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Representatives from pharmacy organisations were asked for their insights into why community pharmacies continue to endure medicines shortages during a Lords inquiry yesterday.

Giving evidence to the Lords Public Services Committee inquiry on medicines security, Martin Sawer, the executive director of the Healthcare Distribution Association (HDA) which represents pharmaceutical wholesalers, said the supply chain “was very resilient” but insisted his organisation was concerned that “incentives” were “driving behaviours” and weakening that resilience. 

“In the UK, the supply chain and delivery mechanisms are very, very good and they’re driven by incentives,” he said.

“Why I’m pleased this inquiry is being conducted is we are concerned that perhaps some of those incentives are driving behaviours that make that supply chain more fragile perhaps for the future than it’s ever been.”

Sawer said it was becoming increasingly difficult for his members to supply businesses which have “varying demands that are difficult to understand and see”.

“On the demand side, it’s becoming very complicated. There’s lots of technologies in primary care, whether you’ve got hub and spoke, distance-selling pharmacy, online pharmacy,” he said.

“Our outlets we supply to have varying demands that are difficult to understand and see. Medicines could well be in the wrong place. We have concerns about how that might manifest itself in 10 years’ time.”

He added: “Understanding medicines security for the UK and globally is also of concern given the supply side of medicines is driven by global concentration of global businesses in fewer places than there used to be.”

Sawer maintained his members were operating “on very low margins” and producing “unbelievable efficiencies”. On the root causes of fragility in the supply chain, he said: “At the moment, it is probably driven more by economics and technologies and perhaps lack of communication within the supply chain and some lack of accountability by some of the players in the supply chain to the authorities.”

However, he said “overall, the system is very good” and suggested: “It’s about tuning the engine which hasn’t, if I can use this analogy, probably got enough petrol in it properly to flow and balance demand and supply which is what our businesses do.”

CCA: Invest more money in supply chain and Drug Tariff

The Company Chemists’ Association chief executive Malcolm Harrison told the inquiry the “vast majority” of the 14,000 licensed medicines in the UK “are in good supply” but warned “the number of times we’re not able to supply is increasing and evidence shows resilience is being eroded in the supply chain”.

He repeated his call for the Government to invest more money in the supply chain as well as Drug Tariff pricing and retained margin, which he insisted were “essential steps to stabilising” supply and “ensuring the UK remains a competitive market to global manufacturers”.

Harrison said: “There are many, many reasons for any shortages we find. I think there is a large percentage of them around the supply of the manufacturing part of things.

“There’s an economic reality in terms of how do we ensure the market in which medicines flow through is competitive and viable?”

CPE concerned about impact of ‘economic fragility’ on supply

Community Pharmacy England’s director of research and insights James Davies agreed with Harrison about the impact of “economic fragility” on supply.

“The resilience of community pharmacy is the final point that many patients encounter,” Davies said. “Accessing their medicines is a key part of that supply chain and as pharmacy continues to be underfunded, the NHS’s own commissioned research shows there’s about a £2 billion funding deficit for community pharmacy.

“We’re seeing pharmacies closing, we’re seeing the resilience in the community pharmacy network is decreasing.”

Referencing research from the Office of National Statistics, Davies said one in five patients have “a problem accessing their prescription medicine immediately in a community pharmacy”.

He added: “In many cases, those patients are having their problems resolved in the same day or the next day or very soon afterwards. But it’s certainly having more of an impact on patients than it ever has before.”

Wholesalers do not talk to one another, says HDA chief

When asked if pharmacies and distributors have access to information to help them manage medicines stocks and shortages, Sawer said: “The wholesale distribution sector works very closely with the manufacturing partners to try to understand the forecasting that manufacturers have worked on for UK distribution.

“That can be really top class, with some of the really well-known global companies almost doing weekly stocktakes with their wholesaler to try to understand exactly where their products are going.

“Or, there can be no contact at all. There’s everything in between. There’s a huge variety. So, the manufacturer is the first port of call for ongoing stock understanding by the wholesaler.”

Sawer said the problem was when manufacturers supply more than one wholesaler, those wholesalers do not talk to one another if any supply issues arise “for competition reasons because they are all trying to get the manufacturer’s business”.

“There’s a challenge there for visibility but the manufacturer knows that. So, obviously, they will direct their products accordingly and share stock levels as appropriate,” he said.

Sawer also reminded the inquiry that manufacturers are required by law to report any “stock problems” in the UK.

“The Department of Health will take a view because they have a medicines supply team which we work very closely with and is a terrific organisation,” he said.

“What they will do is take the view as to whether the manufacturer’s problem is serious enough to involve other players in the supply chain. They can involve wholesalers, either individually or as a group, perhaps some of my members, to decide whether we need to manage that stock because it’s not enough for the UK.”

The ‘crisis’ of EpiPen supply a few years ago

Sawer used the “crisis” of EpiPen supply a few years ago as an example of the Department of Health and Social Care managing “the prescription by prescription of that through the wholesaler who could only supply it when a patient needed it because there were so few.”

“That was a really critical situation,” he said. “That was a 24/7 open line to the Department of Health and the manufacturer, so that combination can work in crises, as it’s done with HRT and ADHD, to an extent. We had to manage that crisis.

“So, we get visibility when there’s a crisis but we don’t in normal times, other than the individual manufacturer-wholesaler commercial relationship.”

Harrison said community pharmacies were “struggling now to hold sufficient stocks” of medicines “to meet the needs of their immediate forecasts of patient needs”.

“Perhaps there was a time when they were able to hold stocks to meet the needs of their immediate forecasts of patient need,” he said.

“(But) margins have been squeezed and the community pharmacy contractual framework and the gap between the cost of providing NHS pharmaceutical care and what they currently pay, means businesses are having to make very difficult decisions on ‘can I keep a couple of boxes of that in stock just in case someone comes in or do I have to wait and then have to try and get it and there’s a risk it might not be available’.

“So, we’re starting to see a change in the behaviour in community pharmacy. It used to be you would keep something in case because you were in competition with other pharmacies and you wanted to make sure you retained the customer.

“Now, more and more, pharmacies are looking at cashflow and saying ‘can I afford to tie up the little cashflow that I have in stock that sits on the shelf just in case, or am I better waiting and assuming I can get it just in time?’”

RPS director for England calls for national medicines shortage strategy

Amandeep Doll, the director for England at the Royal Pharmaceutical Society, also gave evidence at the inquiry and called for greater transparency and data-sharing across the supply chain to anticipate and mitigate shortages.

She urged the Government to implement a national medicines shortage strategy with “clear guidance for pharmacy teams and healthcare professionals” and “improved communication channels between government, regulators and NHS to ensure timely updates and coordinated responses”.

“Medicine shortages are not just a supply chain issue, they directly impact patient care and safety,” Doll said.

“Pharmacists are often the first to identify and respond to shortages, but they need better tools, clearer guidance, and stronger support to do so effectively.”