Of 586 GPs who took part in the GPonline poll, 87% had seen a rise in medicines they prescribe becoming unavailable in the past year. Among 190 GP partners who responded, this figure rose to 97%.
Medicine shortages have had a clear impact on workload, with 31% of GPs saying they spend an hour or more each week dealing with the effects of medicines shortages - potentially writing new prescriptions or carrying out follow-up appointments. A total of 7% of all GPs - and 11% of partners - reported that medicines shortages added two hours or more to their working week.
The vast majority of GPs say shortages have forced them to prescribe a second-choice medicine in the past year - with more than half saying this happens 'very' or 'fairly' often.
The findings are in line with a national trend reflected in the Pharmaceutical Services Negotiating Committee (PSNC)’s ‘price concessions’ list, which has grown sharply in recent months. The list shows drugs for which the NHS has agreed to pay a temporarily higher price to prevent shortages, offering a picture of which medicines are currently low in stock.
Dr Andrew Green, GPC clinical and prescribing lead, said: ‘This survey reflects what GPs have been telling us for some time – that the medicines supply chain is too fragile to be relied on, and increasing amounts of GP time is being wasted in trying to provide alternatives. We must also not forget the impact on patients, relatives, and our pharmacy colleagues.’
Many participants described medicine shortages as ‘frustrating’ and called for more information on which medicines were out of stock. One GP wrote: ‘I have always been baffled that we get no advance warning of likely shortages - surely the problem is predictable? It’s frustrating not to know what isn’t available until the patient has been to the pharmacy so you are then trying to solve the problem quickly for them but often while you have other patients waiting.’
Another said shortages 'create increasing work for an already stretched primary care service', adding that the problem 'needs to be managed outside of primary care’. One GP wrote: ‘This issue is adding new and unnecessary challenges to already increased workloads and time constraints in busy GP surgeries.’
BMA leaders called earlier this year for an ‘early warning system’ to flag up medicine supply problems, reduce practice workload and alleviate patient stress.
Several GPs taking part in the survey speculated that the shortages could be worsening as an ‘unintended consequence of Brexit’. One respondent wrote ‘It’s terrifying what might happen if Brexit goes ahead - it’s going to create a massive workload with significant risk.’ Another said: ‘I’m worried it will become an increasing problem and that patients will start stockpiling.'
A DHSC spokesperson told GPonline last month that there was ‘no evidence’ that medicine supply issues were linked to EU exit preparations, adding that any problems were probably ‘due to manufacturing or distribution issues’.
Mike Dent, PSNC director of pharmacy funding, told GPonline: ‘Medicine supply issues are not a new phenomenon, but community pharmacies are increasingly reporting that they are struggling to source certain medicines so we are not surprised to see GPs becoming more aware of the situation.
‘While there have been fluctuations in the number of generic medicines unavailable to purchase at drug tariff price over the past year, we have seen a surge since October 2018.
‘These shortages are due to a combination of factors such as manufacturing problems and the UK being seen as a less attractive market for manufacturers as community pharmacies have helped drive down medicine prices for the NHS. Uncertainty around Brexit and contingency planning may also be exacerbating these issues.’