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The All-Party Parliamentary Group (APPG) on Pharmacy has launched an inquiry into the ongoing issue of medicines shortages in England, focusing on their impact, contributing factors and potential solutions. As part of this inquiry, the APPG has issued a call for written evidence from key stakeholders across the healthcare sector, including pharmacists, pharmacy teams, GPs, prescribers, patient groups, professional organisations and medicines manufacturers and distributors. This inquiry comes in response to the growing concerns about the impact of medicines shortages on patient care and the challenges faced by pharmacy teams in dispensing medicines in a timely way. The APPG aims to develop practical recommendations to address this ongoing challenge and its impact.

A combination of factors, including the doctors' strike, medicine shortages, and funding scarcity, indicates that this upcoming winter could be the most challenging period for both community pharmacies and the NHS, Community Pharmacy England has said. In a September 4 blog post, CPE Chief Executive Janet Morrison emphasised that the relentless pressures show no signs of easing. "Pharmacy businesses, like numerous other sectors, are grappling with the challenges of staying afloat in the current economic climate, compounded by the detrimental effects of historical funding cuts." "The doctors' strike, despite ongoing assurances from the Health Secretary that their pay deal is final, will inevitably exacerbate the demand for both primary and secondary care, leading people to turn to their local pharmacies for assistance," she added. "This, in turn, will heighten the pressure on community pharmacies." "Whatever the coming winter brings I am sure of two things: that community pharmacies are going to be more critical to the health of the population than ever before, and that your representatives here will be fighting on all fronts to get you the help that you need."

A report released by the Independent Commission has blamed Brexit supply issues for medicine shortages. NHS is forced to pay extortionate prices to fulfil the demand for vital antibiotics, anti-depressants, Attention Deficit Hyperactivity Disorder (ADHD), and Hormone Replacement Therapy (HRT) drugs. The report highlights the impact of affected medicine supply issues on community pharmacies and patients. Janet Morrison, the chief executive of Community Pharmacy England, backed the report and said that the "medicine shortages and market instability appear to be as bad as they have ever been". She also explained how the Ukraine conflict, the COVID-19 pandemic, and broader economic instability also play a major factor in the situation.

Switzerland is experiencing medicine shortages due to supply chain issues linked to COVID lockdowns in China and war in Europe, the country's pharmacists association said. "We have the biggest problems with children's medications, especially fever-reducing syrup," Enea Martinelli from pharmaSuisse told Swiss broadcaster SRF. "There are also shortages of blood pressure medications, psychiatric medications and Parkinson's medications," he said.

The government has responded to the Health and Social Care Select Committee's report on community pharmacy, acknowledging 17 of the 19 recommendations. In its report published on 29 May 2024, the Committee recommended, among other things, an overhaul of the Community Pharmacy Contractual Framework (CPCF), closing the funding gap, tackling medicines shortages by introducing generic substitution, and establishing an integrated and fully funded workforce plan for pharmacy. In its response, released today, the government stated that NHS England is currently conducting an economic analysis of the sector, which will inform future proposals for funding and contractual arrangements. On medicine shortages, it mentioned that the Department of Health and Social Care, working closely with NHS England, is taking forward a range of actions to improve their ability to mitigate and manage shortages and strengthen resilience. Additionally, the government has stated that it will "publish a refreshed Long Term Workforce Plan" this summer and is "committed to growing the pharmacy workforce."

The Royal Pharmaceutical Society (RPS) England Chair Thorrun Govind has called for Government action to support pharmacy teams experiencing huge demand for their services. "Pharmacy teams are under immense pressure at the moment, in common with other NHS services, and working extremely hard with health service colleagues to provide the right care for patients," said Govind. "As winter pressures mount, pharmacies see increased numbers of patients seeking support with illness and also because they have heard other areas of the health service are struggling to cope. The society has also stated staffing pressures, alongside an increase in workload has created an extra burden which takes a toll on the wellbeing of pharmacy teams. Govind added: "Issues such as medicine shortages can also take up many hours of time for pharmacy teams tracking down medicines when they could be directly helping patients. In community pharmacies, rising costs and fairly static funding are adding to business pressures. "However, pharmacies remain the most accessible part of the health service and provide expert advice to patients without the need for an appointment and are open long hours and at weekends."

The Royal Pharmaceutical Society (RPS) in England and 19 other organisations have written to health secretary Wes Streeting, calling for a cohesive cross-government strategy to tackle medicine shortages across the UK. The letter stresses the need for actions to build supply chain resilience, support UK manufacturing, improve data connectivity, protect access to life-critical medicines, and reduce duplication across the NHS. As the government works on its 10-Year NHS Plan, the signatories emphasise the importance of ensuring patients' continued access to vital medicines, which are "an investment in their health." They underscore that the strategy would require engagement by the government across the NHS and the whole of the medicines supply chain, including manufacturers, suppliers, health professions, and patients. The letter also highlights that delays in accessing medicines could be reduced by changing legislation to empower community pharmacists to make minor amendments to prescriptions when shortages occur.

The Royal Pharmaceutical Society (RPS) has called pharmacy employers and pharmacy trade unions to come together to a round table meeting to agree on principles for a way forward that ensures patients benefit consistently from access to high quality, adequately staffed, safe pharmacy services. It has also urged the governments, NHS organisations and individual pharmacy teams to define clear prioritisation plans, which can be embedded in organisational business continuity plans which set out the pharmacy services that are essential and must always be provided and can be de-prioritised at specific levels of pressures. The challenges for pharmacies are compounded by the escalating cost of living crisis. With unprecedented levels of burnout among pharmacists, pharmacy closures and the potential for strike action, RPS has called for three things- 'professionalism, respect and prioritisation.'

Recently, the English Health Secretary has talked about introducing a 'Pharmacy First' model similar to that which exists in Scotland. This would be a win-win outcome providing people with better access to essential healthcare support, advice and treatment whilst relieving strain on other parts of the NHS, not least GPs and A&E. It is a no-brainer and yet despite a few media headlines there are still no firm proposals on the table to make this a reality. It surely cannot be right that you can receive a broad range of patient care services in Scotland which are not available in England. It works well in Scotland, Wales is keen to develop more pharmacy-based services and Northern Ireland, leaving aside the current funding dispute, has had a minor ailments service for many years. If the English Health Secretary is sincere in his interest in adopting an English version of the Scottish model, then there are critical aspects he needs to consider. Firstly, start with the patient journey through the healthcare ecosystem from illness prevention through to long-term condition management. What is the role of community pharmacy and how do we guide people to seek support from the most appropriate healthcare professional? What is the vision for community pharmacy delivering patient care in the next decade? The lesson from Scotland is that the government needs to sit down with the sector and map that out together. There are no quick fix overnight solutions. This needs to be a long-term commitment backed by adequate funding. Supervision regulations need to change and there needs to be a thought through workforce strategy which avoids community pharmacy shortages as that does nothing to deliver improved patient outcomes.

A new report commissioned by the National Pharmacy Association (NPA) has revealed harsh financial realities faced by community pharmacies in England. The report by Professor David Taylor of University College London warned that 1000s of community pharmacy closure might take place by 2024 in England if the sector was not supported with additional funds. At the launch of the report titled 'Protecting UK Public Interests in NHS Community Pharmacy', Prof Taylor said: "There will be several 1,000s of closures over the next few years unless we take appropriate action, which doesn't mean to pour money all over it, but it is to fund appropriately when necessary. "At the moment, if we got a partial collapse in the pharmacy network it would disrupt medicine supply and increase health inequalities… For me, it's missing out on the future development of better and more accessible care, which would be the tragedy of reducing, harming and damaging the pharmacy network unnecessarily."

The trade bodies and four largest pharmacy chains in England, have jointly written to the Secretary of State for Health, Steve Barclay, warning that the sector needs urgent investment for sustainability. The letter from AIMp, CCA, NPA, PSNC, Boots UK, Lloyds Pharmacy, Well, and Phoenix UK, warned that the 30 per cent real terms funding cuts that pharmacies have faced over the past seven years have left many businesses in a cashflow crisis. The letter said that the government is facing a choice over the future of the country's 11,000+ community pharmacies, with permanent closures likely and medicines supply at risk if no urgent action is taken. "If the funding situation is not addressed, the sector is likely to move rapidly towards many permanent closures of pharmacies." The organisations say that once these closures start, they will be hard to stop, as the sector is now so fragile other pharmacies would struggle to pick up the slack.

The Department of Health in Northern Ireland has announced an immediate intervention worth over £5.3m in value, and a commitment to progress wider reform arrangements in collaboration with the Community Pharmacy NI (CPNI) to support pharmacies to deal with the ongoing pressure. The Minister and Department are 'very aware of the pressures facing community pharmacies'. They discussed the situation with CPNI representatives at a meeting last week. The scale of the unprecedented budgetary pressures and uncertainty currently facing the Department were spelt out. The Department said: "Notwithstanding these pressures, CPNI were informed that a support package for their sector was being finalised. This package includes immediate interventions worth over £5.3m in value, plus a commitment to progress wider reform arrangements in collaboration with CPNI." Recently, the CPNI highlighted that community pharmacists have issued a stark warning that shortages and skyrocketing prices of many medicines could result in pharmacies being unable to supply important prescription medicines to patients.

The British Generic Manufacturers Association (BGMA) on Monday alerted the Health and Social Care Committee that medicines shortages have increased and are "around double what they were a year ago." BGMA chief executive Mark Samuels told the committee that they have been highlighting the medicine shortage risk to ministers since July 2021 and the association is "very concerned" about the current situation. "We've been monitoring it for several years now, and as you saw in the written evidence, shortages have increased. They're around double what they were a year ago. We have them at 101 shortages in February this year," said Samuels. Dr Rick Greville, director of distribution and supply at the Association of the British Pharmaceutical Industry (ABPI), highlighted that the problem of drug shortages in the UK is a "long-standing issue" and the scarcity of certain medications "continues to be challenging".

Pharmacy contractors continue to grapple with profit pressures despite many reporting significant sales revenue increases, according to Hutchings Consultants' England Pharmacy Market Update 2024. The report emphasises that gross profit margins are under considerable strain due to factors such as rising wholesale drug costs, the dispensing of certain drug lines at a loss, reduced drug tariff reimbursements, and ongoing medicine shortages. These challenges have led to a growing number of pharmacies reporting substantial declines in their profit margins this year. For instance, Cohens Chemists reported a £5.7 million loss in the last financial year, even as sales reached £253 million. Similarly, Day Lewis, the UK's second-largest independent pharmacy chain, experienced a 5.9% sales increase driven by growth in prescription dispensing, over-the-counter sales, and pharmacy services, yet faced a 32% drop in pre-tax profits due to heightened administration costs, which included inflation-driven increases in staff, energy, utilities, and rent. The average profit margin has declined to 33% in 2024, down from 34.4% the previous year.

Instability in the supply chain network is frequently undermining the profit margins in community pharmacies, former Pharmacy Minister and Chair of the Health and Social Care Committee Steve Brine has said. Brine emphasised that community pharmacies often lack information about the prices wholesalers charge for essential generic medications. "They lack visibility into scarcity, and the pricing of these products is often significantly higher compared to other European countries," the former minister remarked during a parliamentary debate focused on the future of community pharmacies on September 14. From financial pressures to workforce crisis and pharmacy closures, the debate delved into critical challenges faced by pharmacies, aiming to propose tangible solutions for a sustainable future in the sector. Chaired by Sir Mark Hendrik, the debate was initiated by Conservative MP Peter Aldous and featured contributions from a host of participants including Labour MPs Taiwo Owatemi and George Howarth among others.

Adding to the growing evidence of global medicine shortages, a new study has revealed that the European generic medicines market is "not in shape" to help Europe meet its public health priorities. In the past decade, the rate of generic medicines withdrawals has risen by 12 per cent, while there has been a three per cent decrease in the launch of generic products, as per Teva Pharmaceuticals' recent analysis of IQVIA data. Within the mental therapeutic area, seven per cent of generic products disappeared between 2013 and 2023, while there was a seven per cent decrease in the availability of generic cancer medicines in just six years (2017-2022). These medicines were listed on the Union List of Critical Medicines to help avoid potential shortages, as the European Commission (EC) said this could cause "significant harm to patients and pose important challenges to health systems." While mature generic products constitute the majority of the List, they remain susceptible to withdrawals, despite containing products crucial for safeguarding Europe's public health, the Teva analysis report noted. Since 2013, the number of generic products for the treatment of schizophrenia and bipolar disorder has declined by 25 per cent, with Hungary and Bulgaria experiencing the biggest loss at 83 per cent and 58 per cent respectively.

A new report from the Royal Pharmaceutical Society (RPS) has called on the government to create a national strategy to manage medicine shortages and to change legislation to empower community pharmacists to amend prescriptions when medicines are in short supply. Currently, patients are required to return to their GP to get their prescriptions amended, leading to delayed access to medication, increased bureaucracy, and additional strain on an already overburdened system. The RPS report, backed by charities and patient groups, proposes allowing pharmacists to make minor amendments, such as adjusting the quantity, strength, or form of prescribed medicines to ensure timely access for patients. Additionally, the report highlighted key factors causing medicine shortages, including manufacturing and supply chain issues, exacerbated by cost pressures and consolidation of manufacturing outlets. This along with unplanned spikes in demand, such as shifts in prescribing practice or increased diagnosis of some conditions, have created "a perfect storm of unstable supply"

In the parliamentary drop-in-event hosted by Community Pharmacy England last week, Members of Parliament (MPs) questioned the Health Secretary on the rising issue of medicines supply. "Eighteen community pharmacists in my constituency are reporting challenges on medicine supplies. What more is the Minister going to do to get a grip of this situation?", Mike Amesbury MP for Weaver Vale, who was present at the event last week, asked the Health Secretary. In his response, the Health Secretary, Steve Barclay MP said: "We have a long-standing team in the Department focused on medical supplies, which are a continual issue; as a matter of routine business, there are often challenges in that area." The Shadow Pharmacy Minister, Karin Smyth MP, also asked: "People across the country rely on local, accessible pharmacies, but whether it is high street closures or supply problems leading to the absurd situation where women are phoning or visiting multiple pharmacies for a prescribed dose of hormone replacement therapy and other drugs…They have repeatedly announced plans to expand the role of community pharmacies but have failed to update legislation that could possibly help. … Why will they not do so?

A Lake District pharmacy is grappling with significant medication supply issues, affecting its ability to provide essential drugs to customers amidst nationwide drug shortages. According to Simon Butterworth, whose family has operated Collins & Butterworth Pharmacy in Hawkshead for nearly 40 years, voiced his concerns to the ITV stating that the staff is "having to spend time hunting for (medications), looking for it or doing our best to find ways to solve that problem" for distressed patients. "They've got to know when they can get the medications they need," he added. Butterworth also highlighted the financial strain pharmacies face due to the NHS's fixed tariff system. "Certain items are actually costing more to buy than we get paid for them by the NHS. An item we were trying to get this morning was 250 per cent higher than the tariff price, which is significant and builds up over lots of items," he explained.

The National Pharmacy Association (NPA) has asked the Secretary of State for Health and Social Care to convene a 'medicines supply taskforce', following weeks of problems with antibiotics supplies. The NPA's chief executive Mark Lyonette wrote a letter to Steve Barclay this week. It cited the precedent of the HRT Taskforce which this summer brought together representatives from across the supply chain after months of supply problems affecting women. "We strongly believe that this situation calls for a similar response from the government. It is imperative that we resolve this supply situation urgently and therefore we request that you convene a Medicines Supply Taskforce, with all the relevant stakeholders in the supply chain, to urgently discuss and agree practical solutions to address the disruptions to the supply of medicines. HRT and antibiotics are the most visible examples of a wider problem with medicines supply which needs to be addressed." NPA board members Olivier Picard and Reena Barai were among the stakeholders joining meetings convened by the HRT Taskforce this summer.