Across the region there are increasing reports of shortages of prescription and over the counter medicines – Gaviscon, Senokot, Andrew’s Salts, pain relief gels, generic hydrocortisone and anti-diabetes insulin stimulants to name a few. But it is not just the lack of drugs, there is also the lack of pharmacies.
No pharmacist; no pharmacy
Repeatedly patients are finding their local pharmacy closed, be it temporarily or permanently. In the main these closures appear to be those owned by the three major chains, LloydsPharmacy, Boots and +Well, rather than independently owned pharmacies.
In Norfolk, the once independent pharmacy in Mundesley, recently bought by +Well Pharmacy, has had customers queuing outside; and only been served standing at the door. More often this pharmacy is closed because there is no pharmacist on the premises. Customers are directed to +Well Pharmacy in North Walsham, five miles away, which is fine if you drive unless it too is closed, as has been reported. The Cottishall branch, 12 miles away, also has erratic opening times. The Boots pharmacy in Stalham was closed on 23 September with customers directed to their North Walsham branch. The explanation on the door said they had to share the pharmacist.
“Recruiting new pharmacists and pharmacy teams has become increasingly difficult,” according to LLoydsPharmacy, when asked for comment. “There is a sector-wide shortage of pharmacists, and the profession is listed on the Home Office’s Shortage Occupation List.”
Throughout the country pharmacies are closing permanently. Boots has announced the closure of 300 stores. LloydsPharmacy withdraw 237 pharmacy services from all Sainsbury’s stores in June 2023 “in response to changing market conditions”. The company say they are reviewing their community pharmacy estate and “selectively selling” some branches with the majority of buyers being “independent pharmacy owners and local business people.”
The new model – online
Bestway National Chemists Limited, the owners of +Well state “In the UK, the pharmacy model hasn’t really moved on in the last 70 years, and we’re working to change that.”
The “new model” that the company is proposing is a prescription delivery service. They claim it “saves you having to find the time (to go to the pharmacy) – simply request your prescription online and we’ll deliver your medicine to your door.”
As residents in Poringland are finding, that’s all very well if you are IT literate and there is no delay in the delivery service.
Helen Franklin told the BBC that the medicines she ordered on 1 September had still not arrived on 25 September. Not only is the non-arrival of medication stressful to patients but abruptly stopping some medications – beta blockers, blood thinners, opioids, steroids, anticonvulsants – can cause serious adverse effects.
Just at a time when there is a national shortage of pharmacists, the Government announced they would be given extra responsibilities in an effort to reduce the workload on GP surgeries. The idea is for them to be an extra NHS resource to prescribe for some common conditions or check blood pressure. A local pharmacist knows their patients, so can act as a secondary check to ensure a doctor’s prescription is appropriate, given other medication taken. However, an online model precludes this service.
Are surgery pharmacies the solution?
The rural village of Mundesley has both a +Well pharmacy and a surgery with a dispensing doctor’s practice. But much to the frustration of villagers, those who live within one mile (as the crow flies) of the surgery cannot collect their prescriptions from the surgery dispensary.
The law on dispensing doctors and on site pharmacies is complicated. A pharmacy may open in a dispensing doctor’s practice and supply medicines to their dispensing patients on the doctor’s behalf (that is to those patients that live further away than a 1 mile radius from the practice) as well as to non-dispensing patients (those that live within the 1 mile radius). But there are logistical difficulties that inhibit this; NHS England will need to know that the pharmacy is able to distinguish between prescriptions for the GP’s dispensing patients and those for other patients.
Is Brexit the cause of drug shortages?
Pharmacies are not just battling a shortage of pharmacists. They are also experiencing serious difficulties getting stocks of certain medication. The UK isn’t the only country affected – in many cases, it’s global.
Germany is also facing problems with a shortage of qualified pharmacists and issues with the supply of medicines. “Most of our medicines come from China or India and if there are delivery problems, we have shortages” said Constanze Seidelman. “We are discussing how to establish production again in Germany. But that is more expensive and could lower the profits of big pharma. Or it will lead to higher costs for health insurance. So it is still only at the discussion stage”.
Sometimes medicine shortages are the result of random factors. According to high street pharmacists the explanation for the shortage of anti-diabetes pens is because of the latest research that semaglutide drugs like Wegovy, a medicine that stimulates the release of insulin, aid weight loss. When this news went viral on social media, demand skyrocketed leading to supply shortages and a particularly worrying time for those with diabetes.
The shortage of Gaviscon, a popular medicine for treating heartburn, is due to a bad harvest. The antacid is made from alginic acid which is found in a specific seaweed only grown in Norway. Australia reported shortages last year and there are ongoing issues with stock in the UK. Pharmacists report that in a situation like this there is a knock-on effect causing a run on other brand antacids leading to further shortages and more empty shelves.
Someone once said “Every prescription filled by a pharmacist is a story of hope, healing, and compassionate care.” Sadly, little by little, the hope is disappearing.
