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GP workload increasing following all time high medicine shortages

GPs have told Pulse they are spending increasing amounts of time dealing with requests for medicines switches due to shortages of common drugs.

One GP said in a recent on-call shift around a third of the queries he received had related to sorting alternative prescriptions.

Another described shortages as a ‘huge problem’ and called for better systems to flag up to prescribers when a medicine was unavailable.

The RCGP said it understood shortages were ‘happening more frequently at present’, and called for contingency measures to be put in place. 

Pharmacists have made repeated warnings in recent months that they are struggling to get hold of many common medicines.

In April, 71 medicines were included on the price concessions list – those drugs for which the Department of Health and Social Care has agreed to pay more because of short supply – following an all time high of 96 medicines in March.

As of 28 May, there were 43 medicines on the price concession list, however PSNC said it was ‘still working with the DHSC’ to agree further concessionary prices on other drugs for the month of May. 

There are several potential reasons for the shortages, including manufacturing issues and availability of raw ingredients, with Brexit also being blamed by some as making matters worse.

Dr Dean Eggitt, chief executive officer for Doncaster LMC, said medicines shortages are a ‘huge problem currently’ and that in his region alternative stock is rarely advertised.

He said: ‘We’re spending increasing time on medication switches for unavailable items.’

Dr Samuel Finnikin, a GP in Sutton Coldfield and research fellow at the University of Birmingham, said having to deal with medicines switches was having a big impact on workload.

He said: ‘It’s frustrating when we’re struggling under increasing workload pressures across the board.’

He said the problem seemed to be getting worse by the day and that in a recent shift a third of his admin work related to medicines shortage problems for simple drugs including nasal steroids, montelukast and nifidepine.

‘It is more apparent when it is a commonly prescribed medication – for example naproxen caused some difficulties at the end of last year, and HRT is a major issue at the moment,’ he added.

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He said discussions with colleagues had shown differences in how shortages were managed, for example in some areas pharmacists had forms suggesting suitable alternatives but in some regions GPs were left with no information on what was available.

When Dr Finnikin raised the topic on social media, GPs from around the country responded to confirm medicines shortages were becoming increasingly time-consuming and frustrating to manage.

Professor Helen Stokes-Lampard, chair of the RCGP, said: ‘We understand that shortages of certain medicines and medical devices happen for a wide variety of reasons and that shortages are happening more frequently at present.’

She said it was key that contingency plans and supplies of alternative options are put in place and that GPs and other healthcare professionals are clearly informed of the shortages and the most suitable alternatives ‘so that we don’t have to spend our scarce time searching for this information and that disruption is minimised’.

Mike Dent, director of pharmacy funding at Pharmaceutical Services Negotiating Committee, which agrees price concessions with the DHSC, said while medicines shortages were not a new phenomenon, pharmacies are increasingly reporting difficulties.

He said this is due to a combination of factors, such as manufacturing issues, availability of raw ingredients, increased demand and product recall as well as uncertainty around Brexit and contingency planning potentially adding to the problems.

He said pharmacy teams were working hard to get hold of medicines which may mean having to call seven or eight wholesalers but may need to liaise with a GP as a ‘last resort’.

He said: ‘Unfortunately, this last resort is becoming more common and issuing a new prescription may be the best route for the patient to receive treatment quickly.

‘We recognise the additional workload medicine shortages bring to GPs and pharmacists and collaborative working at a local level is essential.’

A Department of Health and Social Care spokesperson said: ‘We have well established processes, working closely with GPs and others in the supply chain, to help ensure that any risks to patients are minimised when supply issues do arise. We are aware of some recent issues affecting primary care and are working closely with suppliers to seek assurances that supply problems are being addressed.

‘The vast majority of medicines are not subject to supply problems and every day over twp million prescription items are successfully dispensed in England.’

Earlier this year, Pulse reported that nearly two-thirds of primary care staff predict that Brexit will worsen medicine shortages