Exclusive: Drug shortages drive up GP workload and harm patients

Shortages of medicines commonly prescribed by GPs are adding to primary care workload and putting patients at risk, a GPonline survey reveals.

Drugs: shortages have added to GP workload (Photo: JH Lancy)
Drugs: shortages have added to GP workload (Photo: JH Lancy)

A GPonline survey of 479 GPs found that 85% have experienced an increase in workload as a result of medicines being out of stock. More than 90% of GPs have been forced to prescribe a second-choice drug in the last year.

A third of GPs who had prescribed a second choice drug reported that patients were negatively affected by the switch, with some taking longer to recover or suffering harm. A total of 24% reported that this happened 'rarely', with a further 8% saying a negative effect on patients happened 'often' after a drug switch.

Doctors said the extra work involved in finding alternative drugs and writing out more prescriptions was ‘frustrating, annoying, and tedious’.

GP workload

One GP said it was a ‘recurring problem affecting common drugs and causing huge amounts of unnecessary work’, with some reporting it can take up two hours of a GP’s time every week.

Another commented that shortages caused a ‘massive increase in patient queries, patient dissatisfaction, [and] affect good patient care’.

GPs mentioned that topical steroid creams and ointments were a particular problem.

A spokesman for GSK, which manufactures some topical products mentioned by GPs in the survey, said that manufacturing was halted last year at its dermatology site due to an investigation of a ‘quality issue’.

Manufacturing processes for 20 topical products produced at the site were reviewed and ‘new, more rigorous procedures’ are now in place, he said, but the scale of production made restarting the process difficult.

‘Restarting has been a gradual process and lost production, during and after the investigation, amounted to some 11m units of product,’ he said. ‘Whilst a number of steroidal formulations are now back in supply, we have had challenges with certain product presentations [including] difficulty sourcing raw materials.’

Many of the steroid creams will be in stock by the end of July, but shortages in betnovate ointment are expected to continue until the end of the year, and GSK has set up a website to keep healthcare professionals informed.

GPs also commented that stocks of nitrofurantoin, an antibiotic used to treat urinary tract infections, were an issue. Amdipharm Mercury, which manufactures the drug, declined to comment.

Drug shortage information

GPs responding to the survey blamed ‘poor communication’ for making it difficult to know when drugs are in stock, or when they become available again.

GPC clinical and prescribing subcommittee chairman Dr Andrew Green said there is no simple solution to drug shortages, but better communication is needed.

‘One of the great difficulties GPs face is that they don't know that a substance is in short supply until the patient returns unhappy and without their required medication,’ he said.

‘The DH needs to, at the very least, ensure that GPs are aware of the medications that are in short supply, and what alternatives remain available. This simple measure should save many hours of professional time, as well as significantly improving patient experience.’

The DH told GPonline that it has only informed GPs about drug shortages when they have become critical, and it is pharmaceutical companies’ responsibility to keep prescribers informed about shortages. However, preliminary discussions with NHS England about developing a shortages website are underway.

The Association of the British Pharmaceutical Industry, the trade body of the UK pharmaceutical industry, told GPonline that they are ‘working closely with the DH's Supply Chain Forum alongside other stakeholders in the supply chain’ to minimise the impact of drug shortages.

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