Empty shelves: drug shortages in the UK

Article by Lily Fitzgerald, MSc; Medical Writer at EPG Health

In recent weeks, the UK has been facing difficulties with drug shortages in pharmacies across the country

However, issues with the UK’s medicine supply system have been present for more than a year now¹. There are many contributing factors at play:

• Since March 2020 the COVID-19 has affected drug supplies globally²
• Issues with supply and distribution¹
• Higher rates of infection and demand¹
• Longer prescriptions¹

Why is the UK in this situation and what will happen next?

Empty shelves for basic medicines

The Association of Independent Multiple Pharmacies recently issued a warning of cold and flu medicine shortages in the UK³

There have been reports of shortages of basic medicines for colds and flu in pharmacies across the UK, such as throat lozenges, cough mixtures and some over-the-counter painkillers^3-5. The tail-end of the COVID-19 pandemic and the Christmas season have created more exposure to respiratory infections⁵. This, combined with more indoor mixing and waning immunity and growing rates of infections, is thought to have spiked cases of cold and flu⁵.

Additionally, more patients are choosing to treat themselves with self-care or over-the-counter products⁵. Branded products such as Lemsip, Calpol and Nightnurse in particular have been missing from shelves³.

Some pharmacists accuse UK ministers of a ‘lack of planning’ for what could have been an avoidable problem⁴, and a survey from July 2022 reported 54% of pharmacists thought drug shortages were putting patients at risk¹. But it’s not only over-the-counter products that are running low, prescription drugs, such as antibiotics and antidepressants, are being affected too.

Serious shortage protocols

Serious shortage protocols (SSPs) are issued in the UK when the Department of Health and Social Care (DHSC) makes the decision that there is a major shortage of a drug or medicine⁶. During an SSP, pharmacists can dispense alternative medicines without contacting the patient’s general practitioner first⁶.

As of the 17 January 2023 there were 16 drugs in total with currently issued SSPs by the DHSC⁷

Drugs with SSPs at this time in the UK are⁷:

• Eight types of phenoxymethylpenicillin, an antibiotic used to treat infections, since December 2022
• Two types of atorvastatin chewable tablets, used for treating high cholesterol, one since May and one since November 2022
• Five types of oestradiol (including patches and gel sachets), a form of oestrogen, three since May 2022 and two since September/November 2022
• Fluoxetine 10mg tablets, a selective serotonin reuptake inhibitor (SSRI), since March 2022

Phenoxymethylpenicillin is used to treat Streptococcus A (Strep A) and scarlet fever, of which there have been sharp rises of cases in the UK. According to UK government data, there were 4,622 notifications of scarlet fever in England from Week 37 to 46 this season (2022-2023), and 851 in Week 46⁸. The average for the same period over the last 5 years is 1,294⁸. This increase in cases has led to an unexpected increased demand for phenoxymethylpenicillin and has resulted in drug shortages.

Local pharmacies left out of pocket

The effect of drug shortages isn’t as simple as not being able to provide patients with the right medicines at the right time. It is also affecting pharmacies. As many drugs are in short supply, the wholesale prices of drugs have risen, putting financial strain on community pharmacies⁹.

Pharmacists are not always able to receive timely advice for alternative medications from the NHS when shortages occur.

Drug supply and distribution

Not only increased demand, but also manufacturing issues, distribution problems, supply quotas or medicine pricing can be factors in drug shortages¹⁰. Due to Brexit, the UK’s reputation as a good place to do business has suffered and drug taxes are high¹. A shortage of shipping containers is a problem globally, causing delays to imports and exports of drugs¹. If medicines were prioritised over other products, such as clothing for example, this could potentially combat some of the delays¹.

However, there are UK distribution problems, mainly due to a lack of workforce¹. Delays in authorisation by the Medicines and Healthcare products Regulatory Agency (MHRA) also have a knock-on effect to drug supply.

The UK could consider the following to combat some of the problems due to its drug shortages¹:

• Predicting changing demand in particular drugs ahead of time
• Reducing drug taxes
• Faster action on supply issues
• Improving pay for the UK distribution workforce
• Reducing delays in MHRA drug authorisation
• Providing healthcare professionals timely advice for alternative medicines

A global issue

Drug shortages are not necessarily confined to the UK. In recent years the Pharmaceutical Group of the European Union has reported large numbers of drug shortage across Europe¹¹. In addition, the past seven years has seen the demand for hormone replacement therapy (HRT) rise by 38% and limited manufacturing capacity has created problems with short supply¹¹. In some cases, this can lead to abuse of primary care staff from frustrated patients who are unable to access their medicines¹².

Looking forward, we need to work together as nations, health services, organisations and communities to ensure all patients have access to the drugs they need, avoid pharmacy closures and further crises

References

1. Wickware C. The Pharmaceutical Journal. Fixing the UK’s medicines shortage crisis. https://pharmaceutical-journal.com/article/feature/fixing-the-uks-medicines-shortage-crisis.
2. Salahuddin M, Manzar D, Unissa A, Pandi-Perumal S, BaHammam A. The global shortage of essential drugs during the COVID-19 pandemic: Evidence based on aggregated media and social media reports. Journal of Nature and Science of Medicine. 2022;5(1):23-28.
3. Association of Independent Multiple Pharmacies. National Media. https://www.aimp.co.uk/media-activities/national-media. Accessed 16 January 2023.
4. Ambrose T. The Guardian. Shortage of cold medicines in UK is government’s fault, say pharmacists. https://www.theguardian.com/society/2023/jan/04/shortage-of-cough-and-cold-medicines-in-uk-is-governments-fault-say-pharmacists. Accessed 13 January 2023.
5. Knibbs J. Evening Standard. Pharmacists warn of major shortages of cold and flu medicines across the UK. https://www.standard.co.uk/news/uk/cold-flu-medicines-shortages-uk-pharmacists-lemsip-night-nurse-b1050550.html. Accessed 13 January 2023.
6. The NHS Business Services Authority (NHSBSA). Endorsing serious shortage protocols (SSPs). https://www.nhsbsa.nhs.uk/endorsing-serious-shortage-protocols-ssps-0. Accessed 16 January 2023.
7. The NHS Business Services Authority (NHSBSA). Serious shortage protocols (SSPs). https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/serious-shortage-protocols-ssps. Accessed 17 January 2023.
8. UK Health Security Agency. Group A streptococcal infections: report on seasonal activity in England, 2022 to 2023. https://www.gov.uk/government/publications/group-a-streptococcal-infections-activity-during-the-2022-to-2023-season/group-a-streptococcal-infections-report-on-seasonal-activity-in-england-2022-to-2023. Accessed 13 January 2023.
9. Grant K. inews. NHS crisis: Thousands of pharmacies left out of pocket by DHSC on the brink of closur. https://inews.co.uk/news/health/nhs-crisis-why-local-pharmacy-closure-busier-than-ever-2078864?ito=social_ifb_theipaper. Accessed 13 January 2023.
10. Pharmaceutical Services Negotiating Committee. Medicine Shortages. https://psnc.org.uk/dispensing-and-supply/supply-chain/medicine-shortages/. Accessed 17 January 2023.
11. Wise J. Why are there shortages of HRT and other drugs in the UK? BMJ. 2022;377:o1183.
12. Iacobucci G. Drug shortages leave primary care staff exposed to abuse from frustrated patients. BMJ. 2022;377:o1100.