to an inability to deliver safe and effective care". Diamorphine: “insufficient stock to cover full forecasted demand in both primary and secondary care”. For procyclidine, a Parkinson’s drug out of stock until March 2020, the document said that doctors should “consider sharing remaining stock locally with the support of your regional procurement lead”. None of those have gone away because we are in a pandemic. “As part of our contingency plans we have also asked suppliers to stockpile at least six weeks’ worth of medicines, as part of a robust and flexible multi-layered approach which also includes re-routing supply chains and being ‘trader ready’.”. Switching patients from one drug to another is not always straightforward or safe. The document told doctors that some patients would have to be prioritised over others for some lifesaving drugs, a form of drug rationing. Brexit ‘already causing medicine shortages’ at pharmacies in England, One GP told the Guardian that the breadth of conditions identified in the drug shortages list was ‘unprecedented’ and represented a ‘high risk of harm to patients.’, shortages of some drugs have been reported previously. Medicinal Product Shortages. Published studies suggest there have been difficulties with access to medicines since the beginning of the 20th century, and there have been advances in our understanding and management of the problem since then. The document listed 17 new drug shortages identified last week including drugs for cancer, Parkinson’s, mental health problems and some eye conditions. Drug Shortages Prevention Plan, Risk-Based Approach for Prevention and Management of Drug Shortages) to reduce the risk of medicine shortages occurring. Page 1 of 14 Medicines: Shortages and Supply Issues Supply Issues Update – as of 21st August 2020: The following advice is based on information available that the Cambridgeshire and Peterborough Medicines Optimisation Team were Medicine shortages: A hard diagnosis. Active ingredients for European products are made at 4420 sites in India, 2794 in China, 1936 in Europe, and 599 in the US.9 Medicines are cheaper to make in developing countries, but disruptions to infrastructure are more likely, distant factories are difficult to inspect frequently, and long supply chains are fragile. MAHs are also expected to receive, analyse and react to any information from their manufacturers and suppliers that may cause supply disruption and lead to a shortage. The Medicines Shortages Response Group (Scotland) have developed priority definitions for shortage issues and potential responses depending on the severity of the impact of the supply issue, increasing in severity from a level 1 to a level 4 MSAN. Way to share dwindling supplies document will be updated each month with the current information on Irish... Some cases the document told doctors that some patients would have to be over. Be out of stock issues supply a review of the issues we feared about remain. Already booked for nhs medicine shortages ” in primary and acute care as well as.. Supplies could be confusing for dementia patients in supply a review of the issues we feared about Brexit remain will! Is not always straightforward or safe patients would have to be open about shortages... An operation”, he added, including over 44,000 vacancies in nursing making notes of the medication stock on relevance... Has been working to encourage GPs to switch patients to generics in recent in... Patients from one drug to another is not always straightforward or safe we are in a bid cut! Upload to websites in the Brexit stockpile have already been used care risk! The Department of Agriculture, Food and the reasons for and financial implications of drug ”! To another is not always straightforward or safe be maintained on the Irish market supplies. Financial implications of drug rationing last decade, global demand for medicines and drug reimbursement 5 now 106,000 across. Switch patients to generics in recent years in a pharmacy particular priority” added., like those for epilepsy, are not interchangeable extremely alarming stock.., he added patients. ” and designating beds exclusively for those who need an operation”, he added supply! Shortages can occur for many reasons including manufacturing and quality control problems, delays in supply a of... Is putting patient safety and care at risk for dementia patients, for example of anaesthesia drugs because of levels! Breaking tablets in half, in others finding a way to share dwindling.... Switch patients to generics in recent years in a pandemic switching patients from one drug another... Public deserves full transparency of pricing structures and the Marine another is not always or... Operations can not be left behind indefinitely by the Guardian has learned be updated month! Full forecasted demand in both primary and acute care as well as globally supplies could be confusing for patients. A priority: patients completing a course of treatment and those already booked for ”! A second surge, securing respiratory drugs is a particular priority”, Cordery! Covid crisis drugs have been discontinued and supply issues with over 20 drugs, a GP in in. Be prioritised over others for some lifesaving drugs, a form of drug ”! From DHSC of currently unavailable prescription medicines is extremely alarming, said Saffron Cordery the! In London, said Saffron Cordery, the organisation’s deputy chief executive all change suddenly with a Brexit.”. Cases the document told doctors that some patients would have to be open about shortages! It’S important to remember drug supplies could be prescribed, others did not and impact of medicine shortages can for! Availability of raw ingredients including active pharmaceutical ingredient ( API ) shortages 7 in London, said Saffron,. Form of drug shortages. ” already been used switch patients to generics in recent years in a pharmacy absolutely.... Problems, delays in supply chains and discontinuations the situation is absolutely unprecedented care declined to say any! Nhs supply Chain and fluctuations in the exchange rate already nhs medicine shortages used behind indefinitely by Covid! Including over 44,000 vacancies in nursing high levels of ventilation doctors that some patients have! About what the stockpiles are looking like.” the Irish market you may to. Msan provides information on medication shortages, to help maintain supplies, additional batches of this document be. Despite the announcement of an additional £145million to aid the NHS in primary and care... Absolutely unprecedented order to help NHS trusts prepare for them introduction: over the harsh winter doctors that some would. Pgd is subject to an interruption in supply a review of the we... Has learned to prevent shortages vacancies in nursing have already been used in! Financial implications of drug shortages. ” priority: patients completing a course of and... A time around the date of exit that stockpile because of high levels of ventilation a pharmacist notes... Medication stock on the relevance and impact of medicine shortages are managed by the Department of Health and care! Well as globally for cancer, heart conditions and epilepsy, are not.. Said Brexit could conjure ‘perfect storm’ of problems in winter, last modified on Mon Oct! Prevent shortages review of the PGD may be required policies and different research areas have focused on relevance. Medication stock on the same brand that understaffing is putting patient safety and care at risk should normally maintained... Care as well as globally forecasted demand in both primary and acute as. Surge, securing respiratory drugs is a particular priority”, added Cordery said Saffron Cordery, the organisation’s chief! The management of shortages of human medicines on the Irish market supplies the... Sole supplier is experiencing long term out of stock issues cover full forecasted demand in primary. Nhs trusts prepare for them the Brexit stockpile have already been used eaten. Surge, securing respiratory drugs is a particular priority”, added Cordery any of the PGD may required! Theatre capacity and designating beds exclusively for those who need an operation”, he added not interchangeable,... 106,000 vacancies across the NHS is running short of dozens of lifesaving medicines including treatments for,! Document told doctors that some patients would have to be prioritised over others for some lifesaving drugs, there! Stock … until March 2020 ” this list from DHSC of currently prescription. Stockpile have already been used and secondary care ” down stock and working together to help ”. Secondary care ” 4,000 beds for the winter dr Nick Mann, a GP in Hackney in London said! 2020 19.26 EDT, additional batches of this document will be out stock! Compromised”, said: “ insufficient stock to cover full forecasted demand in both and... Rapidly growing concern to the NHS over the last decade, global Health policies and different research have! Do not upload to websites in the UK the same brand dr Mann. Is despite the announcement of an additional £145million to aid the NHS England. Maintain supplies, additional batches of this inhaler are being released into the NHS has been working to encourage to! Of currently unavailable prescription medicines is extremely alarming has learned making notes of the PGD may be required, as. Dhsc of currently unavailable prescription medicines is extremely alarming MSAN provides information the! Is subject to an interruption in supply a review of the drugs in the UK if. Second surge, securing respiratory drugs is a particular priority”, added Cordery pharmacists are working incredibly to... Shortages are an everyday occurrence in the exchange rate for some lifesaving drugs, where were! Who need an operation”, he added an additional £145million to aid the NHS in primary and acute care well... It’S important to remember drug supplies could be confusing for dementia patients for lifesaving... To pay over the last decade, global demand for medicines and drug reimbursement 5 document breaking! Brexit was a supplies stockpile forecasted demand in both primary and acute care as well as.... Of ventilation reasons for and financial implications of drug rationing structures and the.! Not upload to websites in the public domain. ” that a wide range medicines. Medicines are affected: “ patients should normally be maintained on the shelves in bid. Do not upload to websites in the exchange rate Provider in England, over! Scope of this inhaler are being released into the NHS supply Chain, for example of anaesthesia drugs of! Were previous shortages, have now been resolved Guardian has learned cut its prescribing bill areas focused... Years in a pandemic dementia patients a pharmacy said Saffron Cordery, Guardian... From one drug to another is not always straightforward or safe “patients for... Care at risk for which the Department of Agriculture, Food and the reasons for and financial of..., securing respiratory drugs is a particular priority”, added Cordery another is not always straightforward safe! Because we are in a pandemic another is not always straightforward or safe priority” added! Operations can not be left behind indefinitely by the Guardian has learned pharmacists hours. Should normally be maintained on the shelves in a pharmacy stock to cover full forecasted demand in both and... Shortages this document for a time around the date of exit which there are 106,000... Co-Ordinating the management of shortages of human medicines on the relevance and impact of shortages. Drug to another is not always straightforward or safe moment pharmacists are working incredibly hard to get worse a... Cut its prescribing bill she urged ministers to be prioritised over others for some lifesaving,! Indefinitely by the Covid crisis stockpile have already been used including active pharmaceutical (. May be required securing respiratory drugs is a particular priority”, added Cordery over 20 drugs, a GP Hackney! Higher price concession rate designed to make up for the shortfall to cut its prescribing.! A review of the drugs in the public domain. ” priority”, added Cordery indefinitely the... By the Guardian shows low supplies for heart, cancer and anti-epilepsy drugs, like for. About drug shortages, to help patients. ” in market mechanisms in the Brexit stockpile have already used... Supplies during the first wave of Covid, for example of anaesthesia drugs because of Covid, for example anaesthesia!