GPs face funding cuts as medicines shortages hit CCG budgets

Primary care spending could be slashed as CCGs struggle to cope with a multi-million pound rise in the cost of basic medicines that are in short supply, health leaders have warned.

Medicine shortages (Photo: iStock.com/MJ_Prototype)
Medicine shortages (Photo: iStock.com/MJ_Prototype)

The NHS has been forced to pay around £127m over normal prices so far this financial year for drugs that are in short supply.

Spiralling prescribing costs could force CCGs to cut spending on primary care to balance the books, senior NHS figures have warned.

NHS Clinical Commissioners (NHSCC) chief executive Julie Wood told GPonline: ‘There is indeed a risk to other areas of CCG budgets if prescribing costs increase. Although CCGs have seen an increased allocation there are still considerable challenges ahead as much of this has already been committed on specific programmes, so many CCGs lack the headroom to accommodate increased prescribing costs.

Primary care funding

‘Alongside this is a reduction in their running costs as requested by NHS England, which means they will continue to do more for less and make difficult decisions on availability of services within their local area to ensure the best value for the patients and local populations they serve, which could affect spending in primary care.’

GPonline revealed earlier this month that the number of common medicines on a shortage of supply list for England rose dramatically in October, November and December last year.

Painkillers, antidepressants and blood pressure medicines were among items added to the Pharmaceutical Services Negotiating Committee (PSNC)’s ‘price concessions’ list, showing drugs for which the NHS has agreed to pay a temporarily higher price to prevent shortages.

Estimates published on openprescribing.net show the NHS has faced additional costs of over £127m in price concessions so far this financial year - almost 50% of which occured in the last three months of 2018. Overall, NHS England has paid £145m in price concessions in the last 12 months.

Medicine shortages

Family Doctor Association chair Dr Peter Swinyard also voiced concern over medicine shortages, warning that - although GPs don’t ‘bear the costs’ of CCG prescribing issues - such problems ‘clearly leave less in the pot for other things’.

‘That’s a standard thing whenever people spend too much money on one part of the health service - there’s less elsewhere,’ he said.

Although the supply of medicines is constantly fluctuating, a spokesperson for the Royal Pharmaceutical Society (RCP) confirmed to GPonline that shortages ‘have become more acute’ in recent months.

GPs and pharmacists across the UK have been noticing an increase in the number of medicines becoming unavailable for several weeks, with some speculating that it could be linked to ongoing uncertainty surrounding Brexit. Bradford GP Dr Amir Khan said on Twitter that he had been unable to prescribe a series of widely-used drugs and a pharmacist in Bolton said he was ‘constantly ringing wholesalers’ to obtain medicines.

The BMA also voiced concerns last week that existing issues with medicine shortages - which cause both considerable frustration for doctors, and added stress for patients - could be ‘exacerbated’ by a no-deal Brexit.

However, a DHSC spokesperson said there was ‘no evidence’ that current medicine supply issues were linked to EU exit preparations, adding that any problems were probably ‘due to manufacturing or distribution issues’.

GP workload

In a bid to tackle medicine shortages and issues relating to them, the DHSC has put forward draft legislation on serious shortage protocols (SSPs) which will give pharmacists the right to modify medications that are in short supply ‘without going back to the prescriber’. The legislation is expected to come into force early next month.

The BMA has also called for an ‘early warning system’ to be established so that medicine supply problems can be flagged up early and GPs can ‘avoid unnecessary disruption to patients getting access to the medicines they need.’

Dr Swinyard told GPonline: ‘What really does impact us on the ground is the continual string of notes from pharmacists returning the patient saying "we can’t get that one" - and these are often very common everyday medications that just seem to go out of stock. We don’t get lists of them either, so it’s pure guesswork. It takes me probably 15-20 minutes a day when I’m at work just sorting out prescriptions which they can’t find and trying to sort an alternative.’

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