Medicines shortages are increasing professional tensions between GPs and pharmacy teams, a report has warned.
In both primary and secondary care settings, medicines shortages are ‘often viewed as a pharmacy issue by healthcare teams with little appreciation of the wider context in which shortages occur’, the report from the Royal Pharmaceutical Society (RPS) suggested.
And it set out a series of solutions in which healthcare providers could work together to mitigate the problem, including one that involves training GP receptionists to advise patients unable to get hold of their medicines (see also box below).
The document said that community pharmacy’s ‘unstable economic model’ was ‘potentially contributing to local shortages’, while ‘just-in-time supply chains can exacerbate supply issues, and a lack of visibility into stock levels in primary care hampers collaboration to manage shortages effectively’.
This comes as the RPS has called for a national policy on medicines shortages and other practical changes including enabling community pharmacists to amend prescriptions.
The report is based on engagement with patients, the pharmacy profession, wider healthcare professionals and stakeholders in medicines supply.
It was supported by an independent advisory group including stakeholders from across Great Britain and chaired independently by Bruce Warner, former deputy chief pharmaceutical officer for England.
‘Professional tensions are added to by the lack of clear and timely information about medicines shortages, differences in availability of medicines nationally and locally, limited information about the anticipated resupply of a medicine locally, and a lack of information and understanding of the root causes of medicines shortages,’ the report said.
Community pharmacists quoted in the report said they had to ‘liaise continually with prescribers to amend prescriptions for patients to different brands or strengths of tablets’.
Meanwhile, one GP quoted described ‘five people chasing around to get one prescription supplied’, with the practice pharmacist not having up-to-date information about what was in stock locally.
And the RPS reported that there were fewer appointments available for patients because practice pharmacists or GPs were needing to spend time making changes to prescriptions or managing shortages.
In one ICB, community pharmacies reported spending one to two hours a day resolving shortages through phone calls to patients, GP practices and wholesalers, on a local WhatsApp group dedicated to shortages, or organising and collecting stock.
And local GP practices said they were spending between one to two hours a day changing prescriptions, looking up what the alternative medicines are, checking if pharmacies have the stock, and reassuring patients.
The RPS said that it had heard of ‘increasing frustration between GP practices and community pharmacies, and also between hospital clinical multidisciplinary teams and the pharmacy department’.
And conflict in the management of patients requiring more specialist treatment resulted in them being ‘stuck between general practice and secondary care specialists’.
‘This was cited for shortages of ADHD medications, where there was limited specialist capacity in hospitals to meet the demand created by the shortages, and limited confidence in general practice to alter consultant-initiated therapies,’ the RPS said.
In a survey with 123 respondents from across the UK, more than 50% of patients told the RPS that they felt they didn’t get enough help from healthcare professionals when they couldn’t get the medicines they needed.
And they reported that different parts of the healthcare system and different professionals dealt with medicine shortages inconsistently.
Patients said they needed better and more timely communication about when their medication was likely to be available again and what they should do while it was out of stock.
Meanwhile, healthcare professionals told the RPS that a lack of timely national guidance resulted in duplicated effort, with local systems developing their own response to shortages before national guidance was in place.
The RPS recommended that the Department of Health and Social Care/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’.
Funding should be made available to develop the tool so that it could be integrated into prescribing systems ‘to alert prescribers to shortages and enable alternatives to be prescribed in real time’, as well as to provide proactive updates such as when medicines are no longer in shortage.
The RPS report highlighted examples of community pharmacies and GP practices using software solutions ‘that enable direct, digital, two-way communication between community pharmacists and GPs to resolve medicines supply issues more rapidly’.
Other local solutions highlighted in the report included:
- Community pharmacists telling prescribers what they are able to supply when an alternative is requested
- Practice receptionists being trained about initial advice to give to patients unable to get a supply of medicines
- Patients prescribed a medicine in shortage being given a code that they can use at any pharmacy, avoiding delays for patients having to have their prescription transferred
- A community health trust using nurse prescribers to change prescriptions quickly for patients
- Local WhatsApp groups that include community and practice-based pharmacists, used to identify where stock is available
The RPS also recommended cross-sector protocols for managing shortages locally, as well as emergency protocols for life-critical medicines where patients have no alternative treatment.
‘This will require collaborative working across local systems and the use of regulatory flexibility to allow medicines to flow between primary and secondary care. There should be national/regional oversight to ensure this happens,’ the report recommended.
Meanwhile, regional procurement specialists should be funded and recruited to work with ICBs or the equivalent in other nations ‘to facilitate the development of cross-sector approaches to acute medicines shortages’.
ames Davies, RPS director for England and co-author of the report, said it was ‘essential’ to take a new approach to medicines shortages.
‘A properly resourced UK-wide medicines shortages strategy that helps prevent and manage shortages would greatly improve the resilience of the supply chain,’ he said.
‘This would relieve stress and anxiety for patients and free up time for pharmacists to focus on patient care rather than constantly chasing down supplies.’
And he said the secretary of state for health should ‘give pharmacists the authority to act in the best interests of their patients’ by enabling them to amend prescriptions in the case of shortages.
Three quarters (74%) of GPs experience moral distress because they are unable to prescribe medicines patients need due to ongoing shortages, according to a survey carried out by MDDUS earlier this year.
Nearly half (45%) also reported that they have seen patients’ health deteriorate as a result of medicine shortages.
A version of this article was first published by our sister title The Pharmacist
