Patients harmed as drug shortages force GPs to switch prescriptions

One in seven GPs say patients have experienced negative effects including harm or slower recovery after medicines shortages forced them to switch to second-choice drugs, a GPonline poll reveals.

More than half of 586 GPs who responded to the latest GPonline opinion poll say they have 'often' been forced to prescribe second-choice medication over the past year because of drug shortages. A total of 16% reported being forced to do so 'very often' and a further 35% 'fairly often'.

The vast majority of other respondents had been forced to prescribe a second-choice drug at some point - with 35% reporting this was the case 'occasionally' and 7% 'rarely', the survey found.

GPonline reported earlier this week that nine out of 10 GPs had noticed an increase in medicines they prescribe becoming unavailable over the past year. One in three GPs say they spend more than an hour a week dealing with the problem.

Patient safety

One GP taking part in the survey wrote that medicines becoming unavailable could have a 'devastating effect on patients’ health’. Another said: ‘Shortages do affect patient management tremendously as second line medications are not always ideal and in rare cases not as effective.’

One GP responding to the survey said: ‘It is a particular nuisance for the anti-inflammatories. Patients are having to take stronger or unequal doses which is causing harm.’

Another wrote: ‘I have had patients on HRT who had to change preparation and have found their symptoms are less well controlled.’

GPC chair Dr Richard Vautrey told GPonline: ‘We have been concerned about the increasing problem with medicine unavailability. This causes problems for practices, pharmacists and patients. All too often there is no explanation as to why commonly prescribed medicines are no longer available. It causes significant distress to many patients and if the correct medication is not available for patients there is a risk that they could come to harm if they do not receive a suitable alternative.'

Medicine shortages

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.’

Earlier this month, the government passed legislation on ‘serious shortage protocols’ (SSPs), which give pharmacists powers to dispense an alternative 'quantity, strength [or] pharmaceutical form' as well as a 'therapeutic equivalent or a generic equivalent' of medicines that are in serious short supply ‘without going back to the prescriber’.

The legislation was introduced to address medicine shortages and reduce inconvenience for GPs and patients, but the BMA has warned it could have implications for patient safety.

GP prescribing

Dr Andrew Green, GPC clinical and prescribing lead, said: ‘The serious shortage protocol which has recently been rushed through parliament in response to the threat to medicine supply caused by Brexit may provide some assistance, but is the equivalent of a doctor providing symptom relief without addressing the cause of the patient’s illness.’

A DHSC spokesperson said: 'There is no hard evidence to date to suggest current medicine supply issues are increasing as a result of EU exit.

'Our number one priority is to ensure the continued supply of medicines and we are working closely with industry and partners in the health system to help prevent disruption, including increasing UK buffer stocks. We are confident that, if everyone does what they need to do, the supply of medicines should be uninterrupted in the event of a no deal.

'We have well-established processes to manage and mitigate the small number of supply problems that may arise at any one time due to manufacturing or distribution issues and this has always been the case – every day over 2m prescription items are successfully dispensed in England.'

The Pharmaceutical Services Negotiating Committee (PSNC) told GPonline that there had been fluctuations in the number of generic medicines in short supply over the past year, with a surge since October 2018.

PSNC pharmacy funding director Mike Dent said: 'As a last resort, the pharmacist will liaise with the GP to find an alternative medicine that may be suitable for the patient. Unfortunately, this last resort is becoming more common and issuing a new prescription may be the best route for the patient to receive treatment quickly.’

Use MIMS drug comparison tables to find alternatives to out-of-stock products

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