Drug shortages are a “new normal” in the UK and are being exacerbated by Brexit, a report by the Nuffield Trust health thinktank has warned. A dramatic recent spike in the number of drugs that are unavailable has created serious problems for doctors, pharmacists, the NHS and patients, it found.
The number of warnings drug companies have issued about impending supply problems for certain products has more than doubled from 648 in 2020 to 1,634 last year.
Mark Dayan, the report’s lead author and the Nuffield Trust’s Brexit programme lead, said: “The rise in shortages of vital medicines from rare to commonplace has been 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 obtain.
Some medicine shortages are so serious that they are imperilling the health and even lives of patients with serious illnesses, pharmacy bosses warned.
Health charities have seen a sharp rise in calls from patients unable to obtain 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 are having to travel miles, often visiting multiple pharmacies to try and access their medication.”
Paul Rees, the chief executive of the National Pharmacy Association, which represents most of the UK’s 7,000 independently owned pharmacies, said: “Supply shortages are a real and present danger to those patients who rely on life-saving medicines for their wellbeing. Pharmacy teams have seen the problems get worse in this country over recent years, putting more patients at risk.
“Pharmacists … are spending hours a day hunting down stock, yet too often have to turn patients away. It’s distressing when pharmacy teams find themselves unable to provide a prompt medicines 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 can access drugs.
But Britain’s departure from the EU in 2020 has significantly aggravated the problem, laid bare the “fragility” of the country’s medicines supply networks and could lead to the situation worsening, the report said.
“A clear picture emerged of underlying fragilities at a global and UK level, not fundamentally rooted in Brexit but exacerbated by it in some specific ways, especially through some companies removing 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 through the creation of a requirement for customs checks at the border, as has Britain’s decision to leave the EU’s European Medicines Agency and start approving drugs itself. The UK is now much slower than the EU at making new drugs available, the report found.
Post-Brexit red tape has prompted some firms to stop supplying to the UK altogether.
The fact that the fall in sterling’s value after the Brexit vote in 2016 coincided with drugs being in much shorter supply globally due to pharmaceutical firms experiencing shortages of ingredients, which drove up prices, has also played a key role in creating the shortages.
That has forced the Department of Health and Social Care (DHSC) to agree to pay above the usual price for drugs that are scarce to try to ensure continuity of supply far more often than it used to. “Price concessions” rose tenfold from about 20 a month before 2016 to 199 a month in late 2022, and cost the NHS in England £220m in 2022-23, the thinktank 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 drugs industry, senior DHSC civil servants and European health bodies.
It warned that Brexit had created “further risks … for the UK”. The Nuffield Trust said drug shortages could get worse because the EU’s 27 countries have recently decided to act as a unified bloc to try to minimise the impact of global scarcity, which could leave supplying Britain even less of a priority for drug companies.
Dr Andrew Hill, an expert in the drugs industry at Liverpool University, said: “With this background stress on global supplies, the UK is now more vulnerable to drug shortages. The UK is now stuck 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 medicines, which are usually much cheaper than branded ones, to help tackle shortages, Hill added.
The Royal Pharmaceutical Society, which represents pharmacists, urged ministers to amend the law to allow community pharmacists to circumvent shortages by giving patients slightly different prescriptions, as their counterparts in hospitals already do.
“At present, if a liquid version of a medicine is available but tablets have been prescribed and are out of stock, the pharmacist cannot provide the liquid version,” said James Davies, the society’s director for England. “The patient has no choice but to return to the prescriber for a new prescription, which causes unnecessary workload for GPs and delay for the patient.”
DHSC said most drugs remained available. “Concessionary prices can arise for various reasons and cannot be linked to shortages,” a DHSC spokesperson said.
“Our priority is to ensure patients continue to get the treatments they need. There are around 14,000 licensed medicines and the overwhelming majority are in good supply.”
