Medicines Shortages: The Real Underlying Issues

Our conversations with NHS Chief Pharmacists around their top challenges and issues almost inevitably end up on the topic of medicines shortages. It is, therefore, interesting to see this topic hit the headlines today: “Pharmacists warn of a surge in shortage of common medicines” (link to BBC News article here). As with many news headlines written at the moment, it is implied that this is an impact of the uncertainty surrounding Brexit. However, in reality, shortages are a daily issue for all NHS organisations, which are managed admirably by teams of Pharmacists and Pharmacy Technicians in NHS Trusts across the country, constrained by resources and limited supply chain tools.

In our experience a typical NHS Trust utilises 1 team member (one Trust as high as 2.5 team members) managing shortages, which represents at least £4m in workforce costs and many more times that figure in purchasing alternatives.

To prepare for a potential no-deal Brexit, manufacturers and suppliers have been requested to increase inventories by at least 6 weeks in order to mitigate the impact of any supply disruptions in the short term, whilst Trusts have been asked to operate as normal. This is a crude and expensive approach (six weeks’ worth of medicines stock for the NHS is valued at £2.0bn) to mitigate importation delays but may be successful in the short term, providing all entities in the supply chain act homogeneously. Organisations naturally take independent decisions in their own interest and in the case of NHS Trusts in the interest of their patients. This can result in unintended, but significant consequence when the supply of lifesaving medicines fluctuates.

Stockpiling alone will not address the underlying challenges faced by Pharmacists, which existed long before any no-deal planning. The attention on the medicine’s supply chain and specifically shortages going into a period of uncertainty gives the NHS the opportunity to seek out best practice in supply and demand planning. While it is a cliché to reference other sectors when referring to the NHS, we are consistently asked how FMCG, retail and automotive plan, forecast and manage their supply chains and strongly believe there are learnings that are relevant to the supply of £17bn worth of medicines to the NHS.

Data exists and while utilising it to make relevant supply chain decisions is easier said than done, there is huge value potential; both in terms of direct costs and managing supply risks such as shortages. Longer term demand forecasts can be provided to suppliers, who in return could share data on their supply chain performance. This would enable a clearer view on any potential shortages and the adoption of tactics to mitigate this risk earlier than it can be achieved today. The willingness to share data will be dependent on the length of contracts and level of commitment, and so this should be considered carefully when procuring medicines.

There is also a need for improved technology to enable this big data to be aggregated and matched quickly and efficiently, and in line with the Scan4Safety objectives to use common identifiers. The same medicine can have a different description and identifier in every organisation which makes mapping spend to actual activities a hugely manual task.

These steps are by no means easy to implement, and as such the system should consider the capacity and capability required to meet this challenge combining Pharmacists and Supply Chain expertise and underpinned with best in class tools.

With or without a Brexit deal, medicines shortages will continue to be a problem and the root causes should be given the focus they deserve.